Ultrasound and MR imaging findings of vulvar leiomyoma: case report

Energy Technology Data Exchange (ETDEWEB)

Lee, Jeong Hee; Lee, Jin Hee; Woo, Seong Ku; Kim, Sang Pyu [Keimyung University School of Medicine, Taegu (Korea, Republic of)

2002-11-01

Leiomyomas are common benign neoplasms that can occur at any anatomical site containing smooth muscle, though most originate in the female genital tract. Leiomyomas of the vulval perineum are, however, very rare. We report the ultrasonographic (US) and MR imagings of a vulvar leiomyoma, and briefly review the literature.

Spontanous Vulvar Endometriosis: Report of A Case

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Coşkun Ümit

2016-04-01

Full Text Available Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue outside the uterine cavity. Vulva is one of the rarest location of extrapelvic endometriozis. We report a case of a 44-year-old multiparous woman, referred to our clinic with the complaints of having a vulvar mass and cyclic swelling of the mass during menstruation. She had a history of 2 previous cesarean delivery and no history of previous vulvar or vaginal surgery. The mass was 3-4cm in diameter and localized on the upper-portion of the right labium minus. Complete surgical excision was performed with the suspicion of endometriosis. Final histopathology report confirmed the diagnosis of endometriosis. Three weeks after surgery there was no evidence of endometriosis. In conclusion whether or not having a history of a previous vulvar surgery, vulvar endometriosis should be considered as a part of differential diagnosis in evaluation of vulvar masses.

Chronic vulvar pain from a physical therapy perspective.

Science.gov (United States)

Hartmann, Dee

2010-01-01

When assessing women with chronic vulvar pain, women's health physical therapists search for comorbid mechanical components (including musculoskeletal, fascial, and visceral) and other disorders that may contribute to or be caused by chronic vulvar pain (CVP). Pelvic floor hypertonicity is a key perpetuating factor for CVP. Comprehensive physical therapy evaluation and suggested physical therapy interventions are described. Anatomy of the pelvis, common evaluative findings, and specifics for pelvic floor muscle rehabilitation are presented. Normalization of pelvic floor muscle function contributes to the reduction of CVP. Successful treatment includes the identification and treatment of co-existing physical abnormalities throughout the trunk and pelvis. © 2010 Wiley Periodicals, Inc.

Biological relevance of human papillomaviruses in vulvar cancer.

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Halec, Gordana; Alemany, Laia; Quiros, Beatriz; Clavero, Omar; Höfler, Daniela; Alejo, Maria; Quint, Wim; Pawlita, Michael; Bosch, Francesc X; de Sanjose, Silvia

2017-04-01

The carcinogenic role of high-risk human papillomavirus (HR-HPV) types in the increasing subset of vulvar intraepithelial neoplasia and vulvar cancer in young women has been established. However, the actual number of vulvar cancer cases attributed to HPV is still imprecisely defined. In an attempt to provide a more precise definition of HPV-driven vulvar cancer, we performed HPV-type-specific E6*I mRNA analyses available for 20 HR-/possible HR (pHR)-HPV types, on tissue samples from 447 cases of vulvar cancer. HPV DNA genotyping was performed using SPF10-LiPA 25 assay due to its high sensitivity in formalin-fixed paraffin-embedded tissues. Data on p16 INK4a expression was available for comparative analysis via kappa statistics. The use of highly sensitive assays covering the detection of HPV mRNA in a broad spectrum of mucosal HPV types resulted in the detection of viral transcripts in 87% of HPV DNA+ vulvar cancers. Overall concordance between HPV mRNA+ and p16 INK4a upregulation (strong, diffuse immunostaining in >25% of tumor cells) was 92% (K=0.625, 95% confidence interval (CI)=0.531-0.719). Among these cases, 83% were concordant pairs of HPV mRNA+ and p16 INK4a + and 9% were concordant pairs of HPV mRNA- and p16 INK4a -. Our data confirm the biological role of HR-/pHR-HPV types in the great majority of HPV DNA+ vulvar cancers, resulting in an HPV-attributable fraction of at least 21% worldwide. Most HPV DNA+ vulvar cancers were associated with HPV16 (85%), but a causative role for other, less frequently occurring mucosal HPV types (HPV26, 66, 67, 68, 70 and 73) was also confirmed at the mRNA level for the first time. These findings should be taken into consideration for future screening options as HPV-associated vulvar preneoplastic lesions have increased in incidence in younger women and require different treatment than vulvar lesions that develop from rare autoimmune-related mechanisms in older women.

Perceived stereotyping and seeking care for chronic vulvar pain.

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Nguyen, Ruby H N; Turner, Rachael M; Rydell, Sarah A; Maclehose, Richard F; Harlow, Bernard L

2013-10-01

We examined stereotyping of chronic pain sufferers among women aged 18-40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. Cross-sectional study using a community-based survey of vulvodynia asking if "Doctors think that people with chronic pain exaggerate their pain," and if "People believe that vulvar pain is used as an excuse to avoid having sex". Twelve thousand eight hundred thirty-four women aged 18-40 years in metropolitan Minneapolis/St. Paul, Minnesota. Women were considered to have a history of chronic vulvar pain if they reported vulvar burning lasting more than 3 months or vulvar pain on contact. Four thousand nine hundred eighty-seven (38.9%) women reported a chronic pain condition; 1,651 had chronic vulvar pain. Women experiencing chronic pain were more likely than those without to perceive stereotyping from both doctors and others; a dose-response with the number of pain conditions existed. Women with chronic vulvar pain were more likely to believe that people think vulvar pain is an excuse to avoid intercourse. Half of the women with chronic vulvar pain did not seek medical care for it; of these, 40.4% perceived stereotyping from doctors. However, it was women who actually sought care (45.1%) who were more likely to feel stigmatized by doctors (adjusted relative risk = 1.11, 95% confidence interval: 1.01-1.23). Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who did not feel stigmatized. Wiley Periodicals, Inc.

The impact of the latest classification system of benign vulvar diseases on the management of women with chronic vulvar pruritus

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Kiymet Handan Kelekci

2011-01-01

Full Text Available Background: The management of women with chronic benign vulvar dermatoses has been one of the most difficult and challenging aspects of women′s healthcare for a long time. Aim: Our aim was to compare the ability to approach the specific diagnosis of nonneoplastic and noninfectious vulva diseases, between the new classification system and the old classification system. Methods: One hundred women with chronic vulvar pruritus were included in the study. After detailed examination of the vulva, all visible lesions were biopsied, with normal skin included. All specimens was sent for dermatopathology and examined simultaneously under a binocular microscope by two pathologists. Specific diagnosis if possible and histopathological findings were classified according to both the 1987 and 2006 International Society for the Study of Vulvar Diseases (ISSVD classifications. The ratios that were able to be approached on the specific diagnosis, with the aid the two classification systems, were compared. Results: Specific clinical diagnosis by both pathological and after using clinicopathological correlation was possible in 69 out of 91 patients (75.8% according to the 1987 ISSVD classification, and in 81 out of 91 patients (89.0% according to the ISSVD 2006 classification system. The difference in the clinical diagnosis ratios between the two classification systems was statistically significant ( P < 0.05. In a subgroup of women without specific diagnosis at the time of pathological examination, clinical diagnosis was made in 28 out of 50 women (56% after using the clinicopathological correlation according to the ISSVD 1987 classification, whereas, specific diagnosis was made in 39 out of 49 (79.6% women after using the clinicopathological correlation according to the ISSVD 2006 classification. The difference was statistically significant in terms of the ratio of the ability to achieve a specific diagnosis ( P < 0.01. Conclusion: ISSVD 2006 classification of

Vulvar fibroadenoma: a common neoplasm in an uncommon site

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Cantú de Leon, David; Perez Montiel, Delia; Vázquez, Hugo; Hernández, César; Cetina, Lucely; Lucio, Martha Hernandez

2009-01-01

Vulvar fibroadenomas are sporadic lesions informed in the literature and a controversy about origin has been discussed widely. We report a case of a 19 years old woman with a large slow growing mass in the right labia majora with the final diagnosis of fibroadenoma with mammary tissue surrounding it and positive hormone receptors. In this case, we support the origin in ectopic mammary tissue. PMID:19785728

The role of sentinel node detection techniques in vulvar and cervival cancer

International Nuclear Information System (INIS)

Wydra, D.; Sawicki, S.; Emerich, J.; Romanowicz, G.

2002-01-01

The sentinel node is the first lymph node that receives the lymph drainage from the primary tumour. The pathological status of the sentinel node should reflect the histopathology of the entire regional lymph drainage area - both vulvar and cervical cancer spread through the lymphatic system. In gynaecological oncology recent studies have confirmed the utility of the sentinel node concept in vulvar and cervical cancer. Three techniques for sentinel node localisation are available. The preoperative lymphoscintigraphy and intraoperative handheld gamma probe detection require the administration of the technetium-99m-labelled colloid around the tumour. The other method is based on the injection of the patent blue dye - during the surgery of the sentinel node because of the dye uptake becomes visible. Following detection, the sentinel lymph node can be removed separately and assessed with ultrastaging and immunohistochemical staining. In the early stages of vulvar and cervical cancer the lymph nodes metastases rate is relatively low - in most cases lymphadenectomy is not necessary. The determination of the regional lymph nodes' pathological status may limit the extent of the surgical treatment. The sentinel node detection rate is relatively high and depends on the applied technique. This technique may play an important role in the treatment of vulvar and cervical cancer. This paper describes the details of sentinel node identification and reviews the literature. (author)

Vulvar fibroadenoma: a common neoplasm in an uncommon site

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Cetina Lucely

2009-09-01

Full Text Available Abstract Vulvar fibroadenomas are sporadic lesions informed in the literature and a controversy about origin has been discussed widely. We report a case of a 19 years old woman with a large slow growing mass in the right labia majora with the final diagnosis of fibroadenoma with mammary tissue surrounding it and positive hormone receptors. In this case, we support the origin in ectopic mammary tissue.

Massive vulvar edema in a woman with preeclampsia: a case report.

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Daponte, Alexandros; Skentou, Hara; Dimopoulos, Konstantinos D; Kallitsaris, Athanasios; Messinis, Ioannis E

2007-11-01

Massive vulvar edema in a woman with preeclampsia preceded the development of massive ascites and impending eclampsia. A 17-year-old preeclamptic, primiparous woman was admitted with preeclampsia and massive vulvar edema. Other causes were excluded. The vulvar edema increased as the blood pressure and ascites increased, and a severe headache developed. Cesarean section for increasing preclampsia was performed. In the puerperium, the blood pressure improved and vulvar edema resolved. The clinical picture of the vulvar edema correlated with the severity of the preeclampsia. The presence of vulvar edema in women with preeclampsia should indicate immediate admission to the hospital. These patients must be considered as at high risk, and close monitoring must be instituted. In our case, vulvar edema preceded massive ascites development. We assume a common development mechanism for these signs in preeclampsia, due mainly to increased capillary permeability and hypoalbuminemia. The attending physician must be prepared for immediate delivery and possible preeclampsia complications in these patients.

Fibroadenoma in an ectopic vulvar breast gland: a common neoplasm in an uncommon site.

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Ayadi-Kaddour, A; Khadhar, A; Mlika, M; Braham, E; Ismail, O; Zegal, D; El Mezni, F

2014-03-01

Ectopic breast tissue is defined as glands located outside of the breast. It can be found anywhere along the milk line extending from the axilla to the groin, and can occur in the vulva. Ectopic breast tissue should be excised because it may develop benign or malignant pathologic processes. Less than 40 cases of fibroadenoma in the vulva have been reported in the literature. We report a case of a 37-year-old woman presenting a solitary vulvar mass. The mass was excised completely, and histology demonstrated an ectopic breast fibroadenoma. This is one of the few reports on the benign pathologies of vulvar mammary glands.

Massive vulvar edema in a woman with severe preeclampsia. A ...

African Journals Online (AJOL)

We report a case of massive vulvar edema in a 20 years old primigravida woman with severe preeclampsia at 32 weeks gestation. Other causes of vulvar edema were excluded. The vulvar edema appeared as the blood pressure increased, and cesarean section was performed for increasing preeclampsia and fetal distress.

Vulvar basal cell carcinoma, a rare location

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Cornelia Nitipir

2018-05-01

Full Text Available Basal Cell Carcinoma is the most common human malignant neoplasm. Vulvar basal cell carcinoma is rare, accounting for less than 5% of all vulvar neoplasms. Vulvar basal cell carcinomas are usually diagnosed late because they are often asymptomatic and tend to grow at slow rates. They are usually diagnosed late because they are often asymptomatic. However, these tumours may appear in areas which are normally covered with ultraviolet light. We present the case of a 60 years old woman diagnosed with invasive breast cancer for which she underwent surgery followed by chemotherapy and radiotherapy. The patient presented to our department with an ulcerated vulvar lesion. On inspection, the tumour measured 3/2 cm and was located on the left labium majus. The biopsy confirmed the diagnosis of vulvar basal cell carcinoma and a wide local excision was performed with no relapse at one year. In conclusion, early detection of BCC’s is critical to allow complete surgical cure so any abnormality on the vulva should be biopsied. A wide safety margin of 1cm should be achieved when resecting the tumour and the physician should keep in mind that the BCC’s of the vulva has a high recurrence rate. Previous chemotherapy is not associated with this type of non-melanoma skin cancer.

Management options for vulvar carcinoma in a low resource setting.

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Eke, Ahizechukwu C; Alabi-Isama, Lilian I; Akabuike, Josephat C

2010-11-01

Vulvar carcinoma is a rare tumor of the female genital tract. In Nigeria, very few studies have looked at the management options for vulvar carcinoma. The objective of this study was therefore, to describe the management options available and the challenges in treating this malignancy in Nigeria. A descriptive study of all vulvar cancer cases managed at the Nnamdi Azikiwe University Teaching Hospital, Nnewi over a 12 year period (1998-2009). The theatre, ward register, histo-pathologic records and case notes of all women who had surgery for vulvar carcinomas were retrieved and socio-demographic characteristics, clinical presentation, type of surgery, histologic type and complications of treatment were retrieved and analyzed. There were 867 gynecological malignancies and vulval carcinoma accounted for 11 cases, giving a prevalence of 1.27%. The ages ranged from 54 to 79 years with a mean of 61.2 years. Parity was 2-14, with a mean of 6.7 ± 2.33. Most of the patients were of low socio-economic class. All the 11 patients had surgery as 1st line treatment. Radical vulvectomy was done for 6 cases since they presented in the advanced stage. The complications of surgery included hemorrhage (18.2%), chronic lymphedema, wound infection and anesthetic complications. There were no hospital mortalities. Late presentation, with stage III (45.4%) was the commonest stage at presentation while the majority of the vulvar carcinomas (72.7%) were of epithelial origin. Squamous cell carcinoma predominated (63.6%). Carcinoma of the vulva is a rare gynecological malignancy in Nigeria. Surgery and radiotherapy remains the mainstay of this disease in Nigeria and can be highly successful if patients present early.

Etiopatogenia do câncer vulvar

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Pinto Álvaro P.

2002-01-01

Full Text Available Existem poucos trabalhos na literatura a respeito dos mecanismos moleculares envolvidos na patogênese do carcinoma vulvar. Estudos que servem como base para a compreensão destes mecanismos são discutidos de forma compreensiva neste artigo de revisão. As alterações genéticas, a associação com o papilomavírus humano (HPV e outros possíveis fatores envolvidos na carcinogênese dos tumores vulvares são abordados.

Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma

NARCIS (Netherlands)

van de Nieuwenhof, Hedwig P.; Bulten, Johan; Hollema, Harrie; Dommerholt, Rianne G.; Massuger, Leon F. A. G.; van der Zee, Ate G. J.; de Hullu, Joanne A.; van Kempen, Leon C. L. T.

Lichen sclerosus is considered to be the precursor lesion of vulvar squamous cell carcinoma, of which only 2-5% progress to squamous cell carcinoma. Differentiated vulvar intraepithelial neoplasia (VIN) has been proposed to be the direct precursor lesion, but this is a recently recognized, and a

Genitofemoral neuralgia: adding to the burden of chronic vulvar pain

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Verstraelen H

2015-11-01

Full Text Available Hans Verstraelen,1 Eline De Zutter,1 Martine De Muynck2 1Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University Hospital, Ghent, Belgium; 2Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium Abstract: The vulva is a particularly common locus of chronic pain with neuropathic characteristics that occurs in women of any age, though most women with neuropathic type chronic vulvar pain will remain undiagnosed even following multiple physician visits. Here, we report on an exemplary case of a middle-aged woman who was referred to the Vulvovaginal Disease Clinic with debilitating vulvar burning and itching over the right labium majus that had been persisting for 2 years and was considered intractable. Careful history taking and clinical examination, followed by electrophysiological assessment through somatosensory evoked potentials was consistent with genitofemoral neuralgia, for which no obvious cause could be identified. Adequate pain relief was obtained with a serotonin–noradrenaline reuptake inhibitor and topical gabapentin cream. We briefly discuss the epidemiology, diagnosis, and treatment of genitofemoral neuralgia and provide a series of clues to guide clinicians in obtaining a presumptive diagnosis of specific neuropathic pain syndromes that may underlie chronic vulvar pain. We further aim to draw attention to the tremendous burden of chronic, unrecognized vulvar pain. Keywords: vulvar pain, genitofemoral nerve, neuropathic pain, vulvodynia, vulvar disease

Vulvovaginitis and other common vulvar disorders in children.

Science.gov (United States)

Rome, Ellen S

2012-01-01

Vulvovaginitis, labial adhesions, and other vulvar disorders occur commonly in children and can provoke high anxiety in both the parent and child. Performed correctly, the pediatric gynecologic examination can diagnose and treat, educate and reassure both parent and child. This examination requires patience, sensitivity, direct communication with the child as well as with the parent, and an open manner that inspires trust in both parties to manage a potentially anxiety-provoking situation. This chapter will review common vulvar disorders, including vulvovaginitis, lichen sclerosis et atrophicus, bubble bath vaginitis, labial adhesions, urethral prolapse, and other common problems. A discussion of childhood sexual abuse is beyond the scope of this chapter, with appropriate references available elsewhere. Practical pearls will be offered to make this exam easy for the primary care clinician and/or subspecialist. Copyright © 2012 S. Karger AG, Basel.

Vulvar cancer: epidemiology, clinical presentation, and management options

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Alkatout I

2015-03-01

Full Text Available Ibrahim Alkatout,1 Melanie Schubert,1 Nele Garbrecht,2 Marion Tina Weigel,1 Walter Jonat,1 Christoph Mundhenke,1 Veronika Günther1 1Department of Gynecology and Obstetrics, 2Institute for Pathology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany Epidemiology: Vulvar cancer can be classified into two groups according to predisposing factors: the first type correlates with a HPV infection and occurs mostly in younger patients. The second group is not HPV associated and occurs often in elderly women without neoplastic epithelial disorders. Histology: Squamous cell carcinoma (SCC is the most common malignant tumor of the vulva (95%. Clinical features: Pruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain. Therapy: The gold standard for even a small invasive carcinoma of the vulva was historically radical vulvectomy with removal of the tumor with a wide margin followed by an en bloc resection of the inguinal and often the pelvic lymph nodes. Currently, a more individualized and less radical treatment is suggested: a radical wide local excision is possible in the case of localized lesions (T1. A sentinel lymph node (SLN biopsy may be performed to reduce wound complications and lymphedema. Prognosis: The survival of patients with vulvar cancer is good when convenient therapy is arranged quickly after initial diagnosis. Inguinal and/or femoral node involvement is the most significant prognostic factor for survival. Keywords: vulvar cancer, HPV infection, radical vulvectomy, groin dissection, sentinel lymph node biopsy, overall survival

Feasibility of Collecting Vulvar Pain Variability and Its Correlates Using Prospective Collection with Smartphones

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Ruby H. N. Nguyen

2014-01-01

Full Text Available Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability. Objective. Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0–10, presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse. Results. Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (P<0.001. On the weeks when a woman reported waking with pain, her vulvar pain level was higher by 1.82 on average (P<0.001. Overall, average vulvar pain level was not significantly associated with the frequency of reporting other body pains (P=0.64. Conclusion. Our smartphone tracking system promoted excellent compliance with weekly tracking of factors that are otherwise difficult to recall, some of which were highly associated with vulvar pain level.

Does HPV status influence survival after vulvar cancer?

DEFF Research Database (Denmark)

Rasmussen, Christina Louise; Sand, Freja Laerke; Hoffmann Frederiksen, Marie

2018-01-01

High-risk human papillomavirus (HPV) infection is essential in the carcinogenesis of a substantial part of anogenital and oropharyngeal cancers and has additionally been shown to be a possible predictive marker for survival, especially in oropharyngeal cancer. Studies examining the influence of HPV...... status on survival after vulvar cancer have been conflicting and limited by small study populations. Therefore, the aim of this review and meta-analysis was to examine whether HPV status influences survival after vulvar cancer, which, to our knowledge, has not been done before. We conducted a systematic...... search of PubMed, Cochrane Library and Embase to identify studies examining survival after histologically verified and HPV tested vulvar cancer. A total of 18 studies were eligible for inclusion. Study-specific and pooled HRs of the 5-year OS and DFS were calculated using a fixed effects model. The I2...

Rare vulvar malignancies; incidence, treatment and survival in the Netherlands

NARCIS (Netherlands)

Pleunis, N.; Schuurman, M.S.; Rossum, M.M. van; Bulten, J.; Massuger, L.F.A.G.; Hullu, J.A. de; Aa, M.A. van der

2016-01-01

OBJECTIVE: To describe trends in incidence, treatment and survival of patients with basal cell carcinomas and melanomas of the vulva. Also to compare survival of vulvar and cutaneous melanoma patients. METHODS: All women with a vulvar malignancy between 1989 and 2012 were selected from the Dutch

[Vulvar squamous cell carcinoma in young women with HPV negative].

Science.gov (United States)

Gómez-Alarcon, A; Gómez-García, M T; García-de la-Torre, J P; Del Valle-Morón, M; Arones-Collantes, M A; González-de Merlo, G

2016-03-01

The vulvar cancer is the fourth more frequent neoplasia after the endometrial, cervix and ovarian cancer. Normally, it has been related to old women of ages from 70 to 80 years old. Rarely, it has been detected cases in adult or young women. However, its incidence has been increased in the last years and in more early years. It is for this change in the incidence and its appearance in early years why a possible etiology has been looked for, opening different hypothesis that go from that related to the HPV to those that study an inflammatory chronic process as the basis for the carcinogenesis. In this article, it has been presented the case of a woman who is 34 years old with negative VPH that made her debut with epidermoid carcinoma of the vulva moderately different and on purpose of the case, we do a revision of the literature existent. Vulvar cancer diagnosed in young women as in older, but with different trends, risk factors and natural history. The case reported here escapes the theories studied so far so needed new lines of inquiry to investigate this form of presentation young woman, without HPV infection.

Lymphoscintigraphy and radioguided surgery in cervical and vulvar malignant tumours

International Nuclear Information System (INIS)

Morales Guzman-Barron, Rosanna E.

2006-01-01

Objective: To validate a combined technique in the detection of sentinel nodes in early cervix and vulvar cancer patients. Material and Methods: Seventy patients, 24 to 63 years old (average 40 years), with cervical cancer stages IA2, IB1 and IIA, and fourteen patients, 28 to 80 years old (median 68 years) with vulval neoplasm, stage I and II, had sentinel node (SN) detection using lymphoscintigraphy and a gamma probe in the surgical room, after injection of Tc 99m dextran and patent blue dye. Sentinel nodes were seen between 20 and 135 minutes after injection, in cervical cancer, and between one and sixty minutes in vulvar neoplasms. In patients with cervical tumors, 99 sentinel nodes were localized in the obturator region, 28 were interiliac, nine were located in the external iliac region, three in the common iliac region and one was found in perineum. In patients with a vulvar neoplasm, all sentinel nodes were located in the superficial inguinal region. The detection rate was 98,8% for cervical cancer and 100% for vulvar neoplasms, with bilateral drainage in 46% and 29% respectively. Metastases were found in 10,4% (7/65) of IB1 stage cervical cancer patients (6 squamous cell carcinomas - non keratinizing: 5, keratinizing: 1 and one adenocarcionoma) and none in four patients with IA2 stage (with non keratinizing squamous cell carcinoma). The patients with IIA stage cervical cancer (keratinizing squamous cell carcinoma) had metastases in the SN. Three out of 14 patients with vulvar cancer showed metastases in the sentinel node. Two of them had epidermoid carcinoma and one, malignant melanoma. There were no metastases in non-sentinel nodes when sentinel nodes were negative for metastases, both in cervical or vulvar cancer. Conclusion: It is feasible to localize sentinel nodes in cervical and vulvar cancer, using a combined technique with Tc 99m Dextran and 'patent blue'. (author)

Management of vulvar cancers

NARCIS (Netherlands)

de Hullu, J. A.; van der Avoort, I. A. M.; Oonk, M. H. M.; van der Zee, A. G. J.

2006-01-01

Aim The radical surgical approach in the treatment of vulvar cancer patients has led to a favorable prognosis for the majority of the patients with early stage squamous cell cancer. However, the morbidity is impressive, leading to more individualized treatment. The aim of this review is to give an

Management of vulvar cancers.

NARCIS (Netherlands)

Hullu, J.A. de; Avoort, I.A.M. van der; Oonk, M.H.; Zee, A.G. van der

2006-01-01

AIM: The radical surgical approach in the treatment of vulvar cancer patients has led to a favorable prognosis for the majority of the patients with early stage squamous cell cancer. However, the morbidity is impressive, leading to more individualized treatment. The aim of this review is to give an

Vulvar Skin Disorders throughout Lifetime: About Some Representative Dermatoses

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Jean Doyen

2014-01-01

Full Text Available The objective of this paper is to present general considerations which should be kept in mind by clinicians in charge of women with vulvar diseases. Four representative vulvar dermatoses are described. Lichen simplex chronicus is a pathological condition related to chemical and mechanical irritant agents. Detrimental effects of these irritants, in the presence of other dermatoses, have to be considered when therapeutic responses are unsatisfactory. Lichen sclerosus is the most common vulvar dermatosis in elderly. However, it should be kept in mind that it may be diagnosed at any age. Lichen planus, in spite of sharing a similar range of etiological factors with lichen sclerosus, is a very distinct entity. Finally, Paget’s disease, although rare, is also described especially because of the challenge it represents both clinically and therapeutically.

Vulvar melanoma - Is there a role for sentinel lymph node biopsy?

NARCIS (Netherlands)

de Hullu, JA; Hollema, H; Hoekstra, HJ; Piers, DA; Mourits, MJE; Aalders, JG; van der Zee, AGJ

2002-01-01

BACKGROUND. The objective of this study was to evaluate the author's recent, preliminary experience with the sentinel lymph node procedure in patient with vulvar melanoma and to compare this experience with treatment and follow-up of patients with vulvar melanomas who were treated previously at

The role of interstitial brachytherapy in the treatment of vaginal and vulvar malignancies

International Nuclear Information System (INIS)

Seeger, A.R.; Windschall, A.; Lotter, M.; Sauer, R.; Strnad, V.; Mehlhorn, G.; Beckmann, M.W.

2006-01-01

Background: irradiation has established itself as a treatment for vulvar and vaginal malignancies. Due to the sensitive nature of the vulvar and vaginal tissues, interstitial brachytherapy (iBT) provides an effective, gentle and individualized therapy. Patients and Methods: patients with vulvar (nine of 22) and vaginal (13 of 22) malignancies were treated using interstitial pulsed-dose-rate brachytherapy (PDR-iBT). Twelve out of 22 patients were additionally treated using external-beam therapy to the pelvis and regional lymph nodes. The median total dose of PDR-iBT administered to patients with vulvar carcinoma was 55.0 Gy. The median total PDR dose administered to patients with vaginal malignancies amounted to 20.25 Gy. Results: the median follow-up time for patients with vulvar cancer was 19 months and for patients with vaginal malignancies 27 months. Acute mucositis or skin reactions during iBT were observed in 15 of 22 patients. Two of 22 patients showed delayed side effects. After 6 months, 77.8% of the patients with vulvar cancer (seven out of nine) and 100% of the patients with vaginal malignancies (13 out of 13) achieved complete local remission. One patient out of nine with vulvar carcinoma developed local recurrence, four out of nine regional recurrence, and two out of nine developed regional recurrence and had local tumor following therapy. In patients with malignancies of the vagina, no cases of local recurrence were observed, but distant metastases were found in five out of 13 patients. At the time of analysis, eleven out of 22 patients with vulvar or vaginal carcinoma were still alive. Conclusion: IBT achieved good local control without serious delayed side effects in both localizations. However, survival is limited by regional or distant metastases. (orig.)

Influence of treatments on prognosis for vulvar lichen sclerosus: facts and controversies.

Science.gov (United States)

Brodrick, Brooks; Belkin, Zoe R; Goldstein, Andrew T

2013-01-01

Lichen sclerosus (LS) is an inflammatory dermatosis with a predilection for the anogential skin. Vulvar LS can be a debilitating disease, causing pruritus and pain, and it carries the potential for atrophy, scarring, and significant functional impairment. Recently, many advances have been made regarding the etiology and natural history of the disease process; however, much debate still exists regarding the most advantageous medical and surgical management of this disorder. In an effort to provide a comprehensive review on current vulvar LS literature, the following three controversies will be discussed: (1) optimal disease treatment, (2) theories behind LS's oncogenicity and treatments for minimizing malignancy, and (3) the value of surgical treatment for LS. Ultra-potent topical corticosteroids (TCSs) are the first-line treatment for vulvar LS, while topical calcineurin inhibitors (TCIs) remain second-line agents for patients for whom TCS treatment resulted in incomplete resolution of symptoms or adverse events. Due to the relapsing nature of the disease, long-term maintenance therapy is often required. In addition, recent advances have contributed to the understanding of the association between LS and squamous cell carcinoma (SCC). While the exact mechanism responsible for LS-associated SCC is not known, immune dysregulation and inflammation may play an important role; therefore, successful treatment of LS should be directed towards alleviation of symptoms and reversal of the underlying histopathologic changes. Patients with LS-associated malignancy, as well as patients who need correction of functionally restrictive, scarring processes, can successfully undergo surgical intervention with tissue conservation. © 2013 Elsevier Inc. All rights reserved.

Triple flap technique for vulvar reconstruction.

Science.gov (United States)

Mercut, R; Sinna, R; Vaucher, R; Giroux, P A; Assaf, N; Lari, A; Dast, S

2018-04-09

Perineal defects are encountered ever more frequently, in the treatment of vulvar cancers or abdominoperineal resection. The surgical treatment of vulvar cancer leads to significant skin defect. The aim of the reconstruction is not to provide volume but rather to resurface perineum. We propose a new solution to cover the extensive skin defect remaining after excision. We report 3 patients who underwent large excision for vulvar cancer, with lymph node dissection. For reconstruction, we performed 3 advancement flaps. Two V-Y flaps cantered on the infra-gluteal folds and based on pudendal perforator arteries were used to cover the postero-lateral parts of the defect. The third advancement flap from the superior aspect of the defect was a Y-V Mons pubis flap. The defects were successfully covered by the 3 flap technique. The first patient suffered a non-union that slowly healed by secondary intention. For the other cases, we used the same technique, but applied negative pressure wound therapy on the sutures, with excellent results. The 3 flap technique is a simple and reliable method and the donor site morbidity is minimal. It can be realised without changing the position of the patient after tumour excision, and does not require delicate perforator dissection. This surgical option can be easily applied, allowing better management of these cases. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Differential Associations of Communication and Love in Heterosexual, Lesbian, and Bisexual Women's Perceptions and Experiences of Chronic Vulvar and Pelvic Pain.

Science.gov (United States)

Blair, Karen L; Pukall, Caroline F; Smith, Kelly B; Cappell, Jaclyn

2015-01-01

The literature on genital and pelvic pain has largely focused on heterosexual women. An online study examined characteristics of vulvar pain in 839 lesbian, bisexual, and heterosexual women 18-45 years of age and investigated associations between relationship qualities such as love and communication with participants' perceptions of pain's influence on relationships. Characteristics of vulvar pain were similar across groups. Groups differed in how they perceived pain to impact their relationships, such that better communication for same-sex couples and more love for mixed-sex couples was associated with the perception of their pain as having less of an effect on their relationship functioning.

Clinical features and treatment of vulvar Merkel cell carcinoma: a systematic review.

Science.gov (United States)

Nguyen, Austin Huy; Tahseen, Ahmed I; Vaudreuil, Adam M; Caponetti, Gabriel C; Huerter, Christopher J

2017-01-01

Merkel cell carcinoma is a rare and aggressive neoplasm originating from mechanoreceptor Merkel cells of the stratum basale of the epidermis. Cases affecting the vulva are exceedingly rare, with the currently available literature primarily in case report form. Systematic review of the PubMed database returned 17 cases of Merkel cell carcinoma affecting the vulva. Patients presented at a mean age of 59.6 years with a firm, mobile vulvar mass. Symptoms of pain, erythema, pruritus, edema, and ulceration have been reported. Tumor histology is consistent with that of neuroendocrine tumors and typical Merkel cell carcinomas. Neuroendocrine and cytokeratin immunostains are frequently utilized in histopathological workup. Surgical management was the unanimous first-line therapy with adjuvant radiation in most cases. Recurrence occurred in 70.6% of patients at a mean follow-up of 6.3 months. Mortality was at 47.0% at a mean of 7.8 months after initial operation. Merkel cell carcinoma affecting the vulva is an extremely rare and highly aggressive neoplasm. The present review of published cases serves to comprehensively describe the clinical course and treatment approaches for vulvar Merkel cell carcinoma.

Infection or allergy? The multifaceted nature of vulvar dermatoses

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Alok Vij, MD

2015-12-01

Full Text Available Chronic dermatitis or pruritus affecting the female genital and perianal skin can be challenging to properly diagnose and manage. The differential diagnosis generally includes allergic, inflammatory, infectious, and neoplastic conditions. We report the case of a 52-year-old woman with a 6-month history of a progressive, debilitating vulvar and perianal rash that highlights the multifaceted nature of female genital dermatoses.

Neoplasia intraepitelial vulvar: um problema atual Vulvar intraepithelial neoplasia: a current problem

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José Alberto Fonseca-Moutinho

2008-08-01

Full Text Available A neoplasia intraepitelial da vulva (VIN é uma denominação que foi introduzida incialmente pela International Society for Study of Vulvo-vaginal Diseases (ISSVD e reconhecida posteriormente pela International Society of Gynaecological Pathology (ISGYP e Organização Mundial da Saúde. É uma entidade patológica a que correspondem as VIN de tipo usual (verrucoso, basalióide e misto e as VIN de tipo diferenciado. A incidência das lesões de VIN tem aumentado progressivamente, principalmente em mulheres jovens. A infecção pelo papilomavírus humano (HPV de alto risco, pelo vírus da imunodeficiência humana (HIV, o tabagismo e a neoplasia intraepitelial do colo do útero, da vagina e região anal são factores de risco estabelecidos para as VIN. Não existem sintomas e sinais característicos das VIN, mas a doença se traduz sempre por lesões clinicamente identificáveis. A biópsia com o auxílio do colposcópio permite o diagnóstico. O tratamento da doença está sempre justificado pelo elevado risco de progressão para cancro invasivo. A excisão alargada das lesões ou a sua destruição com laser CO2 têm sido os métodos mais populares de tratamento. Independentemente do método terapêutico utilizado, as taxas de recidiva são elevadas, pelo que está aconselhada a vigilância apertada das doentes após tratamento. A terapêutica tópica com imiquimod se afigura promissora no tratamento das VIN. As vacinas profiláticas contra os tipos de HPV de alto risco prometem se tornar armas poderosas na prevenção primária da doença.Vulvar intraepithelial neoplasia (VIN is a pathological denomination coined by the International Society for Study of Vulvo-vaginal Diseases (ISSVD and adopted by the International Society of Gynaecological Pathology (ISGYP and by the World Health Organization. VIN is a heterogeneous pathological entity with a usual type (warty, basaloid and mixed and a differentiated type. The incidence of the disease is

ROCK1 as a novel prognostic marker in vulvar cancer

DEFF Research Database (Denmark)

Akagi, Erica M; Lavorato-Rocha, André M; Maia, Beatriz de Melo

2014-01-01

infection, but most cases develop in women aged over 50 years through poorly understood genetic mechanisms. Rho-associated coiled-coil-containing protein kinase 1 (ROCK1) has been implicated in many cellular processes, but its function in vulvar cancer has never been examined. In this study, we aimed...... to determine the prognostic value of ROCK1 gene and protein analysis in vulvar squamous cell carcinoma (VSCC). METHODS: ROCK1 expression levels were measured in 16 vulvar tumour samples and adjacent normal tissue by qRT-PCR. Further, 96 VSCC samples were examined by immunohistochemistry (IHC) to confirm...... the involvement of ROCK1 in the disease. The molecular and pathological results were correlated with the clinical data of the patients. Sixteen fresh VSCC samples were analyzed by array-based comparative genomic hybridization (aCGH). RESULTS: In each pair of samples, ROCK1 levels were higher by qRT-PCR in normal...

Preliminary experiences with sentinel lymph node detection in cases of vulvar malignancy

International Nuclear Information System (INIS)

Zambo, Katalin; Schmidt, Erzsebet; Dehghani, Babak; Hartmann, Tamas; Bodis, Jozsef; Kornya, Laszlo; Tinneberg, Hans Rudolf

2002-01-01

Lymph node status is the most important prognostic factor in vulvar malignancy. The aim of this pilot study was to explore the clinical significance of radionuclide lymphoscintigraphy in the management of vulvar neoplasms. Eight patients with squamous cell carcinoma and two patients with malignant melanoma of the vulva were studied with 100 MBq technetium-99m nanocolloid (Sentiscint, OSSKI, Budapest) 1 day before surgery. The location of the sentinel lymph node was checked by a single-head gamma camera-computer system (MB 9200, Mediso, Budapest). Vulvectomy with bilateral inguinofemoral lymphadenectomy was performed in each case. At lymphadenectomy, the sentinel lymph node was separately removed and histologically studied. Three of the ten patients had positive sentinel lymph nodes (micrometastasis). Five months later one of them had local recurrence of the vulvar cancer, and another had inguinal recurrence of the tumour 6 months postoperatively; the third patient was operated on only recently. Our preliminary results are impressive and suggest that lymphoscintigraphy is an easy and reliable method for detection of the sentinel lymph node in vulvar malignancy. (orig.)

Recent trends in surgical and reconstructive management of vulvar cancer: review of literature.

Science.gov (United States)

Vitale, Salvatore Giovanni; Valenti, Gaetano; Biondi, Antonio; Rossetti, Diego; Frigerio, Luigi

2015-12-01

Vulvar cancer (VC) is a rare disease. The most common histologic type is squamous-cell carcinoma. VC could be divided into two types: type one, commonly associated with HPV infection, occurs in young women and type two, associated with non-neoplastic lesions that usually occurs in older women. Previously VC was often treated with radical Vulvectomy. Today update in diagnostic and surgery technique, capable to identify early stages of disease and adaptation in surgery procedures, according to the stage of disease, age of patients and possible physical and psychological morbidity consequence, allow using less radical surgery approaches. That has led to decrease therapy-associated morbidity while preserving oncologic safety and improving psychosexual outcomes. Finally, several surgical treatments are available in case of VC and, despite radical surgery is often required, less radical surgery associated with reconstructive plastic surgery decreases some of short- and long-term associated complications.

VULVAR CANCER – A CASE REPORT

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Špela Smrkolj

2018-02-01

Full Text Available Background: Malignant vulvar lesions arise from premalignant vulvar intraepithelial neoplasm (VIN and occur only rarely (3–4 % of all malignancies of the female genital organs, especially in the menopause. They are associated with human papillomavirus infection. If the change is found sufficiently early and if it is properly treated, the prognosis is favourable. Methods and patients: We present a case of a 60-year-old multiparous postmenopausal woman with recurrence of the vulvar cancer. In May 1995 vulvar biopsy revealed VIN III. In February 2006 she was examined at the Oncology Institute because of expansive lesions which covered the entire area of external genitals from clitoris to the anus. On 7th March, 2006 vulvectomy with broad safety margins and right-sided lymphadenectomy were made. Histological di- agnosis revealed a well-differentiated invasive squamous cell carcinoma (FIGO II, grade I; postoperative radiotherapy followed. In February 2007, suspicious lesions reoccurred in the external genital area, the smear was negative. In December 2007 histological diagnosis of recurrent squamous cancer was made. On 7th October, 2008 the patient was admitted to the Department of Gynecology, University Medical Centre, Ljubljana. Abdominal computed tomography showed a widespread vulvar cancer, T4 in appearance, suspicious lymph nodes in the pre-sacral area and suspicious left inguinal lymph node. Metastases to the liver were not confirmed. On 28th October, 2008 total Brunschwig operation was performed (pelvic exenteration of the bladder, uterus, pelvic lymph nodes, rectum and radical vulvectomy with resection of both ramus ossis pubis, anus praeter and transposition of skin-muscle flap (m. rectus abdominis. The interdisciplinary operation, which lasted 9 hours and blood loss was 6 litres, involved gynaecologists, a urologist, a plastic surgeon, and an oncology surgeon. The histological diagnosis of a 27 × 24 cm large preparation was a moderately

Vulvar lichen sclerosus et atrophicus

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Pragya Ashok Nair

2017-01-01

Full Text Available Vulvar lichen sclerosus (VLS is a chronic inflammatory dermatosis characterized by ivory-white plaques or patches with glistening surface commonly affecting the vulva and anus. Common symptoms are irritation, soreness, dyspareunia, dysuria, and urinary or fecal incontinence. Anogenital lichen sclerosus (LS is characterized by porcelain-white atrophic plaques, which may become confluent extending around the vulval and perianal skin in a figure of eight configuration. Thinning and shrinkage of the genital area make coitus, urination, and defecation painful. LS is not uncommon in India and present as an itchy vulvar dermatosis which a gynecologist may mistake for candidal vulvovaginitis. There is often a delay in diagnosis of VLS due to its asymptomatic nature and lack of awareness in patients as well as physicians. Embarrassment of patients due to private nature of the disease and failure to examine the genital skin properly are the other reasons for delay in diagnosis. There is no curative treatment for LS. Various medications available only relieve the symptoms. Chronic nature of the disease affects the quality of life. Proper and regular follow-up is required as there are chances of the development of squamous cell carcinoma.

A Giant Vulvar Mass: A Case Study of Cellular Angiofibroma

Science.gov (United States)

Aydın, Ümit; Terzi, Hasan; Turkay, Ünal; Eruyar, Ahmet Tuğrul; Kale, Ahmet

2016-01-01

Cellular angiofibroma is a mesenchymal tumor that affects both genders. Nucci et al. first described it in 1997. Cellular angiofibroma is generally a small and asymptomatic mass that primarily arises in the vulvar-vaginal region, although rare cases have been reported in the pelvic and extrapelvic regions. It affects women most often during the fifth decade of life. The treatment requires simple local excision due to low local recurrence and no chance of metastasization. The current study presents a case of angiofibroma in the vulvar region that measured approximately 20 cm. PMID:27293929

A Giant Vulvar Mass: A Case Study of Cellular Angiofibroma

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Ümit Aydın

2016-01-01

Full Text Available Cellular angiofibroma is a mesenchymal tumor that affects both genders. Nucci et al. first described it in 1997. Cellular angiofibroma is generally a small and asymptomatic mass that primarily arises in the vulvar-vaginal region, although rare cases have been reported in the pelvic and extrapelvic regions. It affects women most often during the fifth decade of life. The treatment requires simple local excision due to low local recurrence and no chance of metastasization. The current study presents a case of angiofibroma in the vulvar region that measured approximately 20 cm.

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Energy Technology Data Exchange (ETDEWEB)

Gaffney, David K., E-mail: david.gaffney@hci.utah.edu [Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, Utah (United States); King, Bronwyn [Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre and Epworth Radiation Oncology, Melbourne, Victoria (Australia); Viswanathan, Akila N. [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Harvard Medical School, Boston, Massachusetts (United States); Barkati, Maroie [Department of Radiation Oncology, Centre hospitalier de l' universite de Montreal, Montreal, Quebec (Canada); Beriwal, Sushil [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Eifel, Patricia [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Erickson, Beth [Department of Radiation Oncology, Proedtert and Medical College Clinical Cancer Center, Milwaukee, Wisconsin (United States); Fyles, Anthony [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Goulart, Jennifer [Department of Radiation Oncology, British Columbia Cancer Agency, Victoria, British Columbia (Canada); Harkenrider, Matthew [Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Maywood, Illinois (United States); Jhingran, Anuja; Klopp, Ann [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Koh, Wui-Jin [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); Lim, Karen [Liverpool Cancer Therapy Centre, Radiation Oncology Unit, Sydney, New South Wales (Australia); Petersen, Ivy [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Portelance, Lorraine [Radiation Oncology Department, Miller School of Medicine, University of Miami, Miami, Florida (United States); and others

2016-07-15

Purpose: The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. Methods and Materials: An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. Results: Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. Conclusions: These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

International Nuclear Information System (INIS)

Gaffney, David K.; King, Bronwyn; Viswanathan, Akila N.; Barkati, Maroie; Beriwal, Sushil; Eifel, Patricia; Erickson, Beth; Fyles, Anthony; Goulart, Jennifer; Harkenrider, Matthew; Jhingran, Anuja; Klopp, Ann; Koh, Wui-Jin; Lim, Karen; Petersen, Ivy; Portelance, Lorraine

2016-01-01

Purpose: The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. Methods and Materials: An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. Results: Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. Conclusions: These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.

Fine needle aspiration cytology of vulvar actinomycosis masquerading clinically as malignancy

Directory of Open Access Journals (Sweden)

Rahul Parasram Wanjari

2015-01-01

Full Text Available Actinomycosis is a chronic infection caused by Actinomyces israelii, usually seen in immunocompromised patients or in the background of tissue injury. Vulvar actinomycosis presenting as a fixed swelling in an elderly individual can mimic malignancy and pose a diagnostic dilemma. We report here a case of vulvar actinomycosis diagnosed by fine needle aspiration (FNA. A 60-year-old postmenopausal female presented with a gradually increasing 15 cm × 10 cm vulvar swelling involving the right mons and right labia majora. The swelling was nodular, fixed, and nonulcerated, with multiple healed and few active discharging sinus tracts draining serosanguineous fluid and yellowish sulfur granules. FNA was diagnostic, as it revealed colonies of Actinomyces surrounded by polymorphs. Histopathology of excised specimen confirmed the cytological findings. FNA is an effective tool in the diagnosis of actinomycosis, although, its documentation is rare. Difficulties in the management can be avoided by early diagnosis using the FNA technique.

Vulvar carcinoma

International Nuclear Information System (INIS)

Anderson, John M.; Cassady, J. Robert; Shimm, David S.; Stea, Baldassarre

1995-01-01

Purpose: Controversies exist regarding the use of radiation therapy in the treatment of vulvar carcinoma. A retrospective review was performed to evaluate our institution's experience with surgery and radiation for this disease. Methods and Materials: The medical records of 47 patients treated for squamous cell carcinoma of the vulva at our institution (1974-1992) were reviewed for TNM stage (AJCC criteria), treatment modality, and associated 5-year local control and survival based on Kaplan-Meier analysis. Results: Twenty-eight patients (60%) presented with Stage I and II disease and their 5-year survival was 69%. Stage III patients accounted for 12 (25%) of the patients and their 5-year survival was 73%. Seven patients presented with Stage IV disease and five died within 13 months of diagnosis after predominantly palliative therapy. The 40 patients with Stages I, II, and III disease were treated aggressively and were further evaluated for treatment-modality-associated survival and local control. Radiation therapy was used as primary treatment in nine patients, of whom seven were treated with radiation alone and two were treated postoperatively after wide excision. Surgery alone was performed in 31 patients consisting of either radical vulvectomy (20 patients) or wide excision (11 patients). When comparing outcomes of radical vulvectomy vs. radiation therapy, we noted that the 5-year actuarial survivals were comparable (74% for either modality), despite the presence of more favorable prognostic factors in the group treated with radical vulvectomy. Patients treated with wide excision alone had a trend for a poorer 5-year actuarial survival (51%) and local control (50%). Conclusions: Radical vulvectomy offers good locoregional control and survival. This retrospective review further supports the use of radiation therapy with conservative surgery as an alternative treatment option for patients with vulvar carcinoma treated with curative intent. In contrast, the use of

Effects of previous surgery on the detection of sentinel nodes in women with vulvar cancer.

NARCIS (Netherlands)

Ennik, T.A.; Allen, D.G; Bekkers, R.L.M.; Hyde, S.E.; Grant, P.T.

2011-01-01

BACKGROUND: There is a growing interest to apply the sentinel node (SN) procedure in the treatment of vulvar cancer. Previous vulvar surgery might disrupt lymphatic patterns and thereby decrease SN detection rates, lengthen scintigraphic appearance time (SAT), and increase SN false-negative rate.

DESVIOS DE SAÚDE EM PORTADORAS DE CONDILOMA VULVAR

Directory of Open Access Journals (Sweden)

Maria Albertina Rocha Diógenes

2009-01-01

Full Text Available El Condiloma vulvar se caracteriza por verrugas genitales causadas por papilomavirus humano (VHP, enfermedad sexualmente transmisible. Se planteó identificar comportamientos de auto-cuidado a partir de los requisitos por desvío de salud en mujeres portadoras de Condiloma vulvar. Estudio transversal en una muestra de atención médica de uno de los investigadores de una institución pública, referencia en Enfermedades Sexualmente Transmisibles, en Fortaleza - CE, con 30 mujeres, entre agosto y septiembre del 2007. Se empleó una entrevista con preguntas abiertas y cerradas. Los datos fueron analizados descriptivamente. Se observó que las entrevistadas poseen bajo nivel socio-económico y educacional. Los comportamientos de auto-cuidado identificados, en esta investigación, a partir de los requisitos por desvío de salud fueron: desconocimiento de la enfermedad, inestabilidad emocional, falta de colaboración de los compañeros, dificultad financiera para comparecer a citas marcadas. De esa manera, conocer los comportamientos de auto-cuidado por desvío de salud en mujeres portadoras de Condiloma vulvar permitió percibir que presentan déficit de auto-cuidado que independen de la voluntad de estas mujeres.

A rare case of vulvar squamous cell carcinoma; case presentation

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Cristina N. Cozma

2018-05-01

Full Text Available Objectives. Vulvar cancer is a rare gynecological malignancy, with an incidence of 1.5 per 100 000 women/year. The most common vulvar cancer is developed in squamous cells, the most encountered type of skin cells. Case report. We report a case of a 72-year-old female admitted in the Department of Plastic Surgery of Emergency Clinical Hospital “Prof. Dr. Agrippa Ionescu” with a 5/4.2 cm painful ulcerated tumoral mass located in the vulvar area. The lesion slowly increased in size over the past 12 months. The tumour was surgically removed with oncological safety margins and sent for histopathological evaluation. The histopathological examination revealed an ulcerated squamous carcinoma with lymphovascular and perineural invasion, but with negative margins. Postoperative results were favorable, and no local or general complications were observed. Conclusion. We highlight this case due to its unusual presentation in the clitoral area. Moreover, considering the potential for recurrence we point out the importance of the radical vulvectomy with regional lymphadenectomy and histopathological examination, in order to put a precise diagnosis and ensure the best possible treatment for the patient.

What's New in Vulvar Cancer Research and Treatment?

Science.gov (United States)

... with cancer that has spread to lymph nodes benefit from chemotherapy or pelvic radiation therapy. The use of internal radiation therapy, called brachytherapy, along with external beam radiation is ... vulvar tumors might benefit from it, too. More research is needed to ...

MRI of vulvar Crohn disease

Energy Technology Data Exchange (ETDEWEB)

Pai, Deepa; Dillman, Jonathan R.; Mahani, Maryam Ghadimi; Strouse, Peter J. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital, F3503, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States)

2011-04-15

Crohn disease is a chronic granulomatous inflammatory disorder that most commonly affects the gastrointestinal tract, particularly the distal small bowel and colon. While certain extraintestinal manifestations of Crohn disease are relatively common and well-known, others, such as metastatic cutaneous involvement, are quite rare and may be difficult to recognize, particularly in the pediatric population. This case report illustrates the magnetic resonance imaging (MRI) appearance of vulvar region cutaneous Crohn disease in an 11-year-old girl. (orig.)

Vulvar Epidermoid Cyst and Type 2 Radical Genital Mutilation

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Ozer Birge

2015-01-01

Full Text Available About 100 million women are estimated to be circumcised globally. Various rates of complications have been encountered, especially after circumcision, such as bleeding, infection, shock, menstrual irregularity, difficulty in urination or common urinary tract infections, inguinal pain, difficulty in sexual intercourse, and genital circumcision scar especially at the vulvar region, and cystic or solid character mass in short and long term. Furthermore, the maternal-fetal morbidity and mortality increase due to bleeding and fistula, which develop after prolonged labor, travail, and difficult labors. Our aim in this paper was to discuss a 42-year-old multiparous female case who had undergone type 2 radical genital mutilation (circumcision when she was 7 years of age, along with the literature, which has been evaluated for the gradually growing mass at the left inguinal canal region in the last 10 years and diagnosed as epidermoid inclusion cyst developing secondary to postcircumcision surgical ground trauma, since there was no other case found in the literature search that had been circumcised at such an early age and developing after circumcision at such advanced age, and, therefore, this is suggested to be the first case on this subject.

Neuroendocrine tumor of vulva: A case report and review of literature

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Sheikh Zahoor

2010-01-01

Full Text Available Neuroendocrine tumor (Merkel cell carcinoma-MCC of the vulva is a very rare entity with less than 15 cases reported in the English literature. It is known for its aggressive behaviour and propensity for early dissemination. The actual cell of origin and etiology of this disease is controversial. In absence of any definite guidelines for management (due to its rarity, extrapolation of data from extra-vulvar MCC seems logical. We present a case of vulvar neuroendocrine tumor who presented at a locally advanced stage.

Results of radiation therapy for vulvar carcinoma

Energy Technology Data Exchange (ETDEWEB)

Pirtoli, L; Rottoli, M L [Florence Univ. (Italy). Ist. di Radiologia

1982-01-01

Radical radiation therapy was given to 19 patients with vulvar squamous cell carcinoma, and as a palliative to 17. Complete regression of the tumor was achieved in 17 patients (47%). The 5-year survival rate was 8/31 patients (26%) in the overall series and 8/19 patients (42%) in the radically irradiated group.

The experience of relocation for specialist treatment for Indigenous women diagnosed with vulvar cancer in East Arnhem Land.

Science.gov (United States)

McGrath, Pam; Rawson, Nicole

2013-01-01

Vulvar cancer is a serious condition that requires a range of specialist treatments including surgery, chemotherapy, and radiation. In Australia, such treatments are only available in major metropolitan hospitals. Thus, women diagnosed with this condition in rural and remote areas must relocate to the metropolitan specialist centers for treatment. The focus of this article is on the experience of relocation for specialist care for Indigenous women diagnosed with vulvar cancer from East Arnhem Land, Northern Territory, Australia. The findings presented in this article explore a range of issues that affect the experience of relocation such as community concerns, cultural distress, loneliness, fear, worry, and physical concerns associated with the condition.

The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer.

Science.gov (United States)

Robertson, N L; Hricak, H; Sonoda, Y; Sosa, R E; Benz, M; Lyons, G; Abu-Rustum, N R; Sala, E; Vargas, H A

2016-03-01

To evaluate the changes in prognostic impression and patient management following PET/CT in patients with vulvar and vaginal carcinoma; and to compare PET/CT findings with those of conventional imaging modalities. We summarized prospectively and retrospectively collected data for 50 consecutive patients from our institution that enrolled in the National Oncologic PET Registry and underwent FDG-PET/CT for a suspected or known primary or recurrent vulvar/vaginal cancer. 54/83 (65%) studies included had a diagnosis of vulvar cancer, and the remaining 29/83 (35%), a diagnosis of vaginal cancer. Following FDG-PET/CT, the physician's prognostic impression changed in 51% of cases. A change in patient management, defined as a change to/from a non-interventional strategy (observation or additional imaging), to/from an interventional strategy (biopsy or treatment), was documented in 36% of studies. The electronic records demonstrated that 95% of the management strategies recorded in the physician questionnaires were implemented as planned. MRI and/or CT were performed within one month of the FDG-PET/CT in 20/83 (24%) and 28/83 (34%) cases, respectively. FDG-PET/CT detected nodes suspicious for metastases on 29/83 (35%) studies performed. MRI and CT detected positive nodes on 6 and 11 studies respectively. Distant metastases were identified in 10 cases imaged with FDG-PET and 5 cases that had additional conventional CT imaging. All suspicious lesions seen on CT were positively identified on PET/CT. In 4 cases, an abnormality identified on PET/CT, was not seen on diagnostic CT. FDG-PET/CT may play an important role in the management of vulvar and vaginal carcinoma. Copyright © 2015 Elsevier Inc. All rights reserved.

Cognitive, psychophysical, and neural correlates of vulvar pain in primary and secondary provoked vestibulodynia: a pilot study.

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Sutton, Katherine; Pukall, Caroline; Wild, Conor; Johnsrude, Ingrid; Chamberlain, Susan

2015-05-01

Provoked vestibulodynia (PVD) is a common condition characterized by localized, provoked pain that can be present since first vaginal penetration attempt (primary) or can develop after a period of pain-free penetration (secondary). Research has demonstrated psychosocial and psychophysical differences between women with these subtypes of PVD, but the question of whether neural responses to pain also differ remains to be investigated. This study aims to examine whether cognitive, psychophysical, and neural responses to vulvar pressure pain differ between women with PVD1 and PVD2. Women with PVD1 and PVD2 were compared for group differences using multiple modalities, including questionnaires, psychophysical testing, and neuroimaging. Pain ratings were held constant across groups, rather than amount of pressure applied. Demographics, sexual functioning, four questionnaires examining anxiety and catastrophizing, quantitative sensory testing at the vulvar vestibule using a vulvalgesiometer, and functional and structural magnetic resonance imaging (MRI). Findings suggest that women with PVD1 are more anxious and that they catastrophize more about their vulvar and nonvulvar pain than women with PVD2. Overall, MRI results demonstrated structural and functional similarities to other chronic pain findings for both groups of women. Gray matter (GM) density also differed between groups: women with PVD1 showed significant decreases in GM throughout areas associated with pain processing. Functionally, between-groups differences were found during painful vulvar stimulation despite lower pressures applied to the vulva for women with PVD1 because of their heightened sensitivity; the determination of the level of vulvar pressure to elicit pain was based on subjective ratings. Findings are limited by sample size and liberal alpha values; however, future research is certainly warranted based on the preliminary findings of this study suggesting both similarities and differences between

Use of Cetuximab in Combination with Cisplatin and Adjuvant Pelvic Radiation for Stage IIIB Vulvar Carcinoma

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Jennifer Bergstrom

2015-01-01

Full Text Available Vulvar cancer is a rare carcinoma constituting only 4% of gynecologic malignancies and 0.6% of female cancers. Most chemotherapy regimens have been created from extrapolation from anal and cervical cancer research. Advanced stages have the worst prognosis and oftentimes invasive surgical procedures are needed to cure disease with high recurrence rates. Case. A 50 yo G2P2 presented for a 2 cm mass in her right labia. The patient underwent a partial radical vulvectomy and bilateral superficial and deep inguinal lymph node dissection. Bilateral inguinal lymph nodes were positive for residual disease. The patient underwent whole pelvic radiation with cisplatin as a radiosensitizer. The primary tumor was epidermal growth factor receptor (EGFR positive and cetuximab, a monoclonal antibody to EGFR, was added. The patient underwent seven cycles of chemotherapy including cisplatin and cetuximab with adjuvant radiation therapy to the pelvis. She currently is without evidence of disease recurrence since completing treatment 4 years ago. Conclusion. One previous case report showed short-term palliative success of five months for recurrent, metastatic vulvar cancer. This case suggests that cetuximab could possibly be used in initial management of patients with advanced stages of vulvar cancer to improve prognosis.

A Case Of Vulvar Myiasis

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Bishwa Raj Dawadi

2016-10-01

antibiotics, analgesics and anti-in ammatory medication. Daily local asepsis of the wound with antiseptic solution (betadine was done. We removed more than 30 larvae by the fourth day after which no more larvae were seen and she gradually recovered in the following days. It is our opinion that the cause of vulvar myiasis in our patient was her poor sanitary hygiene. Simple measures such as washing clothes thoroughly, drying and ironing of clothes are also necessary to reduce the risk of this human myiasis. Keywords: external genitalia; female; maggots; myiasis.

Does T1, N0-1 vulvar cancer treated by vulvectomy but not lymphadenectomy need inguinofemoral radiation?

International Nuclear Information System (INIS)

Manavi, Mahmood; Berger, Andreas; Kucera, Elisabeth; Vavra, Norbert; Kucera, Herwig

1997-01-01

Purpose: The objective of our study was to demonstrate differences in relapse rates, total survival times, and complication rates between inguinofemoral radiation and its absence in cases of invasive vulvar carcinoma without lymph node involvement (FIGO Stages T1, N0-1). Methods and Materials: From 1974 to 1990, 135 patients with invasive vulvar carcinoma in Stage T1 without clinical evidence of inguinal lymph node involvement underwent simple vulvectomy performed by hot-knife resection without lymphadenectomy. Although 65 patients (Group 1) received postoperative inguinofemoral radiation therapy, 70 patients (Group 2) did not, and none received local vulva irradiation. Results: The 5-year survival rates were 93.7% in Group 1 and 91.4% in Group 2 (p = NS). Although clitoris involvement was significantly more prevalent in the irradiation group (p = 0.04), inguinal relapse was found less frequently in Group 1 (4.6% or 3 out of 65 patients) than in group 2 (10% or 7 out of 70 patients) (p = 0.32). The complication rates were, 7.7% in Group 1 and 2.9% in Group 2, 2.7% for vaginal stenosis (two patients in each group), 1.5% for inguinal pain (one patient in Group 1), 1.5% for recto vaginal fistula (one patient in Group 1), 1.5% for vulvar infection (one patient in Group 1). Conclusion: No statistically significant differences in the relapse rates and survival times were found. Risk factors were equally distributed in both study groups except for clitoris involvement. The 5-year survival rates in both groups were similar to those reported in the literature for radical vulvectomy and inguinal lymph-node dissection (83-96%). Morbidity in our study was low. Although our data showed similar results in both groups, we are not recommending at this time to omit groin radiation in general, but it may be justified in low-risk cases

Flexitouch® Home Maintenance Therapy or Standard Home Maintenance Therapy in Treating Patients With Lower-Extremity Lymphedema Caused by Treatment for Cervical Cancer, Vulvar Cancer, or Endometrial Cancer

Science.gov (United States)

2014-12-29

Lymphedema; Stage 0 Cervical Cancer; Stage 0 Uterine Corpus Cancer; Stage 0 Vulvar Cancer; Stage I Uterine Corpus Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IB Cervical Cancer; Stage II Uterine Corpus Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Uterine Corpus Cancer; Stage III Vulvar Cancer; Stage IV Uterine Corpus Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer; Stage IVB Vulvar Cancer

European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer

DEFF Research Database (Denmark)

Oonk, Maaike H M; Planchamp, François; Baldwin, Peter

2017-01-01

OBJECTIVE: The aim of this study was to develop clinically relevant and evidence-based guidelines as part of European Society of Gynaecological Oncology's mission to improve the quality of care for women with gynecologic cancers across Europe. METHODS: The European Society of Gynaecological...... Oncology Council nominated an international development group made of practicing clinicians who provide care to patients with vulvar cancer and have demonstrated leadership and interest in the management of patients with vulvar cancer (18 experts across Europe). To ensure that the statements are evidence...

Cryotherapy for massive vulvar lymphatic leakage complicated with lymphangiomas following gynecological cancer treatment.

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Yanazume, Shintaro; Douzono, Haruhiko; Kubo, Hidemichi; Nagata, Tomomi; Douchi, Tsutomu; Kobayashi, Hiroaki

2014-11-01

Vulvar lymphatic leakage is a severe complication associated with gynecological cancer treatments. However, standard treatment strategies have not yet been determined. We encountered a rare case of a 76-year-old multiparous woman suffering from massive lymphatic fluid leakage from the entire vulva, and papules developed and were identified as lymphangiomas. A large amount of straw-colored discharge continued from all vulvar papules, which extended over the mons pubis. Nine years ago, the patient had undergone a radical hysterectomy with concurrent chemoradiation for uterine cervical cancer treatment. Her serum albumin level was 1.9 mg/dl, which was attributed to the loss of a large amount of lymph fluid due to leakage from the vulva. Her quality of life gradually decreased because of general fatigue and the need for frequent diaper exchanges every 2 h. The patient received a less-invasive treatment with cryotherapy using liquid nitrogen. She also received a multimodality treatment consisting of the intravenous administration of albumin, massage of the lower limbs and intensive rehabilitation. Cryotherapy was administered once a week for 3 months. Her discharge almost stopped and vulvar lymphangiomas decreased without any major complications. To the best of our knowledge, this is the first case report of massive lymphatic leakage complicated with vulvar lymphangiomas. Additionally, this case may represent the first successful treatment of vulva lymph leakage by cryotherapy without recurrence. Cryotherapy may have the potential to improve the quality of life as a less-invasive treatment for gynecological cancer survivors without serious complications. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[The incidence of human papilloma virus associated vulvar cancer in younger women is increasing and wide local excision with sentinel lymph node biopsie has become standard].

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Fehr, Mathias K

2011-10-01

Sentinel lymph node (SLN) dissections have been shown to be sensitive for the evaluation of nodal basins for metastatic disease and are associated with decreased short-term and long-term morbidity when compared with complete lymph node dissection. There has been increasing interest in the use of SLN technology in gynecologic cancers. This review assesses the current evidence-based literature for the use of SLN dissections in gynecologic malignancies. Recent literature continues to support the safety and feasibility of SLN biopsy for early stage vulvar cancer with negative predictive value approaching 100 % and low false negative rates. Alternatively, for endometrial cancer most studies have reported low false-negative rates, with variable sensitivities and have reported low detection rates of the sentinel node. Studies examining the utility of SLN biopsy in early-stage cervical cancer remain promising with detection rates, sensitivities, and false-negative rates greater than 90 % for stage 1B1 tumors. SLN dissections have been shown to be effective and safe in certain, select vulvar cancer patients and can be considered an alternative surgical approach for these patients. For endometrial and cervical cancer, SLN dissection continues to have encouraging results and however needs further investigation.

Vulvar cancer in Tunisia: Epidemiological and clinicopathological features multicentric study

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Mehdi Kehila, MD

2017-06-01

Conclusion: Vulvar cancer in Tunisia is a rare disease, occurs mostly in elderly women, and is diagnosed at advanced stages. Our findings emphasize that a greater effort should be made to facilitate early diagnosis, as treatment in earlier stages is less extensive and potentially curative.

Human papillomavirus infection in squamous cell carcinoma of the vulva, in various synchronous epithelial changes and in normal vulvar skin

NARCIS (Netherlands)

Kagie, M. J.; Kenter, G. G.; Zomerdijk-Nooijen, Y.; Hermans, J.; Schuuring, E.; Timmers, P. J.; Trimbos, J. B.; Fleuren, G. J.

1997-01-01

OBJECTIVE: To investigate the prevalence of human papillomavirus (HPV) infection in various vulvar lesions. METHODS: HPV infection using consensus primer-PCR was studied in 66 patients with vulvar carcinoma and in the synchronous epithelial lesions. RESULTS: HPV infection was present in 13/66

ABO blood groups as a prognostic factor for recurrence in ovarian and vulvar cancer.

Science.gov (United States)

Montavon Sartorius, Céline; Schoetzau, Andreas; Kettelhack, Henriette; Fink, Daniel; Hacker, Neville F; Fedier, André; Jacob, Francis; Heinzelmann-Schwarz, Viola

2018-01-01

The relationship between ABO blood groups (BG) and risk of incidence in cancers including gynecological cancers has been widely studied, showing increased incidence risk for BG A patients. As available data are inconsistent we investigated whether BG and their anti-glycan antibodies (anti-A and anti-B) have prognostic values in gynecological cancers. We retrospectively evaluated 974 patients with gynecological cancers in three cancer centers (Switzerland and Australia) between 1974 and 2014 regarding the relationships between clinico-pathological findings and the BG. Time to disease recurrence was significantly influenced by BG in patients with ovarian (n = 282) and vulvar (n = 67) cancer. BG O or B patients showed a significantly increased risk for ovarian cancer relapse compared to A, 59% and 82%, respectively (p = 0.045; HR O vs A = 1.59 (CI 1.01-2.51) and (p = 0.036; HR A vs B = 0.55 (CI 0.32-0.96). Median time to relapse for advanced stage (n = 126) ovarian cancer patients was 18.2 months for BG O and 32.2 for A (p = 0.031; HR O vs A = 2.07 (CI 1.07-4.02)). BG also significantly influenced relapse-free survival in patients with vulvar cancer (p = 0.002), with BG O tending to have increased relapse risk compared to A (p = 0.089). Blood groups hence associate with recurrence in ovarian and vulvar cancer: women with BG O seem to have a lower ovarian cancer incidence, however are more likely to relapse earlier. The significance of the BG status as a prognostic value is evident and may be helpful to oncologists in prognosticating disease outcome and selecting the appropriate therapy.

Peripheral subcutaneous vulvar stimulation in the management of severe and refractory vulvodynia.

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De Andres, Jose; Sanchis-Lopez, Nerea; Asensio-Samper, Juan Marcos; Fabregat-Cid, Gustavo; Dolz, Vicente Molsalve

2013-02-01

Vulvodynia is a complex and multifactorial clinical condition with severe pain that occurs in the absence of visible infectious, inflammatory, neoplastic, or neurological findings. A 35-year-old woman with 3 years of dysesthetic vulvodynia tried conventional and interventional medical treatment with inadequate relief. She was offered peripheral subcutaneous vulvar field stimulation and underwent implantation of two vulvar subcutaneous electrodes. At 15 days after treatment and during 1-year follow-up, the patient scored 1 out of 15 on Friedrich scale, 1 out of 10 on the visual analog scale, and 1 out of 10 on the tampon test. The patient no longer requires oral medication. Stimulation with subcutaneous electrodes provided relief from vulvodynia to a patient in whom all previous therapeutic approaches had failed.

Vulvar Asymmetry Due to Silicone Migration and Granulomatous Immune Response Following Injection for Buttock Augmentation.

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Harker, David B; Turrentine, Jake E; Desai, Seemal R

2017-04-01

A 34-year-old woman was referred to the authors' dermatology clinic for evaluation of right labial swelling and dyspareunia. Her symptoms began after receiving a liquid silicone injection into the buttocks at a cosmetic plastic surgery clinic that was operating illegally by an unlicensed provider. A single prior debulking surgery had produced only temporary relief of symptoms, and the swelling returned. Work-up including magnetic resonance imaging and skin biopsy revealed migration of the injected silicone from her buttock to the subcutaneous tissue of the right labia majora, with an associated granulomatous immune response to the silicone. To the authors' knowledge, the extent of contiguous soft tissue involvement shown in this case has not yet been reported in the medical literature, nor has the finding of migration from the buttocks to the vulvar tissues to produce such dramatic asymmetry. Treatment with intralesional steroids and minocycline was initiated with improvement noted at one-month follow-up. Large volume and adulterated silicone injections are associated with a host of complications, including silicone migration and granuloma formation. No consensus for treatment exists, but attempted therapies have included surgery, local steroid injections, systemic steroids, tetracycline antibiotics, and other immune modulators. Treatment must be tailored to the individual case, considering the patient's preferences and medical history.

Pathologic audit of 164 consecutive cases of vulvar intraepithelial neoplasia.

Science.gov (United States)

Scurry, James; Campion, Michael; Scurry, Bonnie; Kim, Soo Nyung; Hacker, Neville

2006-04-01

There are 2 types of vulvar intraepithelial neoplasia (VIN): warty-basaloid and differentiated. Differentiated VIN is uncommon and seldom diagnosed prior to carcinoma and, traditionally, is not graded. There are currently 3 grading systems for warty-basaloid VIN: the World Health Organization (WHO) 3 grade system of VIN 1-3, a 2 grade system of low and high grade vulvar intraepithelial lesions, and the revised International Society for the Study of Vulvovaginal Disease (ISSVD) classification which has no grading of VIN. According to the ISSVD, VIN 1 should be abolished and VIN 2 and 3 combined into a single category, simply termed warty-basaloid VIN. To determine the best system for grading warty-basaloid VIN and learn more about differentiated VIN, we reviewed the pathology of 164 consecutive women with VIN. Of these, 134 (82.3%) had warty-basaloid VIN, 29 (18.2%) had differentiated VIN, and 1 had both. Of warty-basaloid VIN cases, 4 had VIN 1, 13 VIN 2, and 118 VIN 3 when graded according to the WHO. All VIN 1 occurred in condylomata acuminata. VIN 2 and 3 were distinguished only by degree of abnormality. Differentiated VIN was diagnosed before SCC in only 7 cases (26.7%). Because the only VIN 1 cases seen were in condylomata acuminata and because VIN 2 and 3 were difficult to distinguish and there appears little clinical reason to do so, our study supports the ISSVD proposal that VIN 1 be abolished and VIN 2 and 3 be combined. There needs to be more clinical awareness of vulvar conditions, so that differentiated VIN is biopsied before cancer has supervened.

Targeting Human Papillomavirus to Reduce the Burden of Cervical, Vulvar and Vaginal Cancer and Pre-Invasive Neoplasia

DEFF Research Database (Denmark)

Nygard, Mari; Hansen, Bo Terning; Dillner, Joakim

2014-01-01

BACKGROUND: Infection with high-risk human papillomavirus (HPV) is causally related to cervical, vulvar and vaginal pre-invasive neoplasias and cancers. Highly effective vaccines against HPV types 16/18 have been available since 2006, and are currently used in many countries in combination...... with cervical cancer screening to control the burden of cervical cancer. We estimated the overall and age-specific incidence rate (IR) of cervical, vulvar and vaginal cancer and pre-invasive neoplasia in Denmark, Iceland, Norway and Sweden in 2004-2006, prior to the availability of HPV vaccines, in order...... to establish a baseline for surveillance. We also estimated the population attributable fraction to determine roughly the expected effect of HPV16/18 vaccination on the incidence of these diseases. METHODS: Information on incident cervical, vulvar and vaginal cancers and high-grade pre-invasive neoplasias...

Incidence and cost of anal, penile, vaginal and vulvar cancer in Denmark

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Olsen Jens

2012-12-01

Full Text Available Abstract Background Besides being a causative agent for genital warts and cervical cancer, human papillomavirus (HPV contributes to 40-85% of cases of anal, penile, vaginal and vulvar cancer and precancerous lesions. HPV types 16 & 18 in particular contribute to 74-93% of these cases. Overall the number of new cases of these four cancers may be relatively high implying notable health care cost to society. The aim of this study was to estimate the incidence and the health care sector costs of anal, penile, vaginal and vulvar cancer. Methods New anogenital cancer patients were identified from the Danish National Cancer Register using ICD-10 diagnosis codes. Resource use in the health care sector was estimated for the year prior to diagnosis, and for the first, second and third years after diagnosis. Hospital resource use was defined in terms of registered hospital contacts, using DRG (Diagnosis Related Groups and DAGS (Danish Outpatient Groups System charges as cost estimates for inpatient and outpatient contacts, respectively. Health care consumption by cancer patients diagnosed in 2004–2007 was compared with that by an age- and sex-matched cohort without cancer. Hospital costs attributable to four anogenital cancers were estimated using regression analysis. Results The annual incidence of anal cancer in Denmark is 1.9 per 100,000 persons. The corresponding incidence rates for penile, vaginal and vulvar cancer are 1.7, 0.9 and 3.6 per 100,000 males/females, respectively. The total number of new cases of these four cancers in Denmark is about 270 per year. In comparison, the total number of new cases cervical cancer is around 390 per year. The total cost of anogenital cancer to the hospital sector was estimated to be 7.6 million Euros per year. Costs associated with anal and vulvar cancer constituted the majority of the costs. Conclusions Anogenital cancer incurs considerable costs to the Danish hospital sector. It is expected that the current

The clinicopathological and prognostic impact of 14-3-3 sigma expression on vulvar squamous cell carcinomas

International Nuclear Information System (INIS)

Wang, Zhihui; Tropè, Claes G; Suo, Zhenhe; Trøen, Gunhild; Yang, Guanrui; Nesland, Jahn M; Holm, Ruth

2008-01-01

14-3-3 sigma (σ) promotes G2/M cell cycle arrest by sequestering cyclin B1-CDC2 complex in cytoplasm. Down-regulation of 14-3-3σ, which has been demonstrated in various carcinomas, may contribute to malignant transformation. However, the exact role of 14-3-3σ in the pathogenesis of vulvar carcinoma is not fully characterized, and the prognostic impact of 14-3-3σ protein expression is still unknown. We investigated the 14-3-3σ expression in a series of 302 vulvar squamous cell carcinomas using immunohistochemistry and its associations with clinicopathological factors and clinical outcome. In cytoplasm, nucleus and cytoplasm/nucleus of vulvar carcinomas high 14-3-3σ protein expression was found in 72%, 59% and 75% of the carcinomas, respectively, and low levels in 28%, 41% and 25% of the cases, respectively. High level of 14-3-3σ in cytoplasm, nucleus and cytoplasm/nucleus was significantly correlated to large tumor diameter (p = 0.001, p = 0.002 and p = 0.001, respectively) and deep invasion (p = 0.01, p = 0.001 and p = 0.007, respectively). Variations of 14-3-3σ protein expression were not associated to disease-specific survival. Our results indicate that 14-3-3σ may be involved in the development of a subset of vulvar squamous cell carcinomas by down-regulation of 14-3-3σ protein. Neither cytoplasmic nor nuclear level of 14-3-3σ expression was associated with prognosis

Incidence and cost of anal, penile, vaginal and vulvar cancer in Denmark

DEFF Research Database (Denmark)

Olsen, J.; Jorgensen, T. R.; Kofoed, K.

2012-01-01

Background: Besides being a causative agent for genital warts and cervical cancer, human papillomavirus (HPV) contributes to 40-85% of cases of anal, penile, vaginal and vulvar cancer and precancerous lesions. HPV types 16 & 18 in particular contribute to 74-93% of these cases. Overall the number...... of new cases of these four cancers may be relatively high implying notable health care cost to society. The aim of this study was to estimate the incidence and the health care sector costs of anal, penile, vaginal and vulvar cancer. Methods: New anogenital cancer patients were identified from the Danish...... Groups) and DAGS (Danish Outpatient Groups System) charges as cost estimates for inpatient and outpatient contacts, respectively. Health care consumption by cancer patients diagnosed in 2004-2007 was compared with that by an age-and sex-matched cohort without cancer. Hospital costs attributable to four...

Brachytherapy in vulvar cancer: analysis of 18 patients

International Nuclear Information System (INIS)

Frezza, G.; Baldissera, A.; Bernardi, L.; Bunkheila, F.; Galuppi, A.; Salvi, F.

1996-01-01

INTRODUCTION: Vulvar cancer is a rather common neoplasm in elderly patients. Surgery, followed eventually by postoperative radiotherapy, is the treatment of choice. The results of exclusive radiotherapy (external beam irradiation and/or brachytherapy) are not well defined and in the recent literature only small series are reported. Radiotherapy however is the only therapeutic option in patients who are not fit for radical surgery. It is thus necessary to review its indications and its modalities. PATIENTS METHODS AND RESULTS: From 1990 to 1994 18 pts with a diagnosis of squamous cell carcinoma of the vulva have been submitted to brachytherapy. Age ranged from 60 to 92 years (mean age 76, 1 ys). 14 pts were treated at diagnosis (11 pts) or for recurrent disease after surgery (3 pts). In 8 of them brachytherapy (total dose 35-45 Gy, dose rate: 0,4-0,78 Gy/h) was preceded by external beam irradiation (Co60 or electron beam, 40-50 Gy to primary and inguinal nodes); 6 pts were treated with brachytherapy alone (58-60 Gy; dose rate 0,44-0,63 Gy/h). 4 pts underwent to brachytherapy alone for local recurrence after surgery and postoperative radiotherapy (total dose 45-60 Gy; dose rate 0,37-0,49 Gy/h). Brachytherapy was always performed with 192 Ir. Plastic tubes (2 to 5 lines) were used for single plane implantation of small exophytic lesions limited to the labia (8 cases); a perineal template (10 cases) was employed in lesions extended to the vaginal mucosa or involving the clitoris or the area of the perineum. (10(14)) pts treated at diagnosis are alive and free from local recurrence after 11-48 mos. 3 of them, treated with brachytherapy alone, have presented a nodal recurrence in the groin after 14, 15 and 27 mos. respectively. All of them are alive and free from disease after surgery and external radiotherapy. None of the pts treated for recurrent disease after surgery + external beam radiotherapy has achieved a local control. CONCLUSION: Brachytherapy alone or

The clinicopathological and prognostic impact of 14-3-3 sigma expression on vulvar squamous cell carcinomas

Science.gov (United States)

Wang, Zhihui; Tropè, Claes G; Suo, Zhenhe; Trøen, Gunhild; Yang, Guanrui; Nesland, Jahn M; Holm, Ruth

2008-01-01

Background 14-3-3 sigma (σ) promotes G2/M cell cycle arrest by sequestering cyclin B1-CDC2 complex in cytoplasm. Down-regulation of 14-3-3σ, which has been demonstrated in various carcinomas, may contribute to malignant transformation. However, the exact role of 14-3-3σ in the pathogenesis of vulvar carcinoma is not fully characterized, and the prognostic impact of 14-3-3σ protein expression is still unknown. Methods We investigated the 14-3-3σ expression in a series of 302 vulvar squamous cell carcinomas using immunohistochemistry and its associations with clinicopathological factors and clinical outcome. Results In cytoplasm, nucleus and cytoplasm/nucleus of vulvar carcinomas high 14-3-3σ protein expression was found in 72%, 59% and 75% of the carcinomas, respectively, and low levels in 28%, 41% and 25% of the cases, respectively. High level of 14-3-3σ in cytoplasm, nucleus and cytoplasm/nucleus was significantly correlated to large tumor diameter (p = 0.001, p = 0.002 and p = 0.001, respectively) and deep invasion (p = 0.01, p = 0.001 and p = 0.007, respectively). Variations of 14-3-3σ protein expression were not associated to disease-specific survival. Conclusion Our results indicate that 14-3-3σ may be involved in the development of a subset of vulvar squamous cell carcinomas by down-regulation of 14-3-3σ protein. Neither cytoplasmic nor nuclear level of 14-3-3σ expression was associated with prognosis. PMID:18950492

The clinicopathological and prognostic impact of 14-3-3 sigma expression on vulvar squamous cell carcinomas

Directory of Open Access Journals (Sweden)

Suo Zhenhe

2008-10-01

Full Text Available Abstract Background 14-3-3 sigma (σ promotes G2/M cell cycle arrest by sequestering cyclin B1-CDC2 complex in cytoplasm. Down-regulation of 14-3-3σ, which has been demonstrated in various carcinomas, may contribute to malignant transformation. However, the exact role of 14-3-3σ in the pathogenesis of vulvar carcinoma is not fully characterized, and the prognostic impact of 14-3-3σ protein expression is still unknown. Methods We investigated the 14-3-3σ expression in a series of 302 vulvar squamous cell carcinomas using immunohistochemistry and its associations with clinicopathological factors and clinical outcome. Results In cytoplasm, nucleus and cytoplasm/nucleus of vulvar carcinomas high 14-3-3σ protein expression was found in 72%, 59% and 75% of the carcinomas, respectively, and low levels in 28%, 41% and 25% of the cases, respectively. High level of 14-3-3σ in cytoplasm, nucleus and cytoplasm/nucleus was significantly correlated to large tumor diameter (p = 0.001, p = 0.002 and p = 0.001, respectively and deep invasion (p = 0.01, p = 0.001 and p = 0.007, respectively. Variations of 14-3-3σ protein expression were not associated to disease-specific survival. Conclusion Our results indicate that 14-3-3σ may be involved in the development of a subset of vulvar squamous cell carcinomas by down-regulation of 14-3-3σ protein. Neither cytoplasmic nor nuclear level of 14-3-3σ expression was associated with prognosis.

Key factors impacting on diagnosis and treatment for vulvar cancer for Indigenous women: findings from Australia.

Science.gov (United States)

McGrath, Pam; Rawson, Nicole

2013-10-01

To date, there has been limited research on the topic of vulvar cancer. This paper provides findings from a qualitative study conducted with Indigenous women in East Arnhem Land, Northern Territory, Australia on the psychosocial impact of diagnosis and treatment for vulvar cancer. The insights from the study outlined in this paper not only make a contribution to deepening our understanding of the experience of vulvar cancer for Indigenous women, but provide practical recommendations to ensure effective and early engagement for diagnosis and treatment. A qualitative research method was employed through in-depth, open-ended interviews. The participants of the study were a purposive sample of Indigenous women with the condition, health professionals, and Aboriginal health workers. There were a total of 40 participants; with twelve (n = 12) Indigenous women affected with the condition, fourteen (n = 14) Aboriginal Health Workers, ten (n = 10) nurses, three (n = 3) doctors, and one (n = 1) community member. This paper addresses three key issues highlighted by the participants which include the fact that the private nature of the disease makes the condition 'women's business', that there is a sense of shame associated with the condition, and that there is fear and worry generated by the seriousness of the condition. The private nature of the disease and the sense of shame associated with the condition impact upon the diagnosis and treatment for many Indigenous women. In addition, the limitation of resources for health service delivery for East Arnhem Land exacerbates the problems faced by these communities. This paper puts forward suggestions to facilitate early diagnosis and treatment for women affected with the condition.

Diagnosis and treatment for vulvar cancer for indigenous women from East Arnhem Land, Northern Territory: bioethical reflections.

Science.gov (United States)

McGrath, Pam; Rawson, Nicole; Adidi, Leonora

2015-06-01

This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution towards Indigenous health and bioethics and bring to light areas of further research.

Adjuvant radiation for vulvar carcinoma: improved local control

International Nuclear Information System (INIS)

Faul, Clare M.; Mirmow, Dwight; Huang Qingshon; Gerszten, Kristina; Day, Roger; Jones, Mirka W.

1997-01-01

Purpose: Local recurrence is a significant problem following primary surgery for advanced vulva carcinoma. The objectives of this study were to evaluate the impact of adjuvant vulvar radiation on local control in high risk patients and the impact of local recurrence on overall survival. Methods and Materials: From 1980-1994, 62 patients with invasive vulva carcinoma and either positive or close (less 8 mm) margins of excision were retrospectively studied. Thirty-one patients were treated with adjuvant radiation therapy to the vulva and 31 patients were observed after surgery. Kaplan-Meier estimates and the Cox proportional hazard regression model were used to evaluate the effect of adjuvant radiation therapy on local recurrence and overall survival. Independent prognostic factors for local recurrence and survival were also assessed. Results: Local recurrence occurred in 58% of observed patients and 16% in patients treated with adjuvant radiation therapy. Adjuvant radiation therapy significantly reduced local recurrence rates in both the close margin and positive margin groups (p = 0.036, p = 0.0048). On both univariate and multivariate analysis adjuvant radiation and margins of excision were significant prognostic predictors for local control. Significant determinants of actuarial survival included International Federation of Gynecologists and Obstetricians (FIGO) stage, percentage of pathologically positive inguinal nodes and margins of excision. The positive margin observed group had a significantly poorer actuarial 5 year survival than the other groups (p = 0.0016) and adjuvant radiation significantly improved survival for this group. The 2 year actuarial survival after developing local recurrence was 25%. Local recurrence was a significant predictor for death from vulva carcinoma (risk ratio 3.54). Conclusion: Local recurrence is a common occurrence in high risk patients. In this study adjuvant radiation therapy significantly reduced local recurrence rates and

Perceived Health-Related Quality of Life in Women With Vulvar Neoplasia: A Cross Sectional Study.

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Kobleder, Andrea; Nikolic, Nataša; Hechinger, Mareike; Denhaerynck, Kris; Hampl, Monika; Mueller, Michael D; Senn, Beate

2016-09-01

The aim of the study was to determine health-related quality of life (HRQoL) of women with surgically treated vulvar intraepithelial neoplasia (VIN) and vulvar cancer (VC) during the first week after hospital discharge. Further objectives were to investigate differences between women with VIN and VC as well as to examine whether correlations exist between women's symptom experience and HRQoL. This cross-sectional study was conducted in 8 hospitals in Germany and Switzerland. Women with VIN and VC rated HRQoL with the validated German Short-Form 36. Differences between HRQoL in women with VIN and VC were tested with Wilcoxon rank-sum score. The WOMen with vulvAr Neoplasia (WOMAN) - Patient reported Outcome (PRO) self-report instrument was used to measure women's symptom experience. Correlations between symptoms and HRQoL were calculated using Spearman correlation coefficient. Women with VIN and VC (n = 65) reported lower HRQoL in physical aspects (Physical Component Summary [PCS], 34.9) than that in mental aspects (Mental Component Summary, 40.5). Women with VC had lower HRQoL than women with VIN, as manifested by significant differences concerning the dimensions of "physical functioning" and "role-physical." "Difficulties in daily life" as a distressing symptom correlated with MCS and PCS. Wound-related symptoms correlated with PCS and psychosocial symptoms/issues with MCS. Analysis showed that women with vulvar neoplasia reported lower HRQoL in the physical and mental dimensions 1 week after discharge than comparable studies referring to months or years after surgery. Health-related quality of life is influenced by physical impairment because physical symptoms are prevalent 1 week after discharge. Patient education should focus on symptom management in an early postsurgical phase to enhance women's HRQoL.

Treatment outcome in patients with vulvar cancer: comparison of concurrent radiotherapy to postoperative radiotherapy

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Lee, Ja Young; Kim, Sung Hwan; Kim, Ki Won; Park, Dong Choon; Yoon, Joo Hee; Yoon, Sei Chul [St. Vincent' s Hospital, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of); Yu, Mina [St. Mary' s Hospital, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of)

2012-03-15

To evaluate outcome and morbidity in patients with vulvar cancer treated with radiotherapy, concurrent chemoradiotherapy or postoperative radiotherapy. The records of 24 patients treated with radiotherapy for vulvar cancer between July 1993 and September 2009 were retrospectively reviewed. All patients received once daily 1.8-4 Gy fractions external beam radiotherapy to median 51.2 Gy (range, 19.8 to 81.6 Gy) on pelvis and inguinal nodes. Seven patients were treated with primary concurrent chemoradiotherapy, one patient was treated with primary radiotherapy alone, four patients received palliative radiotherapy, and twelve patients were treated with postoperative radiotherapy. Twenty patients were eligible for response evaluation. Response rate was 55% (11/20). The 5-year disease free survival was 42.2% and 5-year overall survival was 46.2%, respectively. Fifty percent (12/24) experienced with acute skin complications of grade III or more during radiotherapy. Late complications were found in 8 patients. 50% (6/12) of patients treated with lymph node dissection experienced severe late complications. One patient died of sepsis from lymphedema. However, only 16.6% (2/12) of patients treated with primary radiotherapy developed late complications. Outcome of patients with vulvar cancer treated with radiotherapy showed relatively good local control and low recurrence. Severe late toxicities remained higher in patients treated with both node dissection and radiotherapy.

Differentiated Vulvar Intraepithelial Neoplasia-like and Lichen Sclerosus-like Lesions in HPV-associated Squamous Cell Carcinomas of the Vulva.

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Rakislova, Natalia; Alemany, Laia; Clavero, Omar; Del Pino, Marta; Saco, Adela; Quirós, Beatriz; Lloveras, Belen; Alejo, Maria; Halec, Gordana; Quint, Wim; de Sanjosé, Silvia; Ordi, Jaume

2018-06-01

Most human papillomavirus (HPV)-associated vulvar squamous cell carcinomas (VSCCs) originate from high-grade squamous intraepithelial lesions, also named usual type vulvar intraepithelial neoplasia. However, growing evidence suggests that morphologic studies have limitations in predicting HPV status in vulvar lesions. We aimed to evaluate adjacent intraepithelial lesions in a series of DNA HPV-positive VSCCs, focusing on unusual histologic patterns mimicking differentiated vulvar intraepithelial neoplasia (dVIN) or lichen sclerosus (LS). We identified 326 DNA HPV-positive VSCC with at least 1 cm of skin adjacent to the invasive tumor and analyzed HPV typing, HPV E6*I mRNA, and p16 immunohistochemistry in all cases. A careful histologic evaluation was conducted. A conclusive association with HPV was based on a positive p16 or HPV E6*I mRNA result or both in addition to the HPV DNA, whereas cases negative for both markers were classified as nonconclusively associated with HPV. One hundred twenty-one tumors (37.1%) had normal adjacent skin, 191 (58.6%) had only high-grade squamous intraepithelial lesions, also named usual type vulvar intraepithelial neoplasia, and unusual intraepithelial lesions were identified in 14 (4.3%) tumors. Seven cases showed dVIN-like features, 5 showed adjacent LS-like lesion, and in 2 cases dVIN-like and LS-like lesions were identified simultaneously. Six of them were conclusively associated with HPV (3 dVIN-like, 2 LS-like, 1 with combined dVIN/LS-like features). All 6 tumors were associated with HPV16 and were positive for both p16 and HPV mRNA, and p16 was also positive in the dVIN-like and LS-like lesions. In summary, a small subset of VSCCs conclusively associated with HPV may arise on intraepithelial lesions, mimicking precursors of HPV-independent VSCC.

The etiologic role of HPV in vulvar squamous cell carcinoma fine tuned.

NARCIS (Netherlands)

Nieuwenhof, H.P. van de; Kempen, L.C.L.T. van; Hullu, J.A. de; Bekkers, R.L.M.; Bulten, J.; Melchers, W.J.G.; Massuger, L.F.A.G.

2009-01-01

PURPOSE: High-risk human papilloma virus (HPV) plays a role in the development of a subset of vulvar squamous cell carcinomas. Uncertainty exists about the true impact of HPV in this tumor type because conflicting reports have been published with diverging prevalence rates. This study was done to

Clinical update on the use of ospemifene in the treatment of severe symptomatic vulvar and vaginal atrophy

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Palacios S

2016-10-01

Full Text Available Santiago Palacios,1 María Jesús Cancelo2 1Palacios Institute of Women’s Health, Madrid, Spain; 2Gynecology and Obstetrics Department, Guadalajara University Hospital, University of Alcalá, Spain Abstract: The physiological decrease in vaginal estrogens is accountable for the emergence of vulvar and vaginal atrophy (VVA and its related symptoms such as vaginal dryness, dyspareunia, vaginal and/or vulvar irritation or itching, and dysuria. The repercussion of these symptoms on quality of life often makes it necessary to initiate treatment. Up until now, the treatments available included vaginal moisturizers and lubricants, local estrogens, and hormonal therapy. However, therapeutic options have now been increased with the approval of 60 mg ospemifene, the first nonhormonal oral treatment with an agonist effect on the vaginal epithelium and an endometrial and breast safety profile which makes it unique. This is the first selective estrogen receptor modulator indicated in women with moderate-to-severe vaginal atrophy not eligible for local estrogen treatment. Considering that “local estrogen noneligible women” are those in whom such treatment cannot be administered either because it is contraindicated or due to skill issues, who are averse to the mode and convenience of vaginal products’ administration or to their use on account of potential systemic absorption, or those who demonstrate dissatisfaction in terms of efficacy and safety, it is clear that there is a significant unmet medical need in VVA management. In fact, a great number of women show lack of adherence, dropping out of at least one VVA treatment, including nonhormonal moisturizers and lubricants, which they consider to be ineffective and uncomfortable. If they could choose, many of them may opt for oral treatment. In Phase III studies, ospemifene demonstrated efficacy in vaginal dryness and dyspareunia, regenerating vaginal cells, improving lubrication, and reducing pain

Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis.

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Engman, Maria; Wijma, Klaas; Wijma, Barbro

2007-01-01

Fifty-three women with partial vaginismus with or without vulvar vestibulitis and 27 asymptomatic women estimated sensations of burning pain and itch at 20 standardized moments during a standardized penetration situation, including vaginal muscle contractions. Forty-three women with partial vaginismus (81.1%) reported burning pain, 23 (43.4%) itch, and 22 (41.5%) both complaints, compared to 0% of the asymptomatic women. In 17 of 22 cases, burning pain preceded the appearance of itch and in four cases the two complaints coincided. The median time from the moment when burning pain started until itch appeared was 150 seconds.

Changes In Men’s Salivary Testosterone And Cortisol Levels, And In Sexual Desire After Smelling Female Axillary And Vulvar Scents

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Ricardo eMondragón-Ceballos

2013-10-01

Full Text Available Several studies have shown that a woman’s vaginal or axillary odors convey information on her attractivity. Yet, whether such scents induce psychoneuroendocrinological changes in perceivers is still controversial. We studied if smelling axillary and vulvar odors collected in the periovulatory and late luteal phases of young women modify salivary testosterone and cortisol levels, as well as sexual desire in men. Forty-five women and 115 men, all of them college students and unacquainted with each other, participated in the study. Female odors were collected on pads affixed to the axilla and on panty protectors both worn the entire night before experiments. Men provided five saliva samples, a basal one before the smelling procedure, and four more 15, 30, 60 and 75 min after exposure to odors. Immediately after smelling the odor source, men answered a questionnaire rating hedonic qualities of scents, and after providing the last saliva sample they answered questionnaire on sexual desire. We found that periovulatory axillary and vulvar odors increased testosterone and cortisol levels, with vulvar scents producing a more prolonged effect. Luteal axilla odors decreased testosterone and cortisol levels, while luteal vulva odors increased cortisol. Periovulatory axilla and vulva scents accounted for a general increase of interest in sex. These odors were also rated as more pleasant and familiar, while luteal vulvar odors were perceived as intense and unpleasant.

Botulinum neurotoxin type A injections for vaginismus secondary to vulvar vestibulitis syndrome.

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Bertolasi, Laura; Frasson, Emma; Cappelletti, Jee Yun; Vicentini, Silvana; Bordignon, Monia; Graziottin, Alessandra

2009-11-01

To investigate whether botulinum neurotoxin type A improves vaginismus and study its efficacy with repeated treatments. Outpatients were referred because standard cognitive-behavioral and medical treatment for vaginismus and vulvar vestibular syndrome failed. From this group, we prospectively recruited consecutive women (n=39) whose diagnostic electromyogram (EMG) recordings from the levator ani muscle showed hyperactivity at rest and reduced inhibition during straining. These women were followed for a mean (+/-standard deviation) of 105 (+/-50) weeks. Recruited patients underwent repeated cycles of botulinum neurotoxin type A injected into the levator ani under EMG guidance and EMG monitoring thereafter. At enrollment and 4 weeks after each cycle, women were asked about sexual intercourse; underwent EMG evaluation and examinations to grade vaginal resistance according to Lamont; and completed a visual analog scale (VAS) for pain, the Female Sexual Function Index Scale, a quality-of-life questionnaire (Short-Form 12 Health Survey), and bowel and bladder symptom assessment. At 4 weeks after the first botulinum neurotoxin type A cycle, the primary outcome measures (the possibility of having sexual intercourse, and levator ani EMG hyperactivity) both improved, as did the secondary outcomes, Lamont scores, VAS, Female Sexual Function Index Scales, Short-Form 12 Health Survey, and bowel-bladder symptoms. These benefits persisted through later cycles. When follow-up ended, 63.2% of the patients completely recovered from vaginismus and vulvar vestibular syndrome, 15.4% still needed reinjections (censored), and 15.4% had dropped out. Botulinum neurotoxin type A is an effective treatment option for vaginismus secondary to vulvar vestibular syndrome refractory to standard cognitive-behavioral and medical management. After patients received botulinum neurotoxin type A, their sexual activity improved and reinjections provided sustained benefits. III.

Lymphocytic Arteritis in Epstein-Barr Virus Vulvar Ulceration (Lipschütz Disease): A Report of 7 Cases.

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Barrett, Mary M; Sangüeza, Martin; Werner, Betina; Kutzner, Heinz; Carlson, John A

2015-09-01

Epstein-Barr virus (EBV) infection can rarely present as painful genital ulcers, mostly in young female adolescents. Typically diagnosed by clinical findings, EBV vulvar ulceration (EBVVU) is rarely biopsied. Herein, the authors report the histopathology in 8 biopsies from 7 EBVVU patients, all serologically confirmed for acute (4/7) or reactivated-chronic (3/7) EBV infection. The 7 women all presented with 1 or more painful, punched-out vulvar ulcers. Only patients with acute EBV infection showed other clinical findings: fever and/or atypical lymphocytosis affected 75% (3/4); lymphadenopathy in 50%; and malaise/fatigue, dysuria and/or hepatomegaly in 25%. All reactivated-chronic EBVVU had a solitary ulcer, and 2 had history of a similar episode of vulvar ulceration (aphthosis). Histopathologically, lymphocytic arteritis was identified in 88% (7/8); a submucosal scar was found in the eighth specimen. Other histopathologies included venulitis (62%), endarteritis obliterans (38%), thrombosis (25%), neutrophilic sebaceous adenitis (25%), and mucosal lymphoid hyperplasia (12%). Dense angiocentric CD3 CD4 T-cell lymphocyte-predominant infiltrates were found, regionally or diffusely. In 2 specimens, neutrophils compromised half of the infiltrate. Minor components of CD8, CD20, and CD30 lymphocytes, CD123 plasmacytoid monocytes, CD68 macrophages, and plasma cells were present. Small-vessel endothelium and smooth muscle adjacent to the ulcers faintly expressed cytoplasmic EBV latent membrane protein-1 (LMP1). In situ hybridization for early EBV mRNA (EBER) identified rare solitary or scattered clustered positive lymphocytes in 38%. Polymerase chain reaction for EBV DNA was positive in one EBER positive biopsy. EBV infection has been documented in muscular vessel vasculitis. Based on the aforementioned, EBVVU appears to be the consequence of localized lymphocytic arteritis.

Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial

DEFF Research Database (Denmark)

Dillner, Joakim; Kjaer, Susanne K; Wheeler, Cosette M

2010-01-01

To evaluate the prophylactic efficacy of the human papillomavirus (HPV) quadrivalent vaccine in preventing low grade cervical, vulvar, and vaginal intraepithelial neoplasias and anogenital warts (condyloma acuminata).......To evaluate the prophylactic efficacy of the human papillomavirus (HPV) quadrivalent vaccine in preventing low grade cervical, vulvar, and vaginal intraepithelial neoplasias and anogenital warts (condyloma acuminata)....

Overexpression of CDC25B, CDC25C and phospho-CDC25C (Ser216 in vulvar squamous cell carcinomas are associated with malignant features and aggressive cancer phenotypes

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Flørenes Vivi

2010-05-01

Full Text Available Abstract Background CDC25 phosphatases are important regulators of the cell cycle. Their abnormal expression detected in a number of tumors implies that their dysregulation is involved in malignant transformation. However, the role of CDC25s in vulvar cancer is still unknown. To shed light on their roles in the pathogenesis and to clarify their prognostic values, expression of CDC25A, CDC25B and CDC25C in a large series of vulvar squamous cell carcinomas were examined. Methods Expression of CDC25A, CDC25B, CDC25C and phosphorylated (phospho-CDC25C (Ser216 were examined in 300 vulvar carcinomas using immunohistochemistry. Western blot analysis was utilized to demonstrate CDC25s expression in vulvar cancer cell lines. Kinase and phosphatase assays were performed to exclude cross reactivity among CDC25s isoform antibodies. Results High nuclear CDC25A and CDC25B expression were observed in 51% and 16% of the vulvar carcinomas, respectively, whereas high cytoplasmic CDC25C expression was seen in 63% of the cases. In cytoplasm, nucleus and cytoplasm/nucleus high phospho-CDC25C (Ser216 expression was identified in 50%, 70% and 77% of the carcinomas, respectively. High expression of CDC25s correlated significantly with malignant features, including poor differentiation and infiltration of vessel for CDC25B, high FIGO stage, presence of lymph node metastases, large tumor diameter, poor differentiation for CDC25C and high FIGO stage, large tumor diameter, deep invasion and poor differentiation for phospho-CDC25C (Ser216. In univariate analysis, high expression of phospho-CDC25C (Ser216 was correlated with poor disease-specific survival (p = 0.04. However, such an association was annulled in multivariate analysis. Conclusions Our results suggest that CDC25C and phospho-CDC25C (Ser216 play a crucial role and CDC25B a minor role in the pathogenesis and/or progression of vulvar carcinomas. CDC25B, CDC25C and phospho-CDC25C (Ser216 were associated with

Overexpression of CDC25B, CDC25C and phospho-CDC25C (Ser216) in vulvar squamous cell carcinomas are associated with malignant features and aggressive cancer phenotypes

International Nuclear Information System (INIS)

Wang, Zhihui; Trope, Claes G; Flørenes, Vivi Ann; Suo, Zhenhe; Nesland, Jahn M; Holm, Ruth

2010-01-01

CDC25 phosphatases are important regulators of the cell cycle. Their abnormal expression detected in a number of tumors implies that their dysregulation is involved in malignant transformation. However, the role of CDC25s in vulvar cancer is still unknown. To shed light on their roles in the pathogenesis and to clarify their prognostic values, expression of CDC25A, CDC25B and CDC25C in a large series of vulvar squamous cell carcinomas were examined. Expression of CDC25A, CDC25B, CDC25C and phosphorylated (phospho)-CDC25C (Ser216) were examined in 300 vulvar carcinomas using immunohistochemistry. Western blot analysis was utilized to demonstrate CDC25s expression in vulvar cancer cell lines. Kinase and phosphatase assays were performed to exclude cross reactivity among CDC25s isoform antibodies. High nuclear CDC25A and CDC25B expression were observed in 51% and 16% of the vulvar carcinomas, respectively, whereas high cytoplasmic CDC25C expression was seen in 63% of the cases. In cytoplasm, nucleus and cytoplasm/nucleus high phospho-CDC25C (Ser216) expression was identified in 50%, 70% and 77% of the carcinomas, respectively. High expression of CDC25s correlated significantly with malignant features, including poor differentiation and infiltration of vessel for CDC25B, high FIGO stage, presence of lymph node metastases, large tumor diameter, poor differentiation for CDC25C and high FIGO stage, large tumor diameter, deep invasion and poor differentiation for phospho-CDC25C (Ser216). In univariate analysis, high expression of phospho-CDC25C (Ser216) was correlated with poor disease-specific survival (p = 0.04). However, such an association was annulled in multivariate analysis. Our results suggest that CDC25C and phospho-CDC25C (Ser216) play a crucial role and CDC25B a minor role in the pathogenesis and/or progression of vulvar carcinomas. CDC25B, CDC25C and phospho-CDC25C (Ser216) were associated with malignant features and aggressive cancer phenotypes. However, the

The Paget Trial: A Multicenter, Observational Cohort Intervention Study for the Clinical Efficacy, Safety, and Immunological Response of Topical 5% Imiquimod Cream for Vulvar Paget Disease.

Science.gov (United States)

van der Linden, Michelle; Meeuwis, Kim; van Hees, Colette; van Dorst, Eleonora; Bulten, Johan; Bosse, Tjalling; IntHout, Joanna; Boll, Dorry; Slangen, Brigitte; van Seters, Manon; van Beurden, Marc; van Poelgeest, Mariëtte; de Hullu, Joanne

2017-09-06

Vulvar Paget disease is a rare skin disorder, which is most common in postmenopausal Caucasian women. They usually present with an erythematous plaque that may show fine or typical "cake icing" scaling or ulceration that may cause itching, pain, irritation, or a burning sensation. Although most cases are noninvasive, vulvar Paget disease may be invasive or associated with an underlying vulvar or distant adenocarcinoma. The histological evidence of so-called "Paget cells" with abundant pale cytoplasm in the epithelium confirms the diagnosis. The origin of these Paget cells is still unclear. Treatment of choice is wide local excision with negative margins. Obtaining clear surgical margins is challenging and may lead to extensive and mutilating surgery. Even then, recurrence rates are high, ranging from 15% to 70%, which emphasizes the need for new treatment options. A number of case reports, retrospective case series, and one observational study have shown promising results using the topical immune response modifier imiquimod. This study aims to investigate the efficacy, safety, and immunological response in patients with noninvasive vulvar Paget disease using a standardized treatment schedule with 5% imiquimod cream. Topical 5% imiquimod cream might be an effective and safe treatment alternative for vulvar Paget disease. The Paget Trial is a multicenter observational cohort study including eight tertiary referral hospitals in the Netherlands. It is ethically approved by the Medical-Ethical Committee of Arnhem-Nijmegen and registered in the Central Committee on Research Involving Human Subjects (CCMO) Register by as NL51648.091.14. Twenty patients with (recurrent) noninvasive vulvar Paget disease will be treated with topical 5% imiquimod cream three times a week for 16 weeks. The primary efficacy outcome is the reduction in lesion size at 12 weeks after end of treatment. Secondary outcomes are safety, immunological response, and quality of life. Safety will be

Imiquimod in cervical, vaginal and vulvar intraepithelial neoplasia: a review.

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de Witte, C J; van de Sande, A J M; van Beekhuizen, H J; Koeneman, M M; Kruse, A J; Gerestein, C G

2015-11-01

Human papillomavirus (HPV) infection is in the vast majority of patients accountable for the development of vulvar, cervical and vaginal intraepithelial neoplasia (VIN, CIN, VAIN); precursors of vulvar, cervical and vaginal cancers. The currently preferred treatment modality for high grade VIN, CIN and VAIN is surgical excision. Nevertheless surgical treatment is associated with adverse pregnancy outcomes and recurrence is not uncommon. The aim of this review is to present evidence on the efficacy, safety and tolerability of imiquimod (an immune response modifier) in HPV-related VIN, CIN and VAIN. A search for papers on the use of imiquimod in VIN, CIN and VAIN was performed in the MEDLINE, EMBASE and Cochrane library databases. Data was extracted and reviewed. Twenty-one articles met the inclusion criteria and were analyzed; 16 on VIN, 3 on CIN and 2 on VAIN. Complete response rates in VIN ranged from 5 to 88%. Although minor adverse effects were frequently reported, treatment with imiquimod was well tolerated in most patients. Studies on imiquimod treatment of CIN and VAIN are limited and lack uniformly defined endpoints. The available evidence however, shows encouraging effect. Complete response rates for CIN 2-3 and VAIN 1-3 ranged from 67 to 75% and 57 to 86% respectively. More randomized controlled trials on the use of imiquimod in CIN, VAIN and VIN with extended follow-up are necessary to determine the attributive therapeutic value in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

State-of-the-evidence reviews: advantages and challenges of including grey literature.

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Benzies, Karen M; Premji, Shahirose; Hayden, K Alix; Serrett, Karen

2006-01-01

Increasingly, health policy decision-makers and professionals are turning to research-based evidence to support decisions about policy and practice. Systematic reviews are useful for gathering, summarizing, and synthesizing published and unpublished research about clearly defined interventions. State-of-the-evidence reviews are broader than traditional systematic reviews and may include not only published and unpublished research, but also published and unpublished non-research literature. Decisions about whether to include this "grey literature" in a review are challenging and lead to many questions about whether the advantages outweigh the challenges. The primary purpose of this article is to describe what constitutes grey literature, and methods to locate it and assess its quality. The secondary purpose is to discuss the core issues to consider when making decisions to include grey literature in a state-of-the-evidence review. A recent state-of-the-evidence review is used as an exemplar to present advantages and challenges related to including grey literature in a review. Despite the challenges, in the exemplar, inclusion of grey literature was useful to validate the results of a research-based literature search. Decisions about whether to include grey literature in a state-of-the-evidence review are complex. A checklist to assist in decision-making was created as a tool to assist the researcher in determining whether it is advantageous to include grey literature in a review.

Quality of life and female sexual function after skinning vulvectomy with split-thickness skin graft in women with vulvar intraepithelial neoplasia or vulvar Paget disease.

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Lavoué, V; Lemarrec, A; Bertheuil, N; Henno, S; Mesbah, H; Watier, E; Levêque, J; Morcel, K

2013-12-01

Vulvar intraepithelial neoplasia (VIN) and vulvar Paget disease are managed with either vulvectomy, destructive treatments (laser, antimitotic drugs) or immunostimulants. All these options are associated with functional complications. The purpose of this study was to evaluate the surgical technique consisting of skinning vulvectomy with split-thickness skin graft, and its effect on overall quality of life and sexual function. A retrospective study was conducted on thirteen patients who underwent skinning vulvectomy with split-thickness skin graft between 1999 and 2009. Overall quality of life and sexual function were assessed with the Medical Outcome Study Short Form 36 (MOS SF-36) and Female Sexual Function Index (FSFI), respectively. The median age of patients was 54 (range: 33-77) years. Three patients had Paget disease and 10 patients had VIN lesions. The excision margins were clear in 46% of cases. The incidence of occult cancer was 31%. The mean follow-up period was 77 (±35) months. Four patients experienced a relapse of their intraepithelial disease. The mean disease-free survival was 58 (±44) months. There was no significant difference in MOS SF-36 scores between the study population and the general population. The patients assessed with the FSFI regained normal sexual function after the surgical procedure. Skinning vulvectomy with split-thickness skin graft is a feasible technique yielding good results in terms of quality of life and sexual function. It enables occult cancer to be diagnosed in patients with VIN or Paget disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

Presença da Proteína p53 como Prognóstico de Recidiva/Progressão de Neoplasia Intra-epitelial Vulvar III p53 Protein Overexpression as a Prognostic Marker for Vulvar Intraepithelial Neoplasia III Recurrence/Progression

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Isabel Cristina Chulvis do Val Guimarães

2002-01-01

Full Text Available Objetivo: avaliar o valor da presença da proteína p53 nos casos de recidiva/progressão da neoplasia intra-epitelial vulvar (VIN III. Métodos: foram selecionadas 20 pacientes com VIN III indiferenciada, seguidas semestralmente por período de até quatro anos, divididas em dois grupos: quatorze sem e seis com recidiva/progressão da lesão. Os casos de recidiva/progressão foram distribuídos da seguinte forma: em três pacientes a recidiva ocorreu uma única vez, em duas, houve dupla recorrência e apenas uma evoluiu para carcinoma escamoso. Em ambos os grupos foram avaliados o sítio vulvar acometido e a presença da proteína p53 com análise do padrão de marcação imunohistoquímica. Estudo semelhante foi realizado nos casos de recidiva/progressão além da análise do intervalo de tempo para o surgimento de recidiva/progressão. Resultados: observou-se recidiva da VIN III em 25% dos casos e, em 5%, progressão para carcinoma. O tempo médio de recidiva foi de 24,5 meses. A localização multifocal da lesão primária foi a mais freqüente (50% em ambos os grupos. Na maioria dos casos (87,5%, a recidiva/progressão ocorreu na mesma localização da lesão vulvar primária. A presença da proteína p53 mostrou-se positiva em 50% das lesões primárias de VIN III e em 75% dos casos de recidiva/progressão. Conclusões: a presença da proteína p53 parece desempenhar papel importante na gênese e na predição do curso clínico das VIN III. As recidivas/progressão das VIN III tendem a ocorrer na mesma área da doença inicial, sugerindo a presença de campo molecular alterado.Purpose: to evaluate p53 overexpression value in vulvar intraepithelial neoplasia (VIN III recurrence/progression. Methods: twenty patients with undifferentiated VIN III were selected and followed up every six months for four years and divided into two groups: fourteen without and six with recurrence/progression lesion. The recurrence/progression cases were

Analysis of full coding sequence of the TP53 gene in invasive vulvar cancers: Implications for therapy.

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Kashofer, Karl; Regauer, Sigrid

2017-08-01

This study evaluates the frequency and type of TP53 gene mutations and HPV status in 72 consecutively diagnosed primary invasive vulvar squamous cell carcinomas (SCC) during the past 5years. DNA of formalin-fixed and paraffin embedded tumour tissue was analysed for 32 HPV subtypes and the full coding sequence of the TP53 gene, and correlated with results of p53 immunohistochemistry. 13/72 (18%) cancers were HPV-induced squamous cell carcinomas, of which 1/13 (8%) carcinoma harboured a somatic TP53 mutation. Among the 59/72 (82%) HPV-negative cancers, 59/72 (82%) SCC were HPV-negative with wild-type gene in 14/59 (24%) SCC and somatic TP53 mutations in 45/59 (76%) SCC. 28/45 (62%) SCC carried one (n=20) or two (n=8) missense mutations. 11/45 (24%) carcinomas showed a single disruptive mutation (3× frame shift, 7× stop codon, 1× deletion), 3/45 SCC a splice site mutation. 3/45 (7%) carcinomas had 2 or 3 different mutations. 18 different "hot spot" mutations were observed in 22/45 cancers (49%; 5× R273, 3× R282; 2× each Y220, R278, R248). Immunohistochemical p53 over expression was identified in most SCC with missense mutations, but not in SCC with disruptive TP53 mutations or TP53 wild-type. 14/45 (31%) patients with TP53 mutated SCC died of disease within 12months (range 2-24months) versus 0/13 patients with HPV-induced carcinomas and 0/14 patients with HPV-negative, TP53 wild-type carcinomas. 80% of primary invasive vulvar SCC were HPV-negative carcinomas with a high frequency of disruptive mutations and "hot spot" TP53 gene mutations, which have been linked to chemo- and radioresistance. The death rate of patients with p53 mutated vulvar cancers was 31%. Immunohistochemical p53 over expression could not reliably identify SCC with TP53 gene mutation. Pharmacological therapies targeting mutant p53 will be promising strategies for personalized therapy in patients with TP53 mutated vulvar cancers. Copyright © 2017. Published by Elsevier Inc.

Recurrent vulvar carcinoma: complex surgical treatment via perineal excision and reconstruction with musculocutaneous flap

Directory of Open Access Journals (Sweden)

Dragoș Popa

2018-04-01

Full Text Available Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion. We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3 for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal sphincter, creating a delicate problem regarding a surgical approach. The size and the extent of the recurrent tumor required a complex surgical intervention using a mixed surgical team of general surgeons and plastic surgeons. Surgical intervention with a large excision of the recurrent cancer along with amputation of the inferior rectum via perineal route, and creation of a left iliac anus was performed. The perineal defect was covered via a musculocutaneous flap using the gracilis muscle. The immediate post-operative evolution was favorable.

Primary extramammary invasive Paget’s vulvar disease: what is the standard, what are the challenges and what is the future for radiotherapy?

International Nuclear Information System (INIS)

Tolia, Maria; Tsoukalas, Nikolaos; Sofoudis, Chrisostomos; Giaginis, Constantinos; Spyropoulou, Despoina; Kardamakis, Dimitrios; Kouloulias, Vasileios; Kyrgias, George

2016-01-01

Primary invasive Extramammary Paget’s vulvar disease is a rare tumor that is challenging to control. Wide surgical excision represents the standard treatment approach for Primary invasive Extramammary Paget’s vulvar disease. The goal of the current study was to analyze the appropriate indications of radiotherapy in Primary invasive Extramammary Paget's vulvar disease because they are still controversial. We searched the Cochrane Gynecological Cancer Group Trials Register, Cochrane Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE database up to September 2015. Radiotherapy was delivered as a treatment in various settings: i) Radical in 28 cases (range: 60–63 Gy), ii) Adjuvant in 25 cases (range: 39–60 Gy), iii) Salvage in recurrence of 3 patients (63 Gy) and iv) Neoadjuvant in one patient (43.3 Gy). A radiotherapy field that covered the gross tumor site with a 2–5 cm margin for the microscopic disease has been used. Radiotherapy of the inguinal, pelvic or para-aortic lymph node should be considered only for the cases with lymph node metastases within these areas. Radiotherapy alone is an alternative therapeutic approach for patients with extensive inoperable disease or medical contraindications. Definitive radiotherapy can be used in elderly patients and/or with medical contraindications. Adjuvant radiotherapy may be considered in presence of risk factors associated with local recurrence as dermal invasion, lymph node metastasis, close or positive surgical margins, perineal, large tumor diameter, multifocal lesions, extensive disease, coexisting histology of adenocarcinoma or vulvar carcinoma, high Ki-67 expression, adnexal involvement and probably in overexpression of HER-2/neu. Salvage radiotherapy can be given in inoperable loco-regional recurrence and to those who refused additional surgery

Evaluating and Using Literature Including People with Disabilities in All Classrooms

Science.gov (United States)

Oslick, Mary Ellen; Pearson, Mary

2016-01-01

To help students see their worlds differently and to expand those views beyond their own backyards, educators can expose them to quality multicultural children's literature. In this article, we focus on a subtopic within the genre of multicultural children's literature: literature including people with disabilities. We chose seven recent texts…

Challenging Ulcerative Vulvar Conditions: Hidradenitis Suppurativa, Crohn Disease, and Aphthous Ulcers.

Science.gov (United States)

Stewart, Kristen M A

2017-09-01

This article discusses the clinical evaluation and approach to patients with 3 complex ulcerative vulvar conditions: hidradenitis suppurativa, metastatic Crohn disease of the vulva, and aphthous ulcers. These conditions are particularly challenging to medical providers because, although each is known to present with nonspecific examination findings that vary in morphology, the predominance of the diagnosis is based on clinical examination and exclusion of a wide variety of other conditions. Care of patients with these conditions is further complicated by the lack of therapeutic data and the significant impact these conditions have on quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

A review of squamous cell vulvar cancers in Waikato region, New Zealand.

Science.gov (United States)

Dass, Prashanth Hari; Kuper-Hommel, Marion Jj

2017-11-10

Squamous cell vulvar cancers (SCVC) are rare. Although management guidelines have recently been published, New Zealand studies presenting "real world" outcomes are limited. Retrospective single-centre review of SCVC diagnosed between 1 January 2000 and 31 August 2015. Clinical characteristics and outcomes were reviewed. Among 47 cases reviewed, 38 were ethnically European and 9 Māori. Cases identified as Stage 1 (16), Stage 2 (5), Stage 3 (17), Stage 4 (9). For Stages 1, 2, 3 and 4, (16, 4, 17 and 6) were managed by local excision; (9, 1, 14 and 2) by node dissection and (2, 1, 3 and 5) by chemoradiotherapy respectively. Wound cellulitis (10) and lymphedema (8) were the commonest acute and late complication, respectively. Seven patients were treated with 5-Fluorouracil and Mitomycin, and four received weekly Cisplatin. Grade 3 toxicities seen in five cases treated with 5-Fluorouracil and Mitomycin versus none in the Cisplatin group. No local recurrences observed in patients treated with chemoradiation. Patients with Age Adjusted Charlson Comorbid Index Score (ACCIS) <5 had better overall survival (OS) compared to scores ≥5 (60% versus 41%) with 33 months median follow-up. Five-year OS and disease-free specific survival was 73% and 94% (Stage 1), 40% and 60% (Stage 2), 44% and 59% (Stage 3) and 29% (Stage 4) respectively. We present "real world" outcomes of vulvar cancers in this older and comorbid population. Larger, prospective multi-centre studies are proposed.

A vulvar mass as the first presentation in colorectal carcinoma: An unusual site of metastasis masquerading a primary cancer

Directory of Open Access Journals (Sweden)

Tzu-Yin Tang

2018-02-01

Conclusion: Secondary tumor in female genital tract is unusual and vulvar metastasis is the rarest kind. The clinical manifestation may be perplexing especially if a patient is presented with a nonspecific gynecological symptom such as abnormal vaginal discharge without any past history.

Sparing Saphenous Vein During Inguinal Lymphadenectomy in Patients with Vulvar Cancer: A Single Center Experience of 10 Years

Directory of Open Access Journals (Sweden)

Mustafa Özat

2011-12-01

CONCLUSIONS: The preservation of saphenous vein during inguinal lymphadenectomy reduces the incidence of short-term and long-term complications without affecting the risk of local recurrence. Depending on the experience of the surgeon, the surgical strategy should be individualized and optimized for each patient with vulvar cancer.

Vulvar mucinous adenocarcinoma with neuroendocrine differentiation: A case report and review of the literature

NARCIS (Netherlands)

Rosmalen, M.H. Van; Reijnen, C.; Boll, D.; Pijnenborg, J.M.A.; Wurff, A.A. van der; Piek, J.M.

2016-01-01

BACKGROUND: There are limited cases in literature of patients with mucinous adenocarcinoma of the vulva with neuroendocrine differentiation have. With this new case, we aim to provide an overview of the existing literature and present a tool with relevant markers for the pathologist in the

Overexpression of CDC25B, CDC25C and phospho-CDC25C (Ser216) in vulvar squamous cell carcinomas are associated with malignant features and aggressive cancer phenotypes

OpenAIRE

Wang, Zhihui; Trope, Claes G; Fl?renes, Vivi Ann; Suo, Zhenhe; Nesland, Jahn M; Holm, Ruth

2010-01-01

Background CDC25 phosphatases are important regulators of the cell cycle. Their abnormal expression detected in a number of tumors implies that their dysregulation is involved in malignant transformation. However, the role of CDC25s in vulvar cancer is still unknown. To shed light on their roles in the pathogenesis and to clarify their prognostic values, expression of CDC25A, CDC25B and CDC25C in a large series of vulvar squamous cell carcinomas were examined. ...

Phase II study on paclitaxel in patients with recurrent, metastatic or locally advanced vulvar cancer not amenable to surgery or radiotherapy: a study of the EORTC-GCG (European Organisation for Research and Treatment of Cancer--Gynaecological Cancer Group)

NARCIS (Netherlands)

Witteveen, P. O.; van der Velden, J.; Vergote, I.; Guerra, C.; Scarabeli, C.; Coens, C.; Demonty, G.; Reed, N.

2009-01-01

No standard treatment options are available for patients with advanced, recurrent or metastatic vulvar carcinoma not amenable for locoregional treatment. In this phase II study, patients with advanced vulvar cancer received paclitaxel (Taxol) every 3 weeks for up to 10 cycles. Primary objective was

Intra-operative lymphatic mapping with Dextran Tc-99m and blue dye for sentinel node detection in patients with primary vulvar malignancies

International Nuclear Information System (INIS)

Morales, R.E.; Aguilar, C.R.; Cano, R.A.; Saavedra, P.; Santos, C.

2004-01-01

Full text: The purpose of this study was to determine the feasibility of sentinel lymph node detection using preoperative lymphoscintigraphy and intra-operative lymphatic mapping in patients with primary vulvar malignancies. Nine patients (29-84 years old) with primary vulvar malignancy were scheduled for sentinel node detection. Two patients had malignant melanoma of the vulva and seven had squamous cell carcinomas. Eight patients did not have a previous surgery of the primary tumour nor of the lymph nodes, one had an aspiration biopsy. Three hours before surgery 1-5 mCi of Tc-99m Dextran was injected intradermally in four points in the skin junction adjacent to the vulvar lesions. Static lymphoscintigraphy was performed using a planar GE gamma camera with a multipurpose low energy collimator, in anterior and lateral views. Images were displayed on a personal computer, through a Portable Imaging Processing software (PIP). In two cases a Siemens ECAM SPECT camera was used, due to necessity of having high-resolution images. Patten blue dye was injected in the junction between the skin and vulvar tumor, in the surgery room, after anaesthesia induction. Agamma probe (Navigator Gamma Guidance System) was used to detect the sentinel node. The activity in the sentinel node was measured in each case, before and after resection. Activity in the remaining tissue was also measured. Nodes were adequately placed in plastic bags and sent to pathology for H-E staining. Non-sentinel nodes were also resected and sent for pathology, except in two cases. Sentinel nodes (SN) were visualised on lymphoscintigraphy 1 to 5 minutes after injection of Tc-99m Dextran. In malignant melanoma drainage to the sentinel node was faster than for other tumours. There were five cases who had bilateral SN in inguinal regions, in other three cases, two SN were located on the same side, two in the inguinal region. In all cases the SN was identified corroborating to the skin mark and with enough

Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial

DEFF Research Database (Denmark)

Dillner, Joakim; Kjaer, Susanne K; Wheeler, Cosette M

2010-01-01

To evaluate the prophylactic efficacy of the human papillomavirus (HPV) quadrivalent vaccine in preventing low grade cervical, vulvar, and vaginal intraepithelial neoplasias and anogenital warts (condyloma acuminata)....

Prognosis of vulvar dysplasia and carcinoma in situ with special reference to histology and types of human papillomavirus (HPV)

DEFF Research Database (Denmark)

Junge, Jette; Poulsen, H; Horn, T

1997-01-01

Sixty-one women with vulvar dysplasia or carcinoma in situ were treated with local laser excision of the initial lesion and of the recurrences, and followed at intervals of from 3 increasing to 12 months. Recurrences were observed in 16 (26%) patients. No case of invasive carcinoma was seen. Pati...

A patient-reported outcome measure to identify occurrence and distress of post-surgery symptoms of WOMen with vulvAr Neoplasia (WOMAN-PRO) - a cross sectional study.

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Senn, Beate; Eicher, Manuela; Mueller, Michael D; Hornung, René; Fink, Daniel; Baessler, Kaven; Hampl, Monika; Denhaerynck, Kris; Spirig, Rebecca; Engberg, Sandra

2013-04-01

The aim of the study was to describe the (a) symptom experience of women with vulvar intraepithelial neoplasia and vulvar cancer (vulvar neoplasia) during the first week after hospital discharge, and (b) associations between age, type of disease, stage of disease, the extent of surgical treatment and symptom experience. This cross-sectional study was conducted in eight hospitals in Germany and Switzerland (Clinical Trial ID: NCT01300663). Symptom experience after surgical treatment in women with vulvar neoplasia was measured with our newly developed WOMAN-PRO instrument. Outpatients (n=65) rated 31 items. We used descriptive statistics and regression analysis. The average number of symptoms reported per patient was 20.2 (SD 5.77) with a range of 5 to 31 symptoms. The three most prevalent wound-related symptoms were 'swelling' (n=56), 'drainage' (n=54) and 'pain' (n=52). The three most prevalent difficulties in daily life were 'sitting' (n=63), 'wearing clothes' (n=56) and 'carrying out my daily activities' (n=51). 'Tiredness' (n=62), 'insecurity' (n=54) and 'feeling that my body has changed' (n=50) were the three most prevalent psychosocial symptoms/issues. The most distressing symptoms were 'sitting' (Mean 2.03, SD 0.88), 'open spot (e.g. opening of skin or suture)' (Mean 1.91, SD 0.93), and 'carrying out my daily activities' (Mean 1.86, SD 0.87), which were on average reported as 'quite a bit' distressing. Negative associations were found between psychosocial symptom experience and age. WOMAN-PRO data showed a high symptom prevalence and distress, call for a comprehensive symptom assessment, and may allow identification of relevant areas in symptom management. Copyright © 2013 Elsevier Inc. All rights reserved.

Fertilisation rate obtained with frozen-thawed boar semen supplemented with rosmarinic acid using a single insemination timed according to vulvar skin temperature changes.

Science.gov (United States)

Luño, Victoria; Gil, Lydia; Olaciregui, Maite; Grandía, Juan; Ansó, Trinidad; De Blas, Ignacio

2015-03-01

Artificial insemination (AI) of sows with frozen-thawed semen usually results in lower pregnancy rates and litter sizes than the use of liquid preserved semen. The present study evaluated the effectiveness of vulvar skin temperature changes as a predictor of ovulation in sows and determined the fertility rates obtained after AI with frozen-thawed semen supplemented with rosmarinic acid (RA). Semen was collected from mature boars and cryopreserved in experimental extenders supplemented with or without 105 μM of RA. Multiparous sows were inseminated with a single dose of semen when vulvar skin temperature decreased to a value below 35 °C. Intrauterine insemination was performed using 1.5 × 109 spermatozoa. The sows were slaughtered 48 h after AI and the embryos and oocytes were recovered from the oviducts. Total and progressive motility, viability and acrosome integrity were significantly (P semen samples compared with the control. Fertilisation occurred in all sows inseminated in the study, although there were no significant differences between the experimental groups. Sows inseminated with RA-supplemented semen showed a slight increase in the number of embryos recovered as compared to sows inseminated with control semen. In conclusion, insemination according to vulvar skin temperature changes resulted in successful fertilisation in all sows, although supplementation of the freezing media with RA did not improve the fertilising ability of frozen-thawed boar sperm.

Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?

Science.gov (United States)

Corazza, Monica; Virgili, Annarosa; Toni, Giulia; Minghetti, Sara; Tiengo, Silvia; Borghi, Alessandro

2016-05-01

Topical remedies based on botanical ingredients are popular. To assess: (i) the usage of botanical substances in subjects affected with itching and chronic vulvar complaints; (ii) the incidence of side-effects associated with their use and the frequency of contact allergy; (iii) the diagnostic usefulness of patch testing. Sixty-six patients were provided with a questionnaire to assess the prevalence and type of topical botanical preparations used and the occurrence of adverse reactions. Patients were patch tested with (i) the Italian baseline series, (ii) a topical medicament series, and (iii) a botanical series. Forty-two patients (63.6%) reported the use of natural topical products on the vulva. Seven (16.7%) noted adverse reactions; 27 showed positive reactions with the baseline series; 14 (21.2%) had at least one relevant reaction, mainly to allergens in topical products and cosmetics; and 2 (3%) showed positive reactions to the botanical series. Of the 7 patients complaining of adverse effects of botanical products, 3 (42.8%) showed relevant sensitization. The use of natural topical products is widespread among women affected with itching vulvar diseases. Contact dermatitis is a possible adverse effect. Botanical series are of questionable usefulness, owing to the wide variety of botanical ingredients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Ospemifene 12-month safety and efficacy in postmenopausal women with vulvar and vaginal atrophy

DEFF Research Database (Denmark)

Goldstein, S R; Bachmann, G A; Koninckx, P R

2014-01-01

OBJECTIVE: Assessment of 12-month safety of ospemifene 60 mg/day for treatment of postmenopausal women with vulvar and vaginal atrophy (VVA). METHODS: In this 52-week, randomized, double-blind, placebo-controlled, parallel-group study, women 40-80 years with VVA and an intact uterus were randomized...... baseline to week 12 in percentage of superficial and parabasal cells and vaginal pH. RESULTS: Of 426 randomized subjects, 81.9% (n = 349) completed the study with adverse events the most common reason for discontinuation (ospemifene 9.5%; placebo 3.9%). Most (88%) treatment-emergent adverse events...

Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection: a multicenter study

NARCIS (Netherlands)

Ansink, A. C.; Sie-Go, D. M.; van der Velden, J.; Sijmons, E. A.; de Barros Lopes, A.; Monaghan, J. M.; Kenter, G. G.; Murdoch, J. B.; ten Kate, F. J.; Heintz, A. P.

1999-01-01

BACKGROUND: The aim of this multicenter study was to investigate the feasibility and negative predictive value of sentinel lymph node detection with blue dye in vulvar carcinoma patients. METHODS: In patients with squamous cell carcinoma of the vulva without suspicious groin lymph nodes, patent blue

Perceptions of dyspareunia in postmenopausal women with vulvar and vaginal atrophy: findings from the REVIVE survey.

Science.gov (United States)

Freedman, Murray A

2014-07-01

Symptoms of vulvar and vaginal atrophy (VVA), including dyspareunia and vaginal dryness, have a distinct negative impact on a woman's quality of life. The REVIVE survey highlighted the lack of awareness of VVA symptoms among postmenopausal women with vaginal symptoms, with many women reluctant to initiate discussions with their healthcare professionals despite the presence of vaginal symptoms. The REVIVE survey also provided insights into women's views of VVA treatments. Women reported displeasure with the vaginal administration route, lack of symptom relief with over-the-counter products, and concerns about the safety of estrogen therapies. With the high prevalence of VVA, obstetricians/gynecologists should become vigilant in identifying women with VVA by implementing screening and discussion of symptoms during routine office visits - providing patients with information about appropriate therapies based on the severity and impact of symptoms, keeping in mind individual preferences and perceptions.

Challenging the concept of microinvasive carcinoma of the vulva: report of a case with regional lymph node recurrence and review of the literature

International Nuclear Information System (INIS)

Sidor, Jutta; Diallo-Danebrock, Raihana; Eltze, Elke; Lellé, Ralph J

2006-01-01

It is widely accepted that vulvar carcinoma with a depth of invasion of less than one millimeter is sufficiently treated by vulvectomy or wide local excision without inguinal lymphadenectomy. However, a patient with inguinal lymph node recurrence 21 months after radical vulvectomy for stage IA squamous cell carcinoma was observed. According to a review of the literature, there are five additional cases of metastasizing vulvar cancer with a depth of invasion of less than one millimeter. Therefore, the definition of microinvasive carcinoma of the vulva based on depth of invasion alone may not be as reliable as previously thought and does not rule out inguinal lymph node involvement or recurrence. Consequently, the necessity of inguinal node dissection for microinvasive carcinoma needs to be discussed on an individual basis taking into account the age of the patient as well as the potential morbidity of extended surgery

The clinicopathological and prognostic impact of 14-3-3 sigma expression on vulvar squamous cell carcinomas

OpenAIRE

Wang, Zhihui; Tropè, Claes G; Suo, Zhenhe; Trøen, Gunhild; Yang, Guanrui; Nesland, Jahn M; Holm, Ruth

2008-01-01

Background 14-3-3 sigma (σ) promotes G2/M cell cycle arrest by sequestering cyclin B1-CDC2 complex in cytoplasm. Down-regulation of 14-3-3σ, which has been demonstrated in various carcinomas, may contribute to malignant transformation. However, the exact role of 14-3-3σ in the pathogenesis of vulvar carcinoma is not fully characterized, and the prognostic impact of 14-3-3σ protein expression is still unknown. Methods ...

Success or failure of vaccination for HPV16-positive vulvar lesions correlates with kinetics and phenotype of induced T-cell responses

NARCIS (Netherlands)

Welters, Marij J. P.; Kenter, Gemma G.; de Vos van Steenwijk, Peggy J.; Löwik, Margriet J. G.; Berends-van der Meer, Dorien M. A.; Essahsah, Farah; Stynenbosch, Linda F. M.; Vloon, Annelies P. G.; Ramwadhdoebe, Tamara H.; Piersma, Sytse J.; van der Hulst, Jeanette M.; Valentijn, A. Rob P. M.; Fathers, Lorraine M.; Drijfhout, Jan W.; Franken, Kees L. M. C.; Oostendorp, Jaap; Fleuren, Gert Jan; Melief, Cornelis J. M.; van der Burg, Sjoerd H.

2010-01-01

One half of a group of 20 patients with human papillomavirus type 16 (HPV16)-induced vulvar intraepithelial neoplasia grade 3 displayed a complete regression (CR) after therapeutic vaccination with HPV16 E6/E7 synthetic long peptides. Patients with relatively larger lesions generally did not display

A Qualitative Study on Experiences After Vulvar Surgery in Women With Lichen Sclerosus and Sexual Pain.

Science.gov (United States)

Brauer, Marieke; van Lunsen, Rik H W; Laan, Ellen T M; Burger, Matthé P M

2016-07-01

Lichen sclerosus (LS) of the vulva can profoundly affect sexual interaction because of painful fissures and narrowing of the vaginal introitus. Successful surgical treatment is usually defined as restoration of (pain-free) penetrative sexual activity. To evaluate the impact of surgery on (dyadic) sexual functioning and pleasure and psychological well-being. Nineteen women with anogenital LS participated in audiotaped, qualitative, individual interviews after surgery to re-enable sexual intercourse. Physical, sexual, and psychological experiences were analyzed using the constant comparative method. Vulvar surgery resulted in a decrease of sexual pain in 13 of 19 patients (68%). Of these 13 patients, 4 were completely free of pain and the other 9 patients expressed a shift from preoperative sexual pain to postoperative sexual discomfort. These women reported improved sexual functioning, increased sexual activity and intimacy with the partner, and reinstated feelings of being an adequate woman and sexual partner. In 1 of the 19 patients (5%), surgery did not result in decreased sexual pain, yet she continued to have intercourse. Five of the 19 patients (26%) stopped having intercourse because of pain; one woman had secondary vaginismus and another woman, in retrospect, had premorbid generalized unprovoked vulvodynia. Four of these women were unable to communicate with their partner about sexual matters and to change their sexual repertoire (satisfactorily) once they had ceased intercourse (attempts). Eighteen women (95%) reported a decrease of LS symptoms in daily life. Vulvar surgery seems an effective treatment for most women with LS who experience sexual pain owing to anatomic or epithelial changes and who wish to resume intercourse. To assess whether women might benefit from such surgery and/or whether (additional) sexual counseling is indicated, preoperative sexological couple-based consultation is needed. This consultation should exclude comorbid vaginismus and

Adjuvant Radiation Therapy for Margin-Positive Vulvar Squamous Cell Carcinoma: Defining the Ideal Dose-Response Using the National Cancer Data Base

International Nuclear Information System (INIS)

Chapman, Bhavana V.; Gill, Beant S.; Viswanathan, Akila N.; Balasubramani, Goundappa K.; Sukumvanich, Paniti; Beriwal, Sushil

2017-01-01

Purpose: Positive surgical margins after radical vulvectomy for vulvar cancer portend a high risk for local relapse, which may be challenging to salvage. We assessed the impact of adjuvant radiation therapy (aRT) on overall survival (OS) and the dose-response relationship using the National Cancer Data Base. Methods and Materials: Patients with vulvar squamous cell carcinoma who underwent initial extirpative surgery with positive margins from 1998 to 2012 were included. Factors associated with aRT and specific dose levels were analyzed using logistic regression. Log-rank and multivariable Cox proportional hazards modeling were used for OS analysis. Results: We identified 3075 patients with a median age of 66 years (range, 22-90 years); the median follow-up time was 36.4 months (interquartile range [IQR] 15.4-71.0 months). Stage IA/B disease represented 41.2% of the cohort. Sixty-three percent underwent lymph node assessment, with a 45% positivity rate. In total, 1035 patients (35.3%) received aRT, with a median dose of 54.0 Gy (IQR 48.6-60.0 Gy). The 3-year OS improved from 58.5% to 67.4% with aRT (P<.001). On multivariable analysis, age, Charlson-Deyo score ≥1, stage ≥II, tumors ≥4 cm, no aRT, and adverse nodal characteristics led to inferior survival. Dose of aRT was positively associated with OS as a continuous variable on univariate analysis (P<.001). The unadjusted 3-year OS for dose subsets 30.0 to 45.0 Gy, 45.1 to 53.9 Gy, 54.0 to 59.9 Gy, and ≥60 Gy was 54.3%, 55.7%, 70.1%, and 65.3%, respectively (P<.001). Multivariable analysis using a 4-month conditional landmark revealed that the greatest mortality reduction occurred in cumulative doses ≥54 Gy: 45.1 to 53.9 Gy (hazard ratio [HR] 0.94, P=.373), 54.0 to 59.9 Gy (HR 0.75, P=.024), ≥60 Gy (HR 0.71, P=.015). No survival benefit was seen with ≥60 Gy compared with 54.0 to 59.9 Gy (HR 0.95, P=.779). Conclusions: Patients with vulvar squamous cell carcinoma and positive surgical

The impact of vulvar lichen sclerosus on sexual dysfunction.

Science.gov (United States)

Haefner, Hope K; Aldrich, Nely Z; Dalton, Vanessa K; Gagné, Hélène M; Marcus, Stephanie B; Patel, Divya A; Berger, Mitchell B

2014-09-01

Lichen sclerosus (LS) is a chronic inflammatory condition that is known to arise on the vulva. Many women with LS report vulvar pain, often affecting a patient's quality of life. In this study, the sexual function of LS patients, with and without pain, was compared to control populations. A case-control study to examine the relationship between LS and sexual dysfunction was conducted. A total of 335 women presenting to the gynecology clinic were included in the study: 197 women with biopsy confirmed LS were compared to two control groups (95 asymptomatic women were "healthy" controls and 43 women had vulvovaginal candidiasis) on self-reported current health complaints, medical and surgical history and current symptoms such as pain and itching, type and frequency of sexual activity, and satisfaction with sexual activity. Women with LS reported less frequent sexual activity than healthy controls (p=0.007) and Candida controls (p=0.04). Currently sexually active women with LS were significantly less likely to report vaginal intercourse (71.6%) than healthy controls (89.0%, p=0.003) or Candida controls (100%, p=0.0003), even though similar proportions of all three groups reported that vaginal intercourse was important. Satisfaction towards the quality of current sexual activity was significantly lower among women with LS compared with both the healthy and Candida control groups. 23.7% of women with LS reported that sexual activity was rarely or never satisfactory as compared with 0% of healthy controls (psexual activity and less satisfying sexual activity when compared with controls.

Vulvar Villoglandular Adenocarcinoma of Colonic Type: A Rare Finding

Directory of Open Access Journals (Sweden)

Heidarali Esmaeili

2018-01-01

Full Text Available Colonic type villoglandular adenocarcinoma of the lower genital tract is an extremely rare condition. Its origin is not clearly understood; however, the cloacal remnants are the more accepted source for this carcinoma.We report the case of a 67-year-old female patient who presented with a 1.2 cm polypoidal nodule at the right side of the fourchette. Morphologic studies revealed a colonic type mucinous adenocarcinoma that arose from within a villous adenoma. Immunohistochemical staining showed positive cytokeratin 7, cytokeratin 20, carcinoembryonic antigen, P53, and progesterone receptor, but negative for estrogen receptor and caudal type homeobox transcription factor 2. Extensive work-up failed to reveal other primary cancers in this patient. Ultimately, she underwent a radical vulvectomy. No recurrence was seen in eight months follow up of this patient after surgery. Careful, thorough histological evaluation and clinical clues enable correct diagnosis of the rare colonic type vulvar villoglandular adenocarcinoma. Due to rarity of this tumor, its management is questionable. Therefore, additional investigation is necessary for its management.

Neoplasia intra-epitelial grau III da vulva e da região perianal tratada com vulvectomia superficial: relato de caso High-grade vulvar and perianal intraepithelial neoplasia treated with skinning vulvectomy: a case report

Directory of Open Access Journals (Sweden)

Walquíria Quida Salles Pereira Primo

2003-05-01

Full Text Available A neoplasia intra-epitelial vulvar grau III (NIV III se manifesta de modo visível, portanto, acessível à biópsia e, por conseguinte, ao diagnóstico histológico. Há duas formas precursoras do câncer vulvar: a NIV associada ao papiloma vírus humano (HPV e a NIV associada ao líquen simples crônico, hiperplasia de células escamosas e líquen escleroso, não tratados. Porém, pode existir sobreposição das duas formas. O termo papulose bowenóide, apesar de ser desencorajado, define uma das formas clínicas da NIV, que se apresenta como lesões pigmentadas, verruciformes, papulares e múltiplas. A NIV III está associada com HPV em mais de 80% dos casos e em 40% das vezes, nota-se envolvimento perianal. O seu tratamento é muito difícil e pode ocorrer recorrência em qualquer tempo e por muitos anos. Embora não exista tratamento padrão definido, os trabalhos apontam para a cirurgia, respeitando margem de segurança, como o mais adequado.High-grade vulvar intraepithelial neoplasia (VIN III is a visible lesion; therefore, it is accessible to biopsy and thus, to a histological diagnosis. There are two forms of vulvar cancer precursors: VIN caused by human papillomavirus (HPV and VIN associated with untreated lichen simplex chronicus, squamous cell hyperplasia, and lichen sclerosus. There may be overlap of the two forms. The term bowenoid papulosis, although discouraged, identifics a clinical form of VIN III. Such lesion appears as pigmented, wart-like growths or papules. VIN III is associated with HPV in more than 80% of the cases, and there is perianal involvement in 40% of the times. Vulvar intraepithelial neoplasia is difficult to cure and relapses can occur at any time for many years. Although there is no defined standard treatment, studies point to surgery, respecting a free margin, as the most adequate one.

The impact of written information and counseling (WOMAN-PRO II Program) on symptom outcomes in women with vulvar neoplasia: A multicenter randomized controlled phase II study.

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Raphaelis, Silvia; Mayer, Hanna; Ott, Stefan; Mueller, Michael D; Steiner, Enikö; Joura, Elmar; Senn, Beate

2017-07-01

To determine whether written information and/or counseling based on the WOMAN-PRO II Program decreases symptom prevalence in women with vulvar neoplasia by a clinically relevant degree, and to explore the differences between the 2 interventions in symptom prevalence, symptom distress prevalence, and symptom experience. A multicenter randomized controlled parallel-group phase II trial with 2 interventions provided to patients after the initial diagnosis was performed in Austria and Switzerland. Women randomized to written information received a predefined set of leaflets concerning wound care and available healthcare services. Women allocated to counseling were additionally provided with 5 consultations by an Advanced Practice Nurse (APN) between the initial diagnosis and 6months post-surgery that focused on symptom management, utilization of healthcare services, and health-related decision-making. Symptom outcomes were simultaneously measured 5 times to the counseling time points. A total of 49 women with vulvar neoplasia participated in the study. Symptom prevalence decreased in women with counseling by a clinically relevant degree, but not in women with written information. Sporadically, significant differences between the 2 interventions could be observed in individual items, but not in the total scales or subscales of the symptom outcomes. The results indicate that counseling may reduce symptom prevalence in women with vulvar neoplasia by a clinically relevant extent. The observed group differences between the 2 interventions slightly favor counseling over written information. The results justify testing the benefit of counseling thoroughly in a comparative phase III trial. Copyright © 2017 Elsevier Inc. All rights reserved.

The Prognostic Value of 14-3-3 Isoforms in Vulvar Squamous Cell Carcinoma Cases: 14-3-3β and ε Are Independent Prognostic Factors for These Tumors

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Wang, Zhihui; Nesland, Jahn M.; Suo, Zhenhe; Trope, Claes G.; Holm, Ruth

2011-01-01

Background The 14-3-3 family is comprised of highly conserved proteins that are functionally important in the maintenance of homeostasis. Their involvement with the cell cycle, their association with proto-oncogenes and oncogenes, and their abnormal expression in various tumors has linked this family of proteins to the etiology of human cancer. Mounting evidence now indicates that 14-3-3σ is a cancer suppressor gene but the roles of the other 14-3-3 isoforms and their interactions in tumorigenesis have not yet been elucidated. In our current study, we examined the expression of 14-3-3β, γ, ε, ζ, η and τ in a large series of vulvar squamous cell carcinomas to evaluate any clinical significance. Methods Tumor biopsies from 298 vulvar carcinomas were examined by immunohistochemistry for the expression of 14-3-3β, γ, ε, ζ, η and τ. Statistical analyses were employed to validate any associations between the expression of any 14-3-3 isoform and clinicopathologic variables for this disease. Results High cytoplasmic levels of 14-3-3β, γ, ζ, ε and η were observed in 79%, 58%, 50%, 86% and 54% of the vulvar carcinomas analyzed, respectively, whereas a low nuclear expression of 14-3-3τ was present in 80% of these cases. The elevated cytoplasmic expression of 14-3-3β, γ, ε, ζ and η was further found to be associated with advanced disease and aggressive features of these cancers. The overexpression of cytoplasmic 14-3-3β and ε significantly correlated with a poor disease-specific survival by univariate analysis (P = 0.007 and P = 0.04, respectively). The independent prognostic significance of these factors was confirmed by multivariate analysis (P = 0.007 and P = 0.009, respectively). Conclusions We reveal for the first time that the 14-3-3β, γ, ε, ζ, η and τ isoforms may be involved in the progression of vulvar carcinomas. Furthermore, our analyses show that high cytoplasmic levels of 14-3-3β and ε independently correlate with

The prognostic value of 14-3-3 isoforms in vulvar squamous cell carcinoma cases: 14-3-3β and ε are independent prognostic factors for these tumors.

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Zhihui Wang

Full Text Available BACKGROUND: The 14-3-3 family is comprised of highly conserved proteins that are functionally important in the maintenance of homeostasis. Their involvement with the cell cycle, their association with proto-oncogenes and oncogenes, and their abnormal expression in various tumors has linked this family of proteins to the etiology of human cancer. Mounting evidence now indicates that 14-3-3σ is a cancer suppressor gene but the roles of the other 14-3-3 isoforms and their interactions in tumorigenesis have not yet been elucidated. In our current study, we examined the expression of 14-3-3β, γ, ε, ζ, η and τ in a large series of vulvar squamous cell carcinomas to evaluate any clinical significance. METHODS: Tumor biopsies from 298 vulvar carcinomas were examined by immunohistochemistry for the expression of 14-3-3β, γ, ε, ζ, η and τ. Statistical analyses were employed to validate any associations between the expression of any 14-3-3 isoform and clinicopathologic variables for this disease. RESULTS: High cytoplasmic levels of 14-3-3β, γ, ζ, ε and η were observed in 79%, 58%, 50%, 86% and 54% of the vulvar carcinomas analyzed, respectively, whereas a low nuclear expression of 14-3-3τ was present in 80% of these cases. The elevated cytoplasmic expression of 14-3-3β, γ, ε, ζ and η was further found to be associated with advanced disease and aggressive features of these cancers. The overexpression of cytoplasmic 14-3-3β and ε significantly correlated with a poor disease-specific survival by univariate analysis (P = 0.007 and P = 0.04, respectively. The independent prognostic significance of these factors was confirmed by multivariate analysis (P = 0.007 and P = 0.009, respectively. CONCLUSIONS: We reveal for the first time that the 14-3-3β, γ, ε, ζ, η and τ isoforms may be involved in the progression of vulvar carcinomas. Furthermore, our analyses show that high cytoplasmic levels of 14-3-3β and ε

Radiation Treatment for Primary Adenocarcinoma of Bartholin Gland- A Case Report and Review of Literature

International Nuclear Information System (INIS)

Oh, Won Yong; Whang, In Soon

1989-01-01

A patient with primary adenocarcinoma of Bartholin gland is reported and the literatures relevant to this disease reviewed. Not only this disease is very rare but also primary carcinomas of Bartholin gland are misdiagnosed as cysts or abscesses in half of the cases, leading to considerable delay in diagnosis. And so, It was wasted long time before definitive therapy. However, because of a different clinical behavior, cancer of the Bartholin gland should be distinguished from other vulvar carcinomas. Histologically, squamous cell carcinoma and adenocarcinoma are the most common. Virtually all histologic types of Bartholin gland carcinoma metastasize to lymph node, bone, lung and liver in distant sites. The authors data and a review of the literature support the concept that radical vulvectomy with or without bilateral inguina1-femoral lymphadenectomy is required. On the other hand, except primary radiation treatment for small or medium sized cancers, the results obtained by radiation therapy in carcinoma of the vulva including Bartholin gland are generally discouraging. A role for postoperative adjuvant radiation therapy suggests because of high incidence of positive inguinal-femoral lymph nodes. In the near time, natural history and biological behavior of Bartholin gland cancer must be disclosed in detail. And also optimal treatment modality and prognostic factors shall be determine

Vulvar vestibulitis syndrome: an important factor in the evaluation of lifelong vaginismus?

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Ter Kuile, Moniek M; Van Lankveld, Jacques J D M; Vlieland, Corrie Vliet; Willekes, Christine; Weijenborg, Philomeen T M

2005-12-01

The aim of the study was to investigate the prevalence of vulvar vestibulitis syndrome (VVS) in a sample of women suffering from lifelong vaginismus (N=91). Lifelong vaginismus is defined as "having a history of never having been able to experience penile entry of the vagina". The results with respect to VVS are compared with the results of women who are suffering from pain during intercourse (superficial dyspareunia) (N=84). Both patients groups were recruited from two treatment outcome studies. Using a standard physical examination, erythema was found in 77%, pain "on touch" in 69% and erythema and pain on the same location was seen in 56% of the patients with lifelong vaginismus. Furthermore, it was found that erythema (94%), pain (98%) and erythema and pain on the same location (92%) were more frequently found in patients with dyspareunia compared to women with lifelong vaginismus. It is concluded that pain is an integral part of the experiences in the majority of women with lifelong vaginismus.

Post-coital burning pain and pain at micturition: early symptoms of partial vaginismus with or without vulvar vestibulitis?

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Engman, Maria; Wijma, Klaas; Wijma, Barbro

2008-01-01

Twenty-four women with partial vaginismus with or without vulvar vestibulitis participated in a semi-structured telephone interview concerning early signs and development of their pain symptoms during/after intercourse. At the onset of the problem, pain after intercourse was more common than pain during penetration. Pain intensity during penetration increased from the onset of the problem to when the women ceased having intercourse. Pain during penetration lasted for 1 minute, and was most often described as sharp/incisive/bursting, while pain after intercourse had a duration of 2 hours and was described as burning and/or smarting. Post-coital pain during micturition was described by 70% of the women.

Conscious sedation with inhaled 50% nitrous oxide/oxygen premix in photodynamic therapy sessions for vulvar lichen sclerosus treatment.

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Cabete, Joana; Campos, Sara; Lestre, Sara

2015-01-01

Photodynamic therapy has been described as an effective therapeutic option in selected cases of anogenital lichen sclerosus that are refractory to first-line treatments. However, procedure-related pain is a limiting factor in patient adherence to treatment. The authors report the case of a 75-year-old woman with highly symptomatic vulvar lichen sclerosus, successfully treated with photodynamic therapy. An inhaled 50% nitrous oxide/oxygen premix was administered during sessions, producing a pain-relieving, anxiolytic, and sedative effect without loss of consciousness. This ready-to-use gas mixture may be a well-tolerated and accepted alternative to classical anesthetics in Photodynamic therapy, facilitating patients' adherence to illumination of pain-prone areas.

Toxic shock syndrome due to community-acquired methicillin-resistant Staphylococcus aureus infection: Two case reports and a literature review in Japan.

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Sada, Ryuichi; Fukuda, Saori; Ishimaru, Hiroyasu

2017-01-01

Community-acquired methicillin-resistant Staphylococcus aureus has been spreading worldwide, including in Japan. However, few cases of toxic shock syndrome caused by Community-acquired methicillin-resistant Staphylococcus aureus have been reported in Japan. We report 2 cases, in middle-aged women, of toxic shock syndrome due to Community-acquired methicillin-resistant Staphylococcus aureus via a vaginal portal of entry. The first patient had used a tampon and the second patient had vaginitis due to a cleft narrowing associated with vulvar lichen sclerosus. Both patients were admitted to our hospital with septic shock and severe acute kidney injury and subsequently recovered with appropriate antibiotic treatment. In our review of the literature, 8 cases of toxic shock syndrome caused by Community-acquired methicillin-resistant Staphylococcus aureus were reported in Japan. In these 8 cases, the main portals of entry were the skin and respiratory tract; however, the portal of entry of Community-acquired methicillin-resistant Staphylococcus aureus from a vaginal lesion has not been reported in Japan previously.

An Online Cross-Sectional Comparison of Women With Symptoms of Persistent Genital Arousal, Painful Persistent Genital Arousal, and Chronic Vulvar Pain.

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Jackowich, Robyn A; Pink, Leah; Gordon, Allan; Poirier, Évéline; Pukall, Caroline F

2018-04-01

Persistent genital arousal disorder (PGAD) is an understudied condition characterized by unwanted physiologic genital arousal in the absence of subjective sexual arousal. Markos and Dinsmore (Int J STD AIDS 2013;24:852-858) theorized that PGAD shares a number of similarities with vulvodynia (unexplained chronic vulvar pain [CVP]), including symptom characteristics and comorbidities. To compare medical histories, symptom characteristics, pain characteristics, and daily functioning among women with persistent genital pain (PGA) (n = 42), painful PGA (n = 37), and CVP (n = 42) symptoms. An online cross-sectional survey was conducted from October 2015 through April 2016. Self-report measures of symptoms, diagnosed medical conditions, pain characteristics (McGill Pain Questionnaire), catastrophizing (Pain Catastrophizing Scale), and daily functioning (Functional Status Questionnaire) were collected. All 3 groups reported similar medical diagnoses and high frequencies of other chronic pelvic pain conditions. Women in all 3 groups reported comparable ages at symptom onset and timing of symptom expression (ie, constant vs intermittent). Women in the 2 PGA groups reported significantly greater feelings of helplessness than women in the CVP group. Women in the painful PGA and CVP groups endorsed significantly more sensory terms to describe their symptoms compared with women in the PGA group, whereas women in the painful PGA group reported significantly more affective terms to describe their symptoms compared with women in the CVP group. Women in the 2 PGA groups reported that their symptoms interfered significantly with most areas of daily functioning. Given the similarities between PGA and CVP symptoms, women with PGA may benefit from similar assessment, treatment, and research approaches. Limitations of the present study include its sole use of self-report measures; the presence of PGA or CVP symptoms was not confirmed by clinical assessment. However, the anonymous

Platelet-rich plasma (PRP for the treatment of vulvar lichen sclerosus in a premenopausal woman: A case report

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D. Franic

2018-04-01

Full Text Available The use of platelet-rich plasma (PRP for the treatment of lichen sclerosus (LS in a 38-year-old premenopausal woman is reported. The diagnosis was confirmed histologically and the symptoms documented using the ICIQ Vaginal Symptoms Questionnaire (ICIQ-VS and the Female Sexual Function Index (FSFI questionnaire. PRP was prepared from autologous blood using the Regen Cellular Matrix Kit. PRP was administered twice over two months. Histology at follow-up one month after the second administration showed the epidermis was nearly normal and upper dermal cellularity had been restored. The patient was symptom-free and both her ICIQ-VS and her FSFI scores had improved significantly. PRP is a potential new treatment option for LS which needs further assessment in randomized controlled trials. Keywords: Platelet-rich plasma, Vulvar lichen sclerosus, Premenopause, Treatment

Estimation of groin recurrence risk in patients with squamous cell vulvar carcinoma by the assessment of marker gene expression in the lymph nodes

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Kowalewska Magdalena

2012-06-01

Full Text Available Abstract Background Regional lymph node (LN status is a well-known prognostic factor for vulvar carcinoma (VC patients. Although the reliable LN assessment in VC is crucial, it presents significant diagnostic problems. We aimed to identify specific mRNA markers of VC dissemination in the LN and to address the feasibility of predicting the risk of nodal recurrence by the patterns of gene expression. Methods Sentinel and inguinal LN samples from 20 patients who had undergone surgery for stage T1-3, N0-2, M0 primary vulvar squamous cell carcinoma were analyzed. Gene expression profiles were assessed in four metastatic [LN(+] and four histologically negative [LN(−] lymph node samples obtained from four VC patients, by the Affymetrix U133 Plus 2.0 gene expression microarrays. Of the set of genes of the highest expression in the metastatic LNs compared to LN(−, seven candidate marker genes were selected: PERP, S100A8, FABP5, SFN, CA12, JUP and CSTA, and the expression levels of these genes were further analyzed by the real-time reverse transcription polymerase chain reaction (qRT-PCR in 71 LN samples. Results All of the seven genes in question were significantly increased in LN(+ compared to LN(− samples. In the initial validation of the seven putative markers of metastatic LN, the Cox proportional hazard model pointed to SFN, CA12 and JUP expression to significantly relate to the time to groin recurrence in VC patients. Conclusions Our findings first provided evidence that SFN, CA12 and JUP have a potential of marker genes for the prediction of the groin recurrence LN in VC patients.

Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT. Pt. 2

International Nuclear Information System (INIS)

Alt, Celine D.; Kauczor, Hans-Ulrich; Hallscheidt, Peter; Brocker, Kerstin A.; Eichbaum, Michael; Sohn, Christof; Arnegger, Florian U.

2011-01-01

To compose diagnostic standard operating procedures for both clinical and imaging assessment for vulvar and vaginal cancer, for vaginal sarcoma, and for ovarian cancer. The literature was reviewed for diagnosing the above mentioned malignancies in the female pelvis. Special focus herein lies in tumor representation in MRI, followed by the evaluation of CT and PET/CT for this topic. MRI is a useful additional diagnostic complement but by no means replaces established methods of gynecologic diagnostics and ultrasound. In fact, MRI is only implemented in the guidelines for vulvar cancer. According to the current literature, CT is still the cross-sectional imaging modality of choice for evaluating ovarian cancer. PET/CT appears to have advantages for staging and follow-up in sarcomas and cancers of the ovaries. (orig.)

Vulvodynia: An unrecognized diabetic neuropathic syndrome

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Bharti Kalra

2013-01-01

Full Text Available Vulvar pain syndromes, including vulvodynia, are a common source of morbidity in women and cause much physical and psychological suffering. This brief communication postulates the hypothesis that unexplained vulvar pain may be hitherto undescribed manifestation of painful sensory diabetic neuropathy. It describes the clinical characteristics of vulvodynia and highlights the similarities between this condition and diabetic neuropathy. The hypothesis calls for women presenting with vulvar pain to be screened for diabetes, as well as women with diabetes to be questioned about vulvar symptomatology. The paper hopes to stimulate extensive research in this important, but so far neglected, field of women′s endocrine health.

Vulvovaginitis and other common childhood gynaecological conditions.

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Garden, Anne S

2011-04-01

Paediatric gynaecological problems, especially those involving the vulvar area, are common in childhood. The conditions frequently seen include recurrent bacterial vulvovaginitis, vulvar irritation, labial adhesions and dermatological conditions. The presentation and management of these conditions will be reviewed.

Radiotherapeutic management of carcinomas of the vagina and vulva

International Nuclear Information System (INIS)

Randall, Marcus E.

1997-01-01

Purpose: To review important basic information regarding vaginal and vulvar carcinomas, including etiology, epidemiology, anatomy, pathology, spread patterns, presentation and work-up and staging. In addition, treatment concepts strategies, and radiotherapeutic techniques will be reviewed and discussed. Discussion: Vaginal carcinoma is rare, making up only 1-2% of gynecologic malignancies. However, the predominant role of radiotherapy (RT) is its management results in a significant number of patients referred to radiation oncology. Treatment and outcomes vary substantially according to stage. Important issues for consideration include the respective roles of external beam RT, brachytherapy, and surgery, intracavitary vs. interstitial brachytherapy, dose rate considerations, combined modality therapy, and management of non-squamous cell histologies. Vulvar carcinoma is similarly uncommon, comprising only 3-5% of gynecologic malignancies. Radiotherapy has a number of established roles in the management of this disease including adjuvant therapy, as part of combined modality treatment for advanced disease, salvage therapy, palliative treatment, and less often, as primary management. These issues will be discussed along with technical factors important in radiotherapeutic management. Finally, relevant literature will be reviewed with an emphasis of completed Gynecologic Oncology Group Trials

Prognosis of vulvar dysplasia and carcinoma in situ with special reference to histology and types of human papillomavirus (HPV)

DEFF Research Database (Denmark)

Junge, Jette; Poulsen, H; Horn, T

1997-01-01

is the involvement of the resection borders. The location of the lesion, the degree and type of dysplasia, and the type of HPV seem to play a minor role. Local excision and subsequent intensive control with removal of any visible new lesion probably prevents development of vulvar invasive carcinoma....... were classified according to the WHO (mild, moderate, severe dysplasia or carcinoma in situ) and Toki et al. (1991) (warty, basaloid, combined warty/basaloid or mixed (warty, basaloid and simple). No pure types of Toki (1991) could be demonstrated. There were no differences regarding recurrences in any...... of these groups. HPV DNA was detected in the initial lesions by PCR in 50/56 (89%) (44 with HPV type 16 and 6 with HPV type 33) and by ISH in 23/61 (38%). The same type of HPV could be demonstrated in all first recurrences except in two, where HPV types 33 was shown in specimens harboring HPV type 16...

Clinical presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature.

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Beyitler, İlke; Kavukcu, Salih

2017-04-01

Vulvovaginitis is the most common cause of gynecological complaints in children and young girls. Some of the factors which cause vulvovaginitis include hypoestrogenism, the anatomical proximity of rectum and delicate vulvar skin and vaginal mucosa. We made a literature search with Pubmed, Medline and Cochrane database from January 2002 to May 2015 in English language using the key words vulvovaginitis, children, clinical, diagnosis and treatment. Vulvovaginitis in girls is usually caused by non-specific factors and hygiene measures, bioyoghurt and avoidance of chemical irritants are generally useful. Weight control if necessary and prevention of voiding dysfunction are effective. Vaginal flora is important in girls and results should be interpreted with clinical features to decide whether an isolated microorganism is part of the normal microflora or is the cause of symptomatic vulvovaginitis. Specific treatment is generally considered in case of a detected pathogen microorganism. Isolation of a sexually transmitted organism requires further investigation. Persistent disease may not always indicate a foreign body but it must be taken into account. Girls and parents are encouraged psychologically in all steps of evaluation, diagnosis and treatment. Probiotics, nanotechnology and petroleum jelly are other important treatment options used in vulvovaginitis. In this review, we present current approach to the presentation and management of vulvovaginitis in childhood. This disorder requires a comprehensive evaluation in all steps of diagnosis, differential diagnosis and treatment.

Vulvar and vaginal graft versus host disease: A healthcare clinic initiative

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Naomi Van Dam

2017-01-01

Full Text Available Objective: In patients receiving bone marrow transplantation (BMT, their mucosa becomes altered and sclerotic changes in the female external genital organs occur. Although a few studies have specifically addressed vulvar and vaginal graft versus host disease (VVGvHD and its repercussions on the sexual health and quality of life of patients, VVGvHD can be overlooked by health practitioners. The objective of the study is to describe the initiation of a health care clinic specializing in VVGvHD in a general tertiary hospital. Methods: A VVGvHD clinic was founded as a part of BMT daycare in a joint initiative of the nursing staff and the medical director of the department and a gynecologist specializing in vulva and vaginal disease. Patients were assessed for vulvovaginal symptoms, such as dryness, burning, itching, pain to touch, pain during intercourse, and dysuria. These patients might be subsequently referred to the VVGvHD clinic according to their needs assessed by daycare nurses. Treatment guidelines were developed by the specialist gynecologist. Results: A total of 81 women aged 2–66 years (median age = 38 years visited the clinic from 2009 to 2015. Of these women, 70 received an allogeneic transplant and 11 underwent autologous transplantation before consultation in our clinic. VVGvHD was detected in 54% of the patients. Conclusions: The VVGvHD clinic was developed to fulfill the specific needs of female patients who underwent BMT. The pioneer clinic was founded as a joint effort of the multidisciplinary team. Evidence supporting the optimum treatment for this condition is insufficient. This was the main reason for performing this study to explore the clinic that was newly based in Israel. VVGvHD may be a fluctuating condition with frequent deterioration and improvement. Therefore, regular clinical examinations are necessary.

Lymphatic mapping and sentinel node biopsy in gynecological cancers: a critical review of the literature

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Dursun Polat

2008-05-01

Full Text Available Abstract Although it does not have a long history of sentinel node evaluation (SLN in female genital system cancers, there is a growing number of promising study results, despite the presence of some aspects that need to be considered and developed. It has been most commonly used in vulvar and uterine cervivcal cancer in gynecological oncology. According to these studies, almost all of which are prospective, particularly in cases where Technetium-labeled nanocolloid is used, sentinel node detection rate sensitivity and specificity has been reported to be 100%, except for a few cases. In the studies on cervical cancer, sentinel node detection rates have been reported around 80–86%, a little lower than those in vulva cancer, and negative predictive value has been reported about 99%. It is relatively new in endometrial cancer, where its detection rate varies between 50 and 80%. Studies about vulvar melanoma and vaginal cancers are generally case reports. Although it has not been supported with multicenter randomized and controlled studies including larger case series, study results reported by various centers around the world are harmonious and mutually supportive particularly in vulva cancer, and cervix cancer. Even though it does not seem possible to replace the traditional approaches in these two cancers, it is still a serious alternative for the future. We believe that it is important to increase and support the studies that will strengthen the weaknesses of the method, among which there are detection of micrometastases and increasing detection rates, and render it usable in routine clinical practice.

Aggressive angiomyxoma in the vulva: a case report

International Nuclear Information System (INIS)

Jeh, Su Kyoung; Ku, Young Mi; Whang, In Yong; Kim, Ki Tae

2005-01-01

Aggressive angiomyxoma is a rare benign tumor that originates in the pelvic or perineal organs of women. We report a case of an aggressive angiomyxoma as a huge vulvar mass, and present its clinical and image characteristics with a review of the literatures

Treatment failure in patients with HPV 16-induced vulvar intraepithelial neoplasia: understanding different clinical responses to immunotherapy.

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van Esch, Edith M G; Welters, Marij J P; Jordanova, Ekaterina S; Trimbos, J Baptist M Z; van der Burg, Sjoerd H; van Poelgeest, Mariëtte I E

2012-07-01

Failure of the immune system to launch a strong and effective immune response to high-risk HPV is related to viral persistence and the development of anogenital (pre)malignant lesions such as vulvar intraepithelial neoplasia (VIN). Different forms of immunotherapy, aimed at overcoming the inertia of the immune system, have been developed and met with clinical success. Unfortunately these, in principal successful, therapeutic approaches also fail to induce clinical responses in a substantial number of cases. In this review, the authors summarize the traits of the immune response to HPV in healthy individuals and in patients with HPV-induced neoplasia. The potential mechanisms involved in the escape of HPV-induced lesions from the immune system indicate gaps in our knowledge. Finally, the interaction between the immune system and VIN is discussed with a special focus on the different forms of immunotherapy applied to treat VIN and the potential causes of therapy failure. The authors conclude that there are a number of pre-existing conditions that determine the patients' responsiveness to immunotherapy. An immunotherapeutic strategy in which different aspects of immune failure are attacked by complementary approaches, will improve the clinical response rate.

Open literature review of threats including sabotage and theft of fissile material transport in Japan

International Nuclear Information System (INIS)

Cochran, John Russell; Furaus, James Phillip; Marincel, Michelle K.

2005-01-01

This report is a review of open literature concerning threats including sabotage and theft related to fissile material transport in Japan. It is intended to aid Japanese officials in the development of a design basis threat. This threat includes the external threats of the terrorist, criminal, and extremist, and the insider threats of the disgruntled employee, the employee forced into cooperation via coercion, the psychotic employee, and the criminal employee. Examination of the external terrorist threat considers Japanese demographics, known terrorist groups in Japan, and the international relations of Japan. Demographically, Japan has a relatively homogenous population, both ethnically and religiously. Japan is a relatively peaceful nation, but its history illustrates that it is not immune to terrorism. It has a history of domestic terrorism and the open literature points to the Red Army, Aum Shinrikyo, Chukaku-Ha, and Seikijuku. Japan supports the United States in its war on terrorism and in Iraq, which may make Japan a target for both international and domestic terrorists. Crime appears to remain low in Japan; however sources note that the foreign crime rate is increasing as the number of foreign nationals in the country increases. Antinuclear groups' recent foci have been nuclear reprocessing technology, transportation of MOX fuel, and possible related nuclear proliferation issues. The insider threat is first defined by the threat of the disgruntled employee. This threat can be determined by studying the history of Japan's employment system, where Keiretsu have provided company stability and lifetime employment. Recent economic difficulties and an increase of corporate crime, due to sole reliability on the honor code, have begun to erode employee loyalty

Physical activity interventions in Latin America: what value might be added by including conference abstracts in a literature review?

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Hoehner, Christine; Soares, Jesus; Parra, Diana C; Ribeiro, Isabela C; Pratt, Michael; Bracco, Mario; Hallal, Pedro C; Brownson, Ross C

2010-07-01

This review assessed whether conference abstracts yield useful information on the types and effectiveness of community-based physical activity (PA) interventions in Latin America, beyond that from interventions included in a recent systematic review of peer-reviewed literature. Abstracts from 9 conferences were searched for community-based interventions to promote PA in Latin America and summarized. Three reviewers classified and screened abstracts. Evaluated interventions that were not included in the previous review were assessed. Search of abstracts from 31 proceedings of 9 conferences identified 87 abstracts of studies on community-based interventions focused on increasing PA. Only 31 abstracts reported on studies with a control group and an outcome related to PA. Ten of these abstracts represented interventions that had not been included in the previous review of peer-reviewed literature, but the abstracts were insufficient in number or detail to make a practice recommendation for any single intervention. This review highlighted the challenges and low added value of including conference abstracts in a systematic review of community PA interventions in Latin America. Stronger evaluation design and execution and more published reports of evaluated interventions are needed to build an evidence base supporting interventions to increase PA in Latin America.

Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies

International Nuclear Information System (INIS)

Lin, Gigin; Chen, Chao-Yu; Liu, Feng-Yuan; Yang, Lan-Yan; Huang, Huei-Jean; Chou, Hung-Hsueh; Lai, Chyong-Huey; Huang, Yi-Ting; Jung, Shih-Ming; Ng, Koon-Kwan

2015-01-01

To prospectively evaluate the value of CT or MRI (CT/MRI) and PET in the management of vulvar malignancies. Abdominal and pelvic CT/MRI and whole-body 18 F-FDG (fluorodeoxyglucose) PET or PET/CT (collectively designated PET hereafter) were performed. Lesion status was determined by the pathological findings or clinical follow-up. The diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curve analysis. The clinical impact of PET was determined on a per scan basis. Twenty-three patients were enrolled, and 38 PET examinations were performed. CT/MRI and PET studies were used for primary staging (n = 17), monitoring the response (n = 7) and restaging after recurrence (n = 14). In primary staging, there was no significant difference between CT/MRI and PET in detecting metastatic inguinal lymph nodes (ILN). CT/MRI was significantly more efficacious than PET in detecting pelvic lymph node (PLN) or distant metastasis (p = 0.007 by ROC per patient basis). PET findings resulted in two positive impacts and one negative impact for both primary staging and restaging. False-positive PLN or distant metastasis PET findings are not uncommon, and hence should be interpreted with caution. PET can be supportive when metastatic ILN/PLN or distant metastasis is suspected on CT/MRI. (orig.)

Oncogenic Viral Prevalence in Invasive Vulvar Cancer Specimens from HIV Positive and Negative Women in Botswana

Science.gov (United States)

Tesfalul, Martha; Simbiri, Kenneth; Wheat, Chikoti M.; Motsepe, Didintle; Goldbach, Hayley; Armstrong, Kathleen; Hudson, Kathryn; Kayembe, Mukendi K.; Robertson, Erle; Kovarik, Carrie

2014-01-01

Objective The primary aim of this study is to describe the prevalence of select oncogenic viruses within vulvar squamous cell carcinoma (VSCC) and their association with Human Immunodeficiency Virus (HIV) status in women in Botswana, where the national HIV prevalence is the third highest in the world. Methods/materials A cross-sectional study of biopsy-confirmed VSCC specimens and corresponding clinical data was conducted in Gaborone, Botswana. Polymerase Chain Reaction (PCR) and Immunohistochemistry (IHC) viral testing were done for Epstein-Barr Virus (EBV), Human Papilloma Virus (HPV) strains, and Kaposi's Sarcoma Herpesvirus (KSHV), and PCR viral testing alone was done for John Cunningham Virus (JCV). Results HPV prevalence by PCR was 100% (39/39 35/35) among tested samples. HPV16 was the most prevalent HPV strain (82.9% by PCR, 94.7% by either PCR or IHC). KSHV prevalence by PCR had a significant association with HIV status (p = 0.013), but not by IHC (p = 0.650). Conclusions The high burden of HPV, specifically HPV16, in VSCC in Botswana suggests a distinct HPV profile that differs from other studied populations, which provides increased motivation for HPV vaccination efforts. Oncogenic viruses KSHV and EBV were also more prevalent in our study population though their potential role in VSCC pathology is unclear. PMID:24651632

Psychophysical properties of female genital sensation.

Science.gov (United States)

Farmer, Melissa A; Maykut, Caroline A; Huberman, Jackie S; Huang, Lejian; Khalifé, Samir; Binik, Yitzchak M; Apkarian, A Vania; Schweinhardt, Petra

2013-11-01

Provoked vestibulodynia (PVD) is characterized by the presence of vulvar touch and pain hypersensitivity. Pain with vaginal distension, which motivates treatment seeking and perpetuates distress, is frequently reported with PVD. However, the concordance between the perception of vulvar and vaginal sensation (ie, somatic and visceral genital sensations, respectively) remains unstudied in healthy women, as well as in clinical populations such as PVD. To evaluate the static and dynamic (time-varying) properties of somatic and visceral genital sensation, women with PVD (n=14) and age- and contraceptive-matched healthy controls (n=10) rated varying degrees of nonpainful and painful genital stimulation. Somatic (vulvar) mechanical sensitivity to nonpainul and painful degrees of force were compared to visceral (vaginal) sensitivity to nonpainful and painful distension volumes. Results indicated that healthy women showed substantial individual variation in and high discrimination of vulvar and vaginal sensation. In contrast, PVD was associated with vulvar allodynia and hyperalgesia, as well as vaginal allodynia. Modeling of dynamic perception revealed novel properties of abnormal PVD genital sensation, including temporal delays in vulvar touch perception and reduced perceptual thresholds for vaginal distension. The temporal properties and magnitude of PVD distension pain were indistinguishable from vaginal fullness in healthy controls. These results constitute the first empirical comparison of somatic and visceral genital sensation in healthy women. Findings provide novel insights into the sensory abnormalities that characterize PVD, including an experimental demonstration of visceral allodynia. This investigation challenges the prevailing diagnostic assessment of PVD and reconceptualizes PVD as a chronic somatic and visceral pain condition. Copyright © 2013. Published by Elsevier B.V.

Pelvic Floor Physical Therapy for Vulvodynia: A Clinician's Guide.

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Prendergast, Stephanie A

2017-09-01

Vulvar pain affects up to 20% of women at some point in their lives, and most women with vulvar pain have associated pelvic floor impairments. Pelvic floor dysfunction is associated with significant functional limitations in women by causing painful intercourse and urinary, bowel, and sexual dysfunction. A quick screening of the pelvic floor muscles can be performed in the gynecology office and should be used when patients report symptoms of pelvic pain. It is now known the vulvar pain syndromes are heterogeneous in origin; therefore, successful treatment plans are multimodal and include physical therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Crohn's disease of the vulva.

Science.gov (United States)

Barret, Maximilien; de Parades, Vincent; Battistella, Maxime; Sokol, Harry; Lemarchand, Nicolas; Marteau, Philippe

2014-07-01

Crohn's disease (CD) of the vulva is a rare, yet under recognized condition. Fistulae arising from the digestive tract account for the greater part of genital lesions in CD. However, cutaneous so-called metastatic lesions of the vulva have been reported in the literature. They are clinically challenging for gastroenterologists as well as for gynecologists, with numerous differential diagnoses, especially among venereal diseases, and require a multidisciplinary approach. The most frequently observed features of the disease are labial swelling, vulvar ulcers, and hypertrophic lesions. Biopsy samples for histological study are mandatory, in order to establish the diagnosis of vulvar CD. Treatment options include oral prolonged courses of metronidazole and systemic immunosuppressive therapy such as corticosteroids and azathioprine, with promising data published on the efficacy of infliximab. Surgery remains restricted to medical treatment failures or resection of unsightly lesions. Prospective studies or case series with long follow-up data are still missing to guide the treatment of this condition. © 2013. Published by Elsevier B.V. All rights reserved.

The American-European difference in vulvar and vaginal atrophy views: a lesson from the REVIVE Survey.

Science.gov (United States)

Nappi, R E; Krychman, M L

2016-06-01

Vulvar and vaginal atrophy (VVA) is a common complaint in postmenopausal women and consists of a variety of symptoms and strong repercussions that negatively affect comfort during sexual activity and ultimately impact quality of life. The EU and US REVIVE surveys have detected significant barriers in health-care professional management and educational programs that prevent correct diagnosis and effective treatment. This was common in both Europe and the US, but differential behaviors and patterns could be detected after reviewing the published results. The frequency of reporting VVA symptoms was lower in European participants. However, a better knowledge that VVA is a consequence of menopause was evident in Europe, probably in relation to more frequent gynecological visits and more frequent specialist visits as a referral health-care professional. Moreover, a trend towards an improved satisfaction with management by the health-care professional was observed in Europe. European participants acknowledged a significantly higher impact of VVA symptoms on sexual intercourse and partner interaction than North American (US) participants, and both cohorts were observed to have differences between their respective VVA symptom profiles. These observations have implications in the overall concerns that participants stated with long-term VVA medication and for the optimal therapeutic approach, providing evidence to support the concept that unexplored methods to improve management of patients with VVA remain.

Distal triceps injuries (including snapping triceps): A systematic review of the literature.

Science.gov (United States)

Shuttlewood, Kimberley; Beazley, James; Smith, Christopher D

2017-06-18

To review current literature on types of distal triceps injury and determine diagnosis and appropriate management. We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10 th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format. Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4 th -5 th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical

HPV-infektion spiller måske en rolle for udvikling af nonmelanom hudkræft hos immunkompetente personer

DEFF Research Database (Denmark)

Birch-Johansen, Fatima; Norrild, Bodil; Olesen, Anne Braae

2012-01-01

Human papillomavirus (HPV) is necessary for the development of cervical cancer and is also involved in vulvar, anus, penis and head and neck cancer. Little is known about the role of HPV infection in non-melanoma skin cancer (NMSC). Through a systematic review of the literature, we studied the HPV...

Are written information or counseling (WOMAN-PRO II program) able to improve patient satisfaction and the delivery of health care of women with vulvar neoplasms? Secondary outcomes of a multicenter randomized controlled trial

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Gehrig, Larissa; Kobleder, Andrea; Werner, Birgit; Denhaerynck, Kris; Senn, Beate

2017-01-01

Background: Patients with vulvar neoplasms report a lack of information, missing support in self-management and a gap in delivery of health care. Aim: The aim of the study was to investigate if written information or counseling based on the WOMAN-PRO II program are able to improve patient satisfaction and the delivery of health care from the health professional's perspective of women with vulvar neoplasms. Method: Patient satisfaction and the delivery of health care have been investigated as two secondary outcomes in a multicenter randomized controlled parallel-group phase II study (Clinical Trial ID: NCT01986725). In total, 49 women, from four hospitals (CH, AUT), completed the questionnaire PACIC-S11 after written information (n = 13) and counseling (n = 36). The delivery of health care was evaluated by ten Advanced Practice Nurses (APNs) by using the G-ACIC before and after implementing counseling based on the WOMAN-PRO II program. Results: There were no significant differences between the two groups identified (p = 0.25). Only few aspects were rated highly by all women, such as the overall satisfaction (M = 80.3 %) and satisfaction with organization of care (M = 83.0 %). The evaluation of delivery of health care by APNs in women who received counseling improved significantly (p = 0.031). Conclusions: There are indications, that the practice of both interventions might have improved patient satisfaction and counseling the delivery of health care. The aspects that have been rated low in the PACIC-S11 and G-ACIC indicate possibilities to optimize the delivery of health care.

A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women

DEFF Research Database (Denmark)

Joura, Elmar A; Giuliano, Anna R; Iversen, Ole-Erik

2015-01-01

obtained by means of biopsy or as part of definitive therapy (including a loop electrosurgical excision procedure and conization) was tested for HPV. RESULTS: The rate of high-grade cervical, vulvar, or vaginal disease irrespective of HPV type (i.e., disease caused by HPV types included in the 9v......HPV vaccine and those not included) in the modified intention-to-treat population (which included participants with and those without prevalent infection or disease) was 14.0 per 1000 person-years in both vaccine groups. The rate of high-grade cervical, vulvar, or vaginal disease related to HPV-31, 33, 45, 52...

Including Fathers in School Psychology Literature: A Review of Four School Psychology Journals

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Greif, Jennifer L.; Greif, Geoffrey L.

2004-01-01

It is well documented that fathers have a significant influence on their children's success in school. To examine the ways in which fathers have been represented in school psychology literature, the authors searched over 1,000 recent articles published in four leading U.S. school psychology journals ("Psychology in the Schools," "School Psychology…

Grey literature in meta-analyses.

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Conn, Vicki S; Valentine, Jeffrey C; Cooper, Harris M; Rantz, Marilyn J

2003-01-01

In meta-analysis, researchers combine the results of individual studies to arrive at cumulative conclusions. Meta-analysts sometimes include "grey literature" in their evidential base, which includes unpublished studies and studies published outside widely available journals. Because grey literature is a source of data that might not employ peer review, critics have questioned the validity of its data and the results of meta-analyses that include it. To examine evidence regarding whether grey literature should be included in meta-analyses and strategies to manage grey literature in quantitative synthesis. This article reviews evidence on whether the results of studies published in peer-reviewed journals are representative of results from broader samplings of research on a topic as a rationale for inclusion of grey literature. Strategies to enhance access to grey literature are addressed. The most consistent and robust difference between published and grey literature is that published research is more likely to contain results that are statistically significant. Effect size estimates of published research are about one-third larger than those of unpublished studies. Unfunded and small sample studies are less likely to be published. Yet, importantly, methodological rigor does not differ between published and grey literature. Meta-analyses that exclude grey literature likely (a) over-represent studies with statistically significant findings, (b) inflate effect size estimates, and (c) provide less precise effect size estimates than meta-analyses including grey literature. Meta-analyses should include grey literature to fully reflect the existing evidential base and should assess the impact of methodological variations through moderator analysis.

Actualización del diagnóstico y tratamiento de la neoplasia intraepitelial vulvar.

Directory of Open Access Journals (Sweden)

Rafael E. Pérez Castro

2011-09-01

Full Text Available La Neoplasia Intraepitelial Vulvar (NIV constituye lesiones potencialmente premalignas del epitelio escamoso de la vulva con diversos grados de diferenciación celular y maduración. En el aspecto histológico son hiperplasia de las células basales y parabasales, además tienen características genéticas morfológicas y metabólicas similares a las células cancerosas. Son etapas previas a la enfermedad. Generalmente las NIV se diagnostican como lesiones de alto grado (NIV I, II y III o carcinoma in situ. Alrededor del 5% progresan a la malignidad. Técnicamente puede ser un diagnóstico fácil, pero en la práctica no resulta así, siendo la vulvoscopia la principal arma para su diagnóstico. Estudios realizados en los últimos años señalan que aumenta cada vez más en mujeres más jóvenes, en pacientes con infección por HPV, en pacientes con neoplasia cervical intraepitelial o en cáncer en otras localizaciones del extracto genital inferior. Para tomar una decisión terapéutica hay que tener en cuenta: la edad de la paciente, la localización de las lesiones (áreas pilosas y no pilosas o descartar siempre un cáncer invasor y no invasor. Los tratamientos de lección pueden ser, extirpación local, vulvahectomía cutania parcial o total, destrucción con crioterapia o láser y técnicas combinadas de escisión o ablación. La conducta expectante valorando algunas características es la tendencia actual.

Truly included? A literature study focusing on the social dimension of inclusion in education

NARCIS (Netherlands)

Bossaert, Goele; Colpin, Hilde; Pijl, Sip Jan; Petry, Katja

2013-01-01

Social participation of students with special educational needs (SEN) is a key issue in the inclusion debate. However, the meaning of concepts like social integration, social inclusion and social participation used in current literature is often unclear. Recently, these concepts were clarified based

Tumor de la vulva, vulvectomía radical Vulvar tumor, total vulvectomy

Directory of Open Access Journals (Sweden)

Asbel Alfredo Vicente de la Cruz

2011-09-01

Full Text Available Los tumores de la vulva no son una rareza entre los cánceres que afectan a las féminas, pero tampoco son de los más frecuentes. Se presenta el caso de una mujer de 59 años, que en el año 2000 se le diagnostica carcinoma epidermoide del clítoris, en 2004 se vuelve a intervenir por recidiva tumoral, y en 2009 acude a nuestra consulta nuevamente y es cuando se decide realizarle vulvectomía y resección de vagina y todo el sistema ginecológico. Concluyó la intervención con una talla vesical extraperitoneal. El tumor se extiende hasta la porción inicial de la vagina y uretra. Se trata de un tumor maligno, bien diferenciado, que se ha comportado en una forma no habitual, con recidivas locales, cuando en apariencia el tumor había sido resecado en toda su extensión, y en esta última oportunidad, a pesar de ser un estadio avanzado, no hemos encontrado metástasis ni multicentricidad del tumor. La evolución posoperatoria fue sin complicaciones y se dio de alta al quinto día.The vulvar tumors are not uncommon among the different types of cancer involving females, but neither are the more frequent ones. This is the case of a female aged 59 that in 2000 is diagnosed with epidermoid carcinoma of clitoris, in 2004 is re-operated on by tumor relapse, and in 2009 she came again to our consultation and a vulvectomy, vagina resection and all gynecological system are carried out. Intervention concluded with an extraperitoneal vesical cutting. The tumor extends up to the initial portion of vagina and urethra. It is a malignant and well-differentiated tumor behaved in non habitual way with local relapses, when apparently the tumor was resected in all its extent, and in this last change, despite and advanced stage, there were neither tumor metastases nor multi-centralization. The postoperative course was free of complications receiving the discharge at fifth day.

Round Ligament of Uterus Leiomyoma: An Unusual Cause of Dyspareunia

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Ozer Birge

2015-01-01

Full Text Available Round ligament of uterus leiomyoma is a rare, benign tumor of the vulva. Its incidence is not known exactly, and the mean age ranges from 13 to 70. Although clinical properties of benign and malignant diseases in the vulvar area are frequently similar, early diagnosis and treatment are essential. Local excision is recommended as definitive therapy. We present an 28-year-old female without any birth with a mass in anterior vaginal wall diagnosed as vulvar leiomyoma. In conclusion, a brief review of relevant literature emphasizes that leiomyomas are quite rare outside of the uterus but they might occur in any tissue or organ containing smooth muscle, spontaneously or parasitically after the spreading effect of an accident or surgical trauma. Clinicians should be alert especially for the diagnosis in a tissue with smooth muscle content.

Vulvar lactating adenoma associated to a fibroadenoma: common ...

African Journals Online (AJOL)

Ectopic breast tissue is defined as glands located outside of the breast. Ectopic breast tissue should be excised because it may develop benign (fibroadenoma) or malignant pathologic processes. Less than forty cases of fibroadenomas have been reported in the literature. Although lactation changes can occur, lactating ...

Dutch guideline for clinical foetal-neonatal and paediatric post-mortem radiology, including a review of literature.

Science.gov (United States)

Sonnemans, L J P; Vester, M E M; Kolsteren, E E M; Erwich, J J H M; Nikkels, P G J; Kint, P A M; van Rijn, R R; Klein, W M

2018-06-01

Clinical post-mortem radiology is a relatively new field of expertise and not common practice in most hospitals yet. With the declining numbers of autopsies and increasing demand for quality control of clinical care, post-mortem radiology can offer a solution, or at least be complementary. A working group consisting of radiologists, pathologists and other clinical medical specialists reviewed and evaluated the literature on the diagnostic value of post-mortem conventional radiography (CR), ultrasonography, computed tomography (PMCT), magnetic resonance imaging (PMMRI), and minimally invasive autopsy (MIA). Evidence tables were built and subsequently a Dutch national evidence-based guideline for post-mortem radiology was developed. We present this evaluation of the radiological modalities in a clinical post-mortem setting, including MIA, as well as the recently published Dutch guidelines for post-mortem radiology in foetuses, neonates, and children. In general, for post-mortem radiology modalities, PMMRI is the modality of choice in foetuses, neonates, and infants, whereas PMCT is advised in older children. There is a limited role for post-mortem CR and ultrasonography. In most cases, conventional autopsy will remain the diagnostic method of choice. Based on a literature review and clinical expertise, an evidence-based guideline was developed for post-mortem radiology of foetal, neonatal, and paediatric patients. What is Known: • Post-mortem investigations serve as a quality check for the provided health care and are important for reliable epidemiological registration. • Post-mortem radiology, sometimes combined with minimally invasive techniques, is considered as an adjunct or alternative to autopsy. What is New: • We present the Dutch guidelines for post-mortem radiology in foetuses, neonates and children. • Autopsy remains the reference standard, however minimal invasive autopsy with a skeletal survey, post-mortem computed tomography, or post

Long-term maintenance therapy for vulvar lichen sclerosus: the results of a randomized study comparing topical vitamin E with an emollient.

Science.gov (United States)

Virgili, Annarosa; Minghetti, Sara; Borghi, Alessandro; Corazza, Monica

2013-04-01

The chronic and relapsing nature of vulvar lichen sclerosus (VLS) represents a challenge for its long-term management after an effective treatment with topical corticosteroids. To compare the effect of topical vitamin E with that of an emollient in reducing the risk of VLS relapse over a 52-week maintenance treatment. 156 patients with VLS were enrolled in a 12-week active treatment phase on topical 0.1% mometasone furoate ointment once daily. Those who achieved disease remission entered a 52-week maintenance phase in which patients were randomized to apply either an emollient or topical vitamin E once daily. 80 patients entered the maintenance phase. At 52 weeks, for the vitamin E maintenance group, the cumulative crude relapse rate was 27.8% and the cumulative modified crude relapse rate was 55.6%. For the emollient maintenance group, the cumulative crude relapse rate was 22.7% and the cumulative modified crude relapse rate was 50.0%. The median time to relapse was 20 weeks for the vitamin E group and 18.7 weeks for the emollient group. Once VLS has been stabilized with topical corticosteroids, long-term treatment with both vitamin E and emollients may be considered in maintain LS remission.

Paraurethral Leiomyoma in a 20 Year-old Woman: A Case Report

Directory of Open Access Journals (Sweden)

Emily Adams-Piper

2016-01-01

Full Text Available We present the case of a 20 year-old woman with a vulvar mass, found to be a paraurethral leiomyoma. She subsequently underwent supermedial-approach paraurethral mass excision, distal urethral reconstruction and cystourethroscopy. Paraurethral leiomyoma make up approximately five percent of urethral tumors. This case depicts the presentation and treatment of a paraurethral leiomyoma in one of the youngest women reported in the literature.

Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey.

Science.gov (United States)

Kingsberg, Sheryl A; Wysocki, Susan; Magnus, Leslie; Krychman, Michael L

2013-07-01

Vulvar and vaginal atrophy (VVA) is a chronic medical condition experienced by many postmenopausal women. Symptoms include dyspareunia (pain with intercourse), vaginal dryness, and irritation and may affect sexual activities, relationships, and activities of daily life. The aim of this study is to characterize postmenopausal women's experience with and perception of VVA symptoms, interactions with healthcare professionals (HCPs), and available treatment options. An online survey was conducted in the United States in women from KnowledgePanel(®) , a 56,000-member probability-selected Internet panel projectable to the overall US population. Altogether, 3,046 postmenopausal women with VVA symptoms (the largest US cohort of recent surveys) responded to questions about their knowledge of VVA, impact of symptoms on their activities, communication with HCPs, and use of available treatments. Percent is calculated as the ratio of response over total responding for each question for all and stratified participants. The most common VVA symptoms were dryness (55% of participants), dyspareunia (44%), and irritation (37%). VVA symptoms affected enjoyment of sex in 59% of participants. Additionally, interference with sleep, general enjoyment of life, and temperament were reported by 24%, 23%, and 23% of participants, respectively. Few women attributed symptoms to menopause (24%) or hormonal changes (12%). Of all participants, 56% had ever discussed VVA symptoms with an HCP and 40% currently used VVA-specific topical treatments (vaginal over-the-counter [OTC] products [29%] and vaginal prescription therapies [11%]). Of those who had discussed symptoms with an HCP, 62% used OTC products. Insufficient symptom relief and inconvenience were cited as major limitations of OTC products and concerns about side effects and cancer risk limited use of topical vaginal prescription therapies. VVA symptoms are common in postmenopausal women. Significant barriers to treatment include lack of

Lipomatous angiomyofibroblastoma: A 20-year literature review

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Julie Guilmette, MD

2015-09-01

Full Text Available Lipomatous angiomyofibroblastoma (LAMF is a rare superficial muco-cutaneous tumor of the female genital tract in women of reproductive age and early menopause. We report the case of a 36-year-old woman who presented with an asymptomatic 1 cm round vulvar mass. The tumor showed both hypercellular and hypocellular areas composed of spindle and epithelioid cells set in a loose fibromyxoid background. Anastomosing networks of small to medium sized dilated vessels, surrounded by condensed spindle cells, were distributed equally throughout the tumor. Mature adipocytes comprised more than half of the tumor's volume. The neoplastic cells were reactive for both desmin and vimentin and did not express CD34, smooth muscle actin, S100 protein and muscle-specific actin. Making the right diagnosis may be challenging to medical professionals as LAMF may mimic both clinically and histologically several other benign and malignant gynecological lesions. LAMF has a benign course without evidence of local recurrence or metastatic potential.

Vulvær intraepithelial neoplasi

DEFF Research Database (Denmark)

Hansen, Signe Østergaard; Vorbeck, Christina Steen; Meinert, Mette

2018-01-01

Vulvar intraepithelial neoplasia Vulvar intraepithelial neoplasia (VIN) is a rare but premalig­nant condition. VIN has two aetiological pathways: a human papillomavirus (HPV)-dependent pathway, which is a vulvar high-grade squamous intraepithelial lesion (HSIL), and an HPV-independent pathway......, called differentiated VIN (d-VIN), associated with lichen sclerosus. d-VIN is more aggressive than vulvar HSIL. In case of symptoms, a biopsy should be performed. The recurrence risk is high: 25-50% regardless of treatment type. We recommend treatment with imiquimod as first choice to avoid mutilating...

The overexpression of p16 is not a surrogate marker for high-risk human papilloma virus genotypes and predicts clinical outcomes for vulvar cancer.

Science.gov (United States)

Sznurkowski, Jacek J; Żawrocki, Anton; Biernat, Wojciech

2016-07-13

We aimed to evaluate the correlation between p16(ink4a)-overexpression and high risk (hr)HPV-DNA in vulvar squamous cell carcinoma (vSCC) tumors as well as the impact of both biomarkers on the prognosis of vSCC patients. PCR-detection of (hr)HPV-DNA and immunohistochemical staining for p16(ink4a) were conducted in 85 vSCC tumors. Survival analyses included the Kaplan-Meier method, log-rank test and Cox proportional hazards model. p16(ink4a)-overexpression and (hr)HPV-DNA were detected in 35 and 37 of the 85 tumors, respectively. Among the 35 p16(ink4a)-positive tumors, 10 lacked (hr)HPV-DNA (29 %). Among the 50 p16(ink4a)-negative tumors, (hr)HPV-DNA was detected in 12 cases (24 %). The median follow-up was 89.20 months (range 1.7-189.5 months). P16(ink4a)-overexpression, but not (hr)HPV-DNA positivity of the primary tumor, was correlated with prolonged overall survival (OS) (p = 0.009). P16(ink4a)-overexpression predicted a better response to radiotherapy (p overexpression (p = 0.022), and adjuvant RTX (p overexpression (HR 1-2.11, 95 % CI 1.13-3.95, p = 0.001) are independent prognostic factors. The discovered overlap suggests the use of p16(ink4a) in combination with HPV-DNA detection as an ancillary test for future research and clinical studies in vSCC. The prognostic and predictive value of p16(ink4a)-overexpression should be tested in larger cohort studies.

Two Distinct Pathways to Development of Squamous Cell Carcinoma of the Vulva

Directory of Open Access Journals (Sweden)

Yutaka Ueda

2011-01-01

Full Text Available Squamous cell carcinoma (SCC accounts for approximately 95% of the malignant tumors of the vaginal vulva and is mostly found in elderly women. The future numbers of patients with vulvar SCC is expected to rise, mainly because of the proportional increase in the average age of the general population. Two different pathways for vulvar SCC have been put forth. The first pathway is triggered by infection with a high-risk-type Human Papillomavirus (HPV. Integration of the HPV DNA into the host genome leads to the development of a typical vulvar intraepithelial neoplasia (VIN, accompanied with overexpression of p14ARF and p16INK4A. This lesion subsequently forms a warty- or basaloid-type SCC. The HPV vaccine is a promising new tool for prevention of this HPV related SCC of the vulva. The second pathway is HPV-independent. Keratinizing SCC develops within a background of lichen sclerosus (LS through a differentiated VIN. It has a different set of genetic alterations than those in the first pathway, including p53 mutations, allelic imbalances (AI, and microsatellite instability (MSI. Further clinical and basic research is still required to understand and prevent vulvar SCC. Capsule. Two pathway for pathogenesis of squamous cell carcinoma of the value are reviewed.

Affective World Literature

DEFF Research Database (Denmark)

Vilslev, Annette Thorsen

The PhD dissertation compares the literary theory and novels of modern Japanese writer Natsume Sōseki. It reads Sōseki’s Theory of Literature (2009, Bungakuron, 1907) as an inherently comparative and interdisciplinary approach to theorizing feelings in world literature. More broadly, the disserta......The PhD dissertation compares the literary theory and novels of modern Japanese writer Natsume Sōseki. It reads Sōseki’s Theory of Literature (2009, Bungakuron, 1907) as an inherently comparative and interdisciplinary approach to theorizing feelings in world literature. More broadly......, the dissertation investigates the critical negotiation of the novel as a travelling genre in Japan in the beginning of the 20th century, and, more specifically, Sōseki’s work in relation to world literature and affect theory. Sōseki’s work is highly influential in Japan and East Asia, and his novels widely...... circulated beyond Japan. Using Sōseki’s theory as an example, and by comparing it to other theories, the dissertation argues that comparative literature needs to include not only more non-Western literature but also more non-Western literary theories in the ongoing debate of world literature. Close...

Prevalence and type distribution of human papillomavirus in squamous cell carcinoma and intraepithelial neoplasia of the vulva

DEFF Research Database (Denmark)

Faber, Mette T; Sand, Freja Lærke; Albieri, Vanna

2017-01-01

In this updated systematic review and meta-analysis, we estimate the pooled prevalence of human papillomavirus (HPV) DNA and HPV type distribution in squamous cell carcinoma of the vulva (vulvar cancer) and vulvar intraepithelial neoplasia (VIN). PubMed, Embase and Cochrane Library databases were...... used to identify studies published between 1990 and 2015 and using a PCR-based or hybrid capture test to evaluate the presence of HPV DNA in vulvar cancer or VIN. Pooled estimates of the HPV prevalence with corresponding 95% confidence intervals (CI) were calculated based on a random effects model...... samples. Thus, HPV vaccination targeting these HPV types may prevent a substantial number of vulvar lesions....

The Content of Literature in the High School.

Science.gov (United States)

Burton, Dwight L.

The content of a literature program defined in terms of the structure of literature is proposed. A three-layer definition of structure is suggested which considers (1) the substance of literature, including man and his gods, man and the natural world, man and other men, and man and himself; (2) mode in literature, including the romantic, comic,…

Literature survey of matrix diffusion theory and of experiments and data including natural analogues

International Nuclear Information System (INIS)

Ohlsson, Yvonne; Neretnieks, I.

1995-08-01

Diffusion theory in general and matrix diffusion in particular has been outlined, and experimental work has been reviewed. Literature diffusion data has been systematized in the form of tables and data has been compared and discussed. Strong indications of surface diffusion and anion exclusion have been found, and natural analogue studies and in-situ experiments suggest pore connectivity in the scale of meters. Matrix diffusion, however, mostly seem to be confined to zones of higher porosity extending only a few centimeters into the rock. Surface coating material do not seem to hinder sorption or diffusion into the rock. 54 refs, 18 tabs

Locating grey literature on communication disorders.

Science.gov (United States)

Shpilko, Inna

2005-01-01

This article provides an overview of selected Web-based resources containing grey literature in the area of communication disorders. It is geared to practitioners, researchers, students, and consumers seeking reliable, freely available scientific information. Grey (or gray) literature has been defined as "that which is produced on all levels of government, academics, business, and industry in print and electronic formats, but which is not controlled by commercial publishers."1 This paper reviews various general reference sources potentially containing grey literature on communication disorders. This review includes identification of the methods specialists in this field use to obtain this valuable, yet often overlooked, literature. Access points and search tools for identifying grey literature on communication disorders are recommended. Commercial databases containing grey literature are not included. Conclusions presented in this article are considered complementary to traditionally published information resources on communication disorders, such as scholarly journals, online databases, etc.

The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature.

Science.gov (United States)

Rasberry, Catherine N; Lee, Sarah M; Robin, Leah; Laris, B A; Russell, Lisa A; Coyle, Karin K; Nihiser, Allison J

2011-06-01

The purpose of this review is to synthesize the scientific literature that has examined the association between school-based physical activity (including physical education) and academic performance (including indicators of cognitive skills and attitudes, academic behaviors, and academic achievement). Relevant research was identified through a search of nine electronic databases using both physical activity and academic-related search terms. Forty-three articles (reporting a total of 50 unique studies) met the inclusion criteria and were read, abstracted, and coded for this synthesis. Findings of the 50 studies were then summarized. Across all the studies, there were a total of 251 associations between physical activity and academic performance, representing measures of academic achievement, academic behavior, and cognitive skills and attitudes. Slightly more than half (50.5%) of all associations examined were positive, 48% were not significant, and 1.5% were negative. Examination of the findings by each physical activity context provides insights regarding specific relationships. Results suggest physical activity is either positively related to academic performance or that there is not a demonstrated relationship between physical activity and academic performance. Results have important implications for both policy and schools. Copyright © 2010 Elsevier Inc. All rights reserved.

Condilomatosis vulvar grave Severe vulvar condyloma

Directory of Open Access Journals (Sweden)

Idalberto Clavijo Balart

Full Text Available Se describe el caso clínico de una paciente que desde hacía 9 años presentaba numerosas verrugas en la vulva, además de prurito y dolor ocasional, más frecuentes al realizar determinadas actividades. Se efectuó vulvectomía simple y se comprobó la presencia de cambios típicos coilocíticos, de modo que no se trataba de lesiones malignas. Resultó imposible determinar el virus del papiloma humano, aunque por las manifestaciones clínicas podía corresponder a las cepas 6 y 11. La fémina fue egresada sin elementos de infección local, con tejido de granulación útil y compensada metabólicamente, pero con seguimiento por consulta externa hasta los 3 meses de operada.A case report of a patient who presented with numerous warts in her vulva for 9 years besides pruritus and occasional pain is described, more frequent when she was doing certain activities. Simple vulvectomy was performed and the presence of typical koilocytotic changes was confirmed, but there were not malignant lesions. It was impossible to determine the human papilloma virus, although by its clinical manifestations could be strains 6 and 11. The patient was discharged metabolically compensated with useful granulation tissue and without local infection, but she was followed for 3 months after surgery in the outpatient department.

Condyloma-like squamous cell carcinoma of the vulva: report of two midline cases

OpenAIRE

Verma, Shyam B; Wollina, Uwe

2012-01-01

Shyam B Verma,1 Uwe Wollina21Nirvana Clinic, Vadodara, Gujarat, India; 2Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, GermanyAbstract: Vulvar cancer is uncommon and may be confused with genital condylomata. We report two cases of middle-aged women presenting with exophytic vulvar tumors of the midline for which diagnosis of a vulvar squamous cell carcinoma was confirmed by histopathology. Risk factors, staging, and treatment options are...

Gray literature: An important resource in systematic reviews.

Science.gov (United States)

Paez, Arsenio

2017-08-01

Systematic reviews aide the analysis and dissemination of evidence, using rigorous and transparent methods to generate empirically attained answers to focused research questions. Identifying all evidence relevant to the research questions is an essential component, and challenge, of systematic reviews. Gray literature, or evidence not published in commercial publications, can make important contributions to a systematic review. Gray literature can include academic papers, including theses and dissertations, research and committee reports, government reports, conference papers, and ongoing research, among others. It may provide data not found within commercially published literature, providing an important forum for disseminating studies with null or negative results that might not otherwise be disseminated. Gray literature may thusly reduce publication bias, increase reviews' comprehensiveness and timeliness, and foster a balanced picture of available evidence. Gray literature's diverse formats and audiences can present a significant challenge in a systematic search for evidence. However, the benefits of including gray literature may far outweigh the cost in time and resource needed to search for it, and it is important for it to be included in a systematic review or review of evidence. A carefully thought out gray literature search strategy may be an invaluable component of a systematic review. This narrative review provides guidance about the benefits of including gray literature in a systematic review, and sources for searching through gray literature. An illustrative example of a search for evidence within gray literature sources is presented to highlight the potential contributions of such a search to a systematic review. Benefits and challenges of gray literature search methods are discussed, and recommendations made. © 2017 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Grey literature: An important resource in systematic reviews.

Science.gov (United States)

Paez, Arsenio

2017-12-21

Systematic reviews aid the analysis and dissemination of evidence, using rigorous and transparent methods to generate empirically attained answers to focused research questions. Identifying all evidence relevant to the research questions is an essential component, and challenge, of systematic reviews. Grey literature, or evidence not published in commercial publications, can make important contributions to a systematic review. Grey literature can include academic papers, including theses and dissertations, research and committee reports, government reports, conference papers, and ongoing research, among others. It may provide data not found within commercially published literature, providing an important forum for disseminating studies with null or negative results that might not otherwise be disseminated. Grey literature may thusly reduce publication bias, increase reviews' comprehensiveness and timeliness and foster a balanced picture of available evidence. Grey literature's diverse formats and audiences can present a significant challenge in a systematic search for evidence. However, the benefits of including grey literature may far outweigh the cost in time and resource needed to search for it, and it is important for it to be included in a systematic review or review of evidence. A carefully thought out grey literature search strategy may be an invaluable component of a systematic review. This narrative review provides guidance about the benefits of including grey literature in a systematic review, and sources for searching through grey literature. An illustrative example of a search for evidence within grey literature sources is presented to highlight the potential contributions of such a search to a systematic review. Benefits and challenges of grey literature search methods are discussed, and recommendations made. © 2017 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Two novel genital human papillomavirus (HPV) types, HPV68 and HPV70, related to the potentially oncogenic HPV39.

OpenAIRE

Longuet, M; Beaudenon, S; Orth, G

1996-01-01

The genomes of two novel human papillomavirus (HPV) types, HPV68 and HPV70, were cloned from a low-grade cervical intraepithelial neoplasia and a vulvar papilloma, respectively, and partially sequenced. Both types are related to HPV39, a potentially oncogenic virus. HPV68 and HPV70 were also detected in genital intraepithelial neoplasia from three patients and one patient, respectively. Comparison with sequence data in the literature indicates that the subgenomic ME180-HPV DNA fragment, clone...

Xp11.22 Microduplications Including HUWE1: Case Report and Literature Review.

Science.gov (United States)

Orivoli, Sonia; Pavlidis, Elena; Cantalupo, Gaetano; Pezzella, Marianna; Zara, Federico; Garavelli, Livia; Pisani, Francesco; Piccolo, Benedetta

2016-01-01

Xp11.22 microduplications have been reported in different patients with X-linked intellectual disability. Comparing the duplicated segments, a minimum region of overlap has been identified. Within this region, only one gene, the HUWE1 gene, coding the E3 ubiquitin protein ligase, turned out to be duplicated in all previously described patients. We provide a review of the literature on this topic, making a comparison not only of genetic aspects, but also of clinical, neurophysiological, and neuroradiological findings. Furthermore, we describe the phenotypic and molecular characterization of a case of intellectual disability in a child carrying one of the smallest Xp11.22 microduplications reported, involving the whole sequence of HUWE1 gene. Unlike previously described cases, our patient's neuroimaging showed abnormal findings; he also experienced one seizure and showed interictal electroencephalogram (EEG) epileptiform abnormalities. Given the fact that HUWE1 duplications and mutations have previously been described in several patients with X-linked cognitive impairment, our findings support the hypothesis that HUWE1 gene might be implicate in the pathogenesis of intellectual disability. Nevertheless, further investigations and a more detailed examination of patients' clinical history are needed to clear up other eventual genotype-phenotype correlations, such as the presence of epilepsy/epileptiform EEG abnormalities. Georg Thieme Verlag KG Stuttgart · New York.

Literature and Science Create an Engaging Combination.

Science.gov (United States)

Brabham, Edna Greene

1997-01-01

Discusses programs and research that support the integration of literature and science. Reviews literature selections across a range of genres that complement topics included in middle school science, including science fiction and poetry. Considers resources educators can use to find additional science-related material. (JPB)

Vaginal itching and discharge - child

Science.gov (United States)

Pruritus vulvae; Itching - vaginal area; Vulvar itching; Yeast infection - child ... Common causes of vaginal itching and discharge in young girls include: Chemicals such as perfumes and dyes in detergents, fabric softeners, creams, ointments, ...

Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report.

Science.gov (United States)

Cobo, Fernando; Rodríguez-Granger, Javier; López, Enrique M; Jiménez, Gemma; Sampedro, Antonio; Aliaga-Martínez, Luis; Navarro-Marí, José María

2017-02-01

The clinical and microbiological characteristics of prosthetic joint infection (PJI) caused by Candida species is described, including 72 cases in the literature and a case of Candida glabrata infection handled at the present centre. We describe one patient and using the key words 'fungal prosthetic joint infection' and 'candida prosthetic joint infection' we searched MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science, CINAHL and Cochrane systematic review databases for case reports of this condition. Out of the 73 patients, 38 were female; mean age at diagnosis was 65.7 (± SD 18) yrs; 50 had risk factors for candidal infection such as systemic disease (e.g. rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus) and/or immunosuppressive therapy in 18 (24.6%) cases, diabetes mellitus in 14 (19.1%), immunosuppression due to malignant or chronic disease in 24 (32.8%) and long-term antibiotic use in four (5.4%) patients. Infection site was the knee in 36 patients and hip in 35; pain was present in 43 patients and swelling in 23 and the mean surgery-diagnosis interval was 32 months. The most frequent species was C. albicans, followed by C. parapsilosis. The diagnosis was obtained from joint fluid aspirate in 33 cases and intra-operative samples in 16. Susceptibility to antifungals was tested in only 21 isolates. The most frequently used antifungals were fluconazole and amphotericin B. Two-stage exchange arthroplasty was performed in 30 patients and resection arthroplasty in 31; 56 patients were cured with a combination of medical and surgical treatment; one patient died from the infection. PJI caused by Candida requires a high index of suspicion; surgery with long-term antifungal therapy is recommended.

Cancer - vulva

Science.gov (United States)

... freckle, which may be pink, red, white, or gray Skin thickening or lump Skin sore (ulcer) Other ... vulvar cancer; HPV - vulvar cancer Images Female perineal anatomy References Jhingran A, Russell AH, Seiden MV, et ...

Macro-regional variation in attitudes toward and experiences of vulvar and vaginal atrophy among Italian post-menopausal women: a post hoc analysis of REVIVE survey data.

Science.gov (United States)

Nappi, Rossella E; Particco, Martire; Biglia, Nicoletta; Cagnacci, Angelo; Di Carlo, Costantino; Luisi, Stefano; Paoletti, Anna Maria

2017-05-01

Italian participants in the European REVIVE survey reported that vaginal and vulvar atrophy (VVA) impaired various aspects of their lives, notably the ability to enjoy sex. The aim of the present study was to explore regional differences in knowledge, experiences, and treatment of VVA in the Italian REVIVE sample (n = 1000), which was analyzed according to region of residence. While many respondents were unfamiliar with the VVA condition, most could relate their VVA symptoms to the menopause. The rate of diagnosis of VVA was twice as high in Central Italy as in the North-East. For individual VVA symptoms, 25.4-41.6% of respondents judged that the symptom had worsened over time. There were no significant regional differences for symptoms in terms of reported rate, change in severity, impact on sexual activity, or health-care visits. Testosterone cream and OTC medication based on hyaluronic acid showed significant regional differences in lifetime rates of use. In Italy, there are modest regional differences in knowledge, diagnosis, and treatment of VVA, some of which may be explained by inter-regional differences in health care. Further efforts are needed to ensure that Italian women are properly informed about VVA and have access to appropriate health care and treatments.

Friendship and literacy through literature.

Science.gov (United States)

Palincsar, A S; Parecki, A D; McPhail, J C

1995-10-01

The exploratory research reported in this article was designed to determine the processes and outcomes of planning thematic literacy instruction in a holistic and contextualized manner. The work was conducted in an upper-elementary, self-contained setting for students identified as learning disabled. Specifically, the instructional activities included (a) interactive readings from literature on friendship, (b) personal written responses to the literature, (c) supported retellings of the literature, (d) performance related to the literature, and (e) journal writing on the topic of friendship. The outcomes are reported in terms of the use of intertextuality over the course of the 6-week unit, the emergence of theme as a salient feature in literature, and a change in the children's conceptions of friendship. More specific literacy outcomes are captured in case studies of 3 children.

Literature Review of Multicultural Instrumentation

Science.gov (United States)

Sarraj, Huda; Carter, Stacy; Burley, Hansel

2015-01-01

Demographic changes at the national level emphasize a critical need for multicultural education to be included as part of undergraduate education. This critical review of the literature examines 10 multicultural instruments that are suitable for use in K-12 or higher education institutions. This is a novel literature review in that it is the first…

Re-Viewing Literature in Hermeneutic Research

Directory of Open Access Journals (Sweden)

Elizabeth Smythe PhD, RN, RM

2012-02-01

Full Text Available In academia there seems to be a taken for granted assumption that there is one way to do a literature review. This paper argues that the manner of reviewing literature needs to be congruent with the particular research methodology. As an example, the authors explicate reviewing literature in hermeneutic research. The paper begins by discussing philosophical assumptions. The authors then offer personal accounts of their experiences of working with literature in ways that are congruent with hermeneutic methodology. It is argued that the key purpose of exploring literature in hermeneutic research is to provide context and provoke thinking. Literature, which can include anything that provokes thinking on the phenomenon of interest, becomes an essential dialogical partner from which scholarly thinking and new insights emerge. In conclusion distinguishing hallmarks of ways of working hermeneutically with literature are articulated

Presence of Ureaplasma diversum in the genital tracts of female dairy cattle in Mato Grosso State, Brazil.

Science.gov (United States)

Azevedo, Jaqueline B; Silva, Gustavo S; Rocha, Priscylla S; Pitchenin, Letícia C; Dutra, Valéria; Nakazato, Luciano; de Oliveira, Anderson Castro Soares; Pescador, Caroline A

2017-02-01

Ureaplasma diversum infection in bovine females may result in various reproductive problems, including granular vulvovaginitis, abortion, weak calves, salpingitis, and spontaneous abortion. The presence of U. diversum in a dairy bovine population from midwestern Brazil has not been established. The aim of this study was to determine whether U. diversum was present in dairy cattle from midwestern Brazil using polymerase chain reaction (PCR). Vulvovaginal mucus was analyzed from 203 cows located in six municipalities in the north region of Mato Grosso State, Brazil. A total of 25% of dairy cows with vulvovaginitis were positive for U. diversum. The factors evaluated were included in a multivariable logistic regression model with the presence of at least one positive cow in the herd serving as the dependent variable. Three variables were significantly associated with a U. diversum-positive PCR and were included in the final multivariable model: number of parities, vulvar lesions, and reproductive problems. For each new parity, the chance of U. diversum infection decreased 0.03-fold, indicating that cows with the highest number of parities were more protected. The presence of vulvar lesions was increased 17.6-fold in females positive for U. diversum, suggesting that this bacterium could be related to the red granular lesions in the vulvar mucosa, whereas reproductive problems were increased 7.6-fold. However, further investigations should be conducted to ascertain the effects of U. diversum in association with other mycoplasma species in the herds studied.

Making Multicultural Literature Meaningful.

Science.gov (United States)

Bishop, Kay

2003-01-01

Discusses definitions and types of multicultural literature and why it should be included in school curriculum. Describes Banks's four-level model for integrating ethnic content into the curriculum with increasing levels of sophistication and discusses how to select and evaluate multicultural resources to include in a media center collection. (LRW)

Searching for Grey Literature for Systematic Reviews: Challenges and Benefits

Science.gov (United States)

Mahood, Quenby; Van Eerd, Dwayne; Irvin, Emma

2014-01-01

There is ongoing interest in including grey literature in systematic reviews. Including grey literature can broaden the scope to more relevant studies, thereby providing a more complete view of available evidence. Searching for grey literature can be challenging despite greater access through the Internet, search engines and online bibliographic…

Fibroma of the vulva: a case report.

Science.gov (United States)

Berlin, Melvin; Berlin, Scott

2007-06-01

It is rare to see large vulvar growths that are not trauma related in young women. The largest vulvar mass recorded dates back to 1851. Fibroma of the vulva is not common but, if not seen early and removed, can be emotionally draining for the patient. A large vulvar mass was found in an 18-year-old woman and was expeditiously excised. The patient was emotionally withdrawn and would not participate in any school or social activities. She would carry moist paper towels with her to prevent maceration of the lower abdomen and lesion wall. An extraordinary physical finding can embarrass and alter a patient's demeanor and should be addressed without delay. The emotional condition of our patient prior to surgery consisted of depression and emotional stress due to the large vulvar mass. Following surgery the patient was comfortable, and her demeanor is now excellent.

Discourse Analysis in Stylistics and Literature Instruction.

Science.gov (United States)

Short, Mick

1990-01-01

A review of research regarding discourse analysis in stylistics and literature instruction covers studies of text, systematic analysis, meaning, style, literature pedagogy, and applied linguistics. A 10-citation annotated bibliography and a larger unannotated bibliography are included. (CB)

17 CFR 230.156 - Investment company sales literature.

Science.gov (United States)

2010-04-01

... literature. 230.156 Section 230.156 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... literature. (a) Under the federal securities laws, including section 17(a) of the Securities Act of 1933 (15... of any means or instrumentality of interstate commerce or of the mails, to use sales literature which...

Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus

Directory of Open Access Journals (Sweden)

Anne N. Flynn, MD

2015-12-01

Conclusions: This study shows high patient satisfaction and low complication risk associated with surgical correction of clitoral phimosis and lysis of vulvar adhesions for VGF caused by LS. Patients reported improvement in clitoral sensation and ability to achieve orgasm, as well as decreased dyspareunia. Surgical correction of vulvar scarring is a viable option to restore vulvar anatomy and sexual function in appropriate candidates with anogenital LS. Flynn AN, King M, Rieff M, Krapf J, and Goldstein AT. Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sex Med 2015;3:251–255.

Epidemiology of vulvar lichen sclerosus and its correlation with other conditions

Directory of Open Access Journals (Sweden)

José Juvenal Linhares

2003-03-01

Full Text Available OBJECTIVES: To investigate some epidemiological data of lichensclerosus patients; to verify its association with other conditionsand compare these data with the literature. METHODS:Retrospective analysis of medical records of patients submitted to12,724 vaginal/cervical examinations and vulvoscopies, at Hospitaldo Servidor Público Estadual “Francisco Morato de Oliveira” – SãoPaulo, from August 1998 to August 2001. RESULTS: The frequencyof lichen sclerosus confirmed by pathological examination was0.73% among these patients. Mean age was 63.6 years. Mostpatients presenting the condition were aged over 50 years (81/93, and the difference was statistically significant as comparedwith younger subjects (12/93. Caucasian women represented91.4% of the sample and black, 8.6%. Smokers accounted for 8.6%of the cases. Autoimmune diseases were detected in 31.2%,psychiatric disorders in 17.2%, and neoplasms in 11.8% of thosesuffering from lichen sclerosus. The colpocytology of one patientwas classified as Papanicolaou class V. CONCLUSION: These datashow the population studied presented findings similar to thosereported in the literature.

Vulvar Pyogenic Granuloma in a Postmenopausal Woman: Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Deniz Cemgil Arikan

2011-01-01

Full Text Available Introduction. Although pyogenic granulomas (PG are common and benign vascular proliferations of the skin and mucous membranes, they are relatively rare on the vulva. Case Presentation. A 57-year-old G7P7 postmenopausal woman presented with a 3-year history of a foul smell and bleeding lesions in the genital region. A gynecologic examination revealed multiple large papillomatous, pedunculated, and lobulated lesions that were cherry-red and infective in appearance. There was a 2-cm lesion at the upper intersection of the labia majora, a 2-cm lesion on the right labium majus, and a 4-cm lesion on the clitoris. The patient complained of itching, and the lesions were asymptomatic, except for occasional bleeding. All lesions were excised and sent for histopathological examination, which revealed an ulcerated polypoidal structure with extensive proliferation of vascular channels lined by a single layer of endothelium. The histopathological features were consistent with PG. Conclusion. The present case is the first case of multiple pyogenic granulomas on the vulva in a postmenopausal woman.

Vulvar Pyogenic Granuloma in a Postmenopausal Woman: Case Report and Review of the Literature

Science.gov (United States)

Arikan, Deniz Cemgil; Kiran, Gurkan; Sayar, Hamide; Kostu, Bulent; Coskun, Ayhan; Kiran, Hakan

2011-01-01

Introduction. Although pyogenic granulomas (PG) are common and benign vascular proliferations of the skin and mucous membranes, they are relatively rare on the vulva. Case Presentation. A 57-year-old G7P7 postmenopausal woman presented with a 3-year history of a foul smell and bleeding lesions in the genital region. A gynecologic examination revealed multiple large papillomatous, pedunculated, and lobulated lesions that were cherry-red and infective in appearance. There was a 2-cm lesion at the upper intersection of the labia majora, a 2-cm lesion on the right labium majus, and a 4-cm lesion on the clitoris. The patient complained of itching, and the lesions were asymptomatic, except for occasional bleeding. All lesions were excised and sent for histopathological examination, which revealed an ulcerated polypoidal structure with extensive proliferation of vascular channels lined by a single layer of endothelium. The histopathological features were consistent with PG. Conclusion. The present case is the first case of multiple pyogenic granulomas on the vulva in a postmenopausal woman. PMID:21912553

A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (Types 6/11/16/18) vaccine against high-grade cervical and external genital lesions

DEFF Research Database (Denmark)

Kjaer, Susanne K; Sigurdsson, Kristján; Iversen, Ole-Erik

2009-01-01

Quadrivalent human papillomavirus (HPV) vaccine has been shown to provide protection from HPV 6/11/16/18-related cervical, vaginal, and vulvar disease through 3 years. We provide an update on the efficacy of the quadrivalent HPV vaccine against high-grade cervical, vaginal, and vulvar lesions bas...

Retropubic cartilaginous cyst presenting as stress urinary incontinence

DEFF Research Database (Denmark)

Elmelund, Marlene; Thind, Peter; Klarskov, Niels

2015-01-01

A pubic cartilaginous cyst is a rare condition and is considered a result of degenerative changes in the symphysis pubis, mainly described in elderly multiparous women. There are only a few reported cases in the literature, and patients presented most frequently with a painful vaginal/vulvar mass....... This case report is the first to describe a patient with rapidly progressing stress urinary incontinence (SUI) due to a retropubic cartilaginous cyst. The patient in this case underwent surgical intervention; symptoms improved postoperatively, suggesting that surgical intervention in symptomatic patients...

Systematic review of the literature on simulation in nursing education.

Science.gov (United States)

Norman, Jamil

2012-01-01

Simulation-based learning is an educational intervention which creates an environment that is conducive to experiential learning. Despite the prevalence of research on the influence of simulation on nursing education, there is a dearth of literature on the effectiveness of simulation-based learning. This systematic review examines literature on simulation outcomes in nursing education from the years 2000-2010. The electronic databases reviewed for the systematic review of the literature included: CINAHL Plus, Medline, Health Source: Nursing/Academic Education, Google Scholar, and Digital Dissertations and Theses through ProQuest. The MeSH search terms included "simulation outcomes measurement" and "nursing education". Seventeen studies were included in the review of the literature. The literature was categorized into three themes; internal outcomes, external outcomes, and clinical evaluation. The available literature on simulation and nursing education provides evidence that that simulation is useful in creating a learning environment which contributes to knowledge, skills, safety, and confidence. This systematic review of the literature revealed a gap in the literature pertaining to the transfer of these outcomes to the clinical setting, and lays a foundation for further research on outcomes specific to simulation and nursing education.

In situ and invasive squamous cell carcinoma of the vulva in Denmark 1978-2007-a nationwide population-based study

DEFF Research Database (Denmark)

Baandrup, L; Varbo, A; Munk, C

2011-01-01

To determine the incidence of vulvar carcinoma in situ (CIS) and cancer of squamous cell (SC) origin in Denmark in the period 1978-2007.......To determine the incidence of vulvar carcinoma in situ (CIS) and cancer of squamous cell (SC) origin in Denmark in the period 1978-2007....

Failure in the detection of the sentinel lymph node with a combined technique of radioactive tracer and blue dye in a patient with cancer of the vulva and a single positive lymph node

NARCIS (Netherlands)

Fons, G.; ter Rahe, B.; Sloof, G.; de Hullu, J.; van der Velden, J.

2004-01-01

Background. In early stage vulvar cancer, the sentinel lymph node procedure with a radioactive tracer appears to be a promising new diagnostic tool to predict lymph node status. No detection failures have been published so far in vulvar cancer. We recently experienced failure in the detection of the

Failure in the detection of the sentinel lymph node with a combined technique of radioactive tracer and blue dye in a patient with cancer of the vulva and a single positive lymph node

NARCIS (Netherlands)

Fons, G; ter Rahe, B; Sloof, G; de Hullu, J; van der Velden, J

Background. In early stage vulvar cancer, the sentinel lymph node procedure with a radioactive tracer appears to be a promising new diagnostic tool to predict lymph node status. No detection failures have been published so far in vulvar cancer. We recently experienced failure in the detection of the

Mapping evidence on the distribution of human papillomavirus-related cancers in sub-Saharan Africa: scoping review protocol.

Science.gov (United States)

Lekoane, Bridget K M; Mashamba-Thompson, Tivani P; Ginindza, Themba G

2017-11-17

Despite the introduction of HPV vaccines, the incidence of HPV-related cancers (cervical, penile, anal, vulvar, vagina, head, and neck) in sub-Saharan Africa has been rising. The increasing incidence of these HPV-related cancers has been attributed to changes in lifestyle-related risk factors, most notably sexual behavior. The main objective of this study is to map evidence on the distribution of HIV-related cancers in sub-Saharan Africa (SSA). We will conduct a scoping review to explore, describe, and map literature on the distribution of HPV-related cancers in sub-Saharan Africa. The primary search will include peer-reviewed and review articles. The list of references from included studies will also be searched. The search will be performed using EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, PubMed, Science Direct, Google scholar and World Health Organization (WHO) library databases, and gray literature. The researcher will search the articles using keywords, from the included studies; abstract and full articles will be screened by two independent reviewers. The screening will be guided by the inclusion and exclusion criteria. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo version 10. We anticipate finding relevant literature on the distribution of HPV-related cancers in sub-Saharan Africa. The study findings will help reveal research gaps to guide future research. PROSPERO CRD42017062403.

Atopic and Contact Dermatitis of the Vulva.

Science.gov (United States)

Pichardo-Geisinger, Rita

2017-09-01

Pruritus, or itch, is a common vulvar complaint that is often treated empirically as a yeast infection; however, yeast infections are just one of the many conditions that can cause vulvar itch. Ignoring other conditions can prolong pruritus unnecessarily. Atopic dermatitis, irritant contact dermatitis, and allergic contact dermatitis are extremely common noninfectious causes of vulvar itch that are often underdiagnosed by nondermatologists. Identifying these conditions and treating them appropriately can significantly improve a patient's quality of life and appropriately decrease health care expenditures by preventing unnecessary additional referrals or follow-up visits and decreasing pharmaceutical costs. Copyright © 2017 Elsevier Inc. All rights reserved.

Vulvar Lobular Capillary Hemangioma: A Rare Location for a Frequent Entity

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F. Abreu-dos-Santos

2016-01-01

Full Text Available Lobular capillary hemangioma, or pyogenic granuloma, is an acquired hemorrhagic benign vascular lesion of the skin and mucous membranes. The pyogenic granuloma of the vulva is a rare finding and a limited number of case reports are available in the literature. To the best of our knowledge this is the first case described as a single pyogenic granuloma on the vulva.

Structured Literature Review of digital disruption literature

DEFF Research Database (Denmark)

Vesti, Helle; Rosenstand, Claus Andreas Foss; Gertsen, Frank

2018-01-01

Digital disruption is a term/phenomenon frequently appearing in innovation management literature. However, no academic consensus exists as to what it entails; conceptual nor theoretical. We use the SLR-method (Structured Literature Review) to investigate digital disruption literature. A SLR......-study conducted in 2017 revealed some useful information on how disruption and digital disruption literature has developed over a specific period. However, this study was less representative of papers addressing digital disruption; which is the in-depth subject of this paper. To accommodate this, we intend...... to conduct a similar SLR-study assembling a body literature having digital disruption as the only common denominator...

Children's Literature: The Great Excluded. Volume Two.

Science.gov (United States)

Butler, Francelia, Ed.

This collection of essays is intended to stimulate writing, teaching, and study of children's literature by humanists. Among the included essays are: "Back to Pooh Corner,""Sophisticated Reading for Children,""Medieval Songs of Innocence and Experience,""Milton's 'Comus' as Children's Literature,""Fantasy in a Mythless Age,""Science Fiction and…

The overexpression of p16 is not a surrogate marker for high-risk human papilloma virus genotypes and predicts clinical outcomes for vulvar cancer

International Nuclear Information System (INIS)

Sznurkowski, Jacek J.; Żawrocki, Anton; Biernat, Wojciech

2016-01-01

We aimed to evaluate the correlation between p16 ink4a -overexpression and high risk (hr)HPV-DNA in vulvar squamous cell carcinoma (vSCC) tumors as well as the impact of both biomarkers on the prognosis of vSCC patients. PCR-detection of (hr)HPV-DNA and immunohistochemical staining for p16 ink4a were conducted in 85 vSCC tumors. Survival analyses included the Kaplan–Meier method, log-rank test and Cox proportional hazards model. p16 ink4a -overexpression and (hr)HPV-DNA were detected in 35 and 37 of the 85 tumors, respectively. Among the 35 p16 ink4a -positive tumors, 10 lacked (hr)HPV-DNA (29 %). Among the 50 p16 ink4a -negative tumors, (hr)HPV-DNA was detected in 12 cases (24 %). The median follow-up was 89.20 months (range 1.7–189.5 months). P16 ink4a -overexpression, but not (hr)HPV-DNA positivity of the primary tumor, was correlated with prolonged overall survival (OS) (p = 0.009). P16 ink4a -overexpression predicted a better response to radiotherapy (p < 0.001). Univariate analysis has demonstrated that age (p = 0.025), tumor grade (p = 0.001), lymph node metastasis (p < 0.001), FIGO stage (p < 0.001), p16 ink4a -overexpression (p = 0.022), and adjuvant RTX (p < 0.001) were prognostic factors for OS. Multivariate analysis has demonstrated that lymph node metastasis (HR 1–2.74, 95 % CI 1.50–5.02, p = 0.019), tumor grade (HR 1–2.80, 95 % CI 1.33–5.90, p = 0.007) and p16 ink4a -overexpression (HR 1–2.11, 95 % CI 1.13–3.95, p = 0.001) are independent prognostic factors. The discovered overlap suggests the use of p16 ink4a in combination with HPV-DNA detection as an ancillary test for future research and clinical studies in vSCC. The prognostic and predictive value of p16 ink4a -overexpression should be tested in larger cohort studies. The online version of this article (doi:10.1186/s12885-016-2503-y) contains supplementary material, which is available to authorized users

Popular Literature: Its Compatibility with the Basics.

Science.gov (United States)

Matthews, Dorothy, Ed.

1983-01-01

This special journal issue contains nine articles on the subject of using popular literature in the classroom. Subjects covered in the articles include (1) using vernacular supernatural literature to teach the skills of literary analysis, (2) teaching Agatha Christie's "Curtain," (3) pairing the classics with detective fiction, (4) using fantasy…

Literature-based discovery of diabetes- and ROS-related targets

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Pande Manjusha

2010-10-01

Full Text Available Abstract Background Reactive oxygen species (ROS are known mediators of cellular damage in multiple diseases including diabetic complications. Despite its importance, no comprehensive database is currently available for the genes associated with ROS. Methods We present ROS- and diabetes-related targets (genes/proteins collected from the biomedical literature through a text mining technology. A web-based literature mining tool, SciMiner, was applied to 1,154 biomedical papers indexed with diabetes and ROS by PubMed to identify relevant targets. Over-represented targets in the ROS-diabetes literature were obtained through comparisons against randomly selected literature. The expression levels of nine genes, selected from the top ranked ROS-diabetes set, were measured in the dorsal root ganglia (DRG of diabetic and non-diabetic DBA/2J mice in order to evaluate the biological relevance of literature-derived targets in the pathogenesis of diabetic neuropathy. Results SciMiner identified 1,026 ROS- and diabetes-related targets from the 1,154 biomedical papers (http://jdrf.neurology.med.umich.edu/ROSDiabetes/. Fifty-three targets were significantly over-represented in the ROS-diabetes literature compared to randomly selected literature. These over-represented targets included well-known members of the oxidative stress response including catalase, the NADPH oxidase family, and the superoxide dismutase family of proteins. Eight of the nine selected genes exhibited significant differential expression between diabetic and non-diabetic mice. For six genes, the direction of expression change in diabetes paralleled enhanced oxidative stress in the DRG. Conclusions Literature mining compiled ROS-diabetes related targets from the biomedical literature and led us to evaluate the biological relevance of selected targets in the pathogenesis of diabetic neuropathy.

Selective Guide to Literature on Agricultural Engineering. Engineering Literature Guides, Number 4.

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Cloud, Gayla Staples, Comp.

Agricultural engineering overlaps many other disciplines. This document is a survey of information sources in agricultural engineering and is intended to identify those core resources which can help engineers and librarians to find information about the discipline. Sections include: (1) "Guides to the Literature"; (2) "Bibliographies"; (3)…

Self-Advocacy Serious Game in Advanced Cancer

Science.gov (United States)

2018-04-05

Ovarian Cancer Stage III; Ovarian Cancer Stage IV; Breast Cancer Stage IV; Cervical Cancer Stage IIIB; Cervical Cancer Stage IVA; Cervical Cancer Stage IVB; Endometrial Cancer Stage III; Endometrial Cancer Stage IV; Vulvar Cancer, Stage III; Vulvar Cancer, Stage IV; Vaginal Cancer Stage III; Vaginal Cancer Stage IVA; Vaginal Cancer Stage IVB

English language and literature students' perceptions of reflective writing, its effects on engagement in writing and literature

OpenAIRE

Uçar, Hakan

2013-01-01

Ankara : The Department of Teaching English as a Foreign Language, Bilkent University, 2013. Thesis (Master's) -- Bilkent University, 2013. Includes bibliographical references leaves 122-139. This study investigated the effects of the reflective writing process on English Language and Literature students’ engagement with writing and literature and their demonstrated engagement level in the reflective writing process. This study was conducted over a period of nine weeks with...

Significance of Literature in Foreign Language Teaching

Science.gov (United States)

Babaee, Ruzbeh; Yahya, Wan Roselezam Bt Wan

2014-01-01

This research aims to consider literature as a significant tool for teaching fundamental language skills including speaking, listening, reading and writing. Reasons for the use of literature in language classrooms and major factors for choosing appropriate kinds of literary texts in such classes should be highlighted in order to make readers aware…

The Literature of Competitive Intelligence.

Science.gov (United States)

Walker, Thomas D.

1994-01-01

Describes competitive intelligence (CI) literature in terms of its location, quantity, authorship, length, and problems of bibliographic access. Highlights include subject access; competitive intelligence research; espionage and security; monographs; and journals. (21 references) (LRW)

Agressive angiomyxoma: Case report

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Fatma Eskicioğlu

2012-09-01

Full Text Available Aggressive angiomyxoma is a rare benign mesenchymal neoplasm. It is often diagnosed in genital, pelvic and perineal region of women in reproductive ages. Aggressive angiomyxoma is associated with a high risk of local recurrence. Aggressive angiomyxoma is mixed with Bartholin’s gland cyst, lipoma and vaginal cysts in diagnosis. Generally, stromal invasion is detected in these benign neoplasms. Therefore, wide local excision should be performed to treat. GnRH agonists could be administered in patient with aggressive angiomyxoma, either primary or recurrent. We reported a case with vulvar aggressive angiomyxoma presented with vulvar mass and treated with wide local excision. J Clin Exp Invest 2012; 3 (3: 420-422Key words: Angiomyxoma, myxoma, vulvar mass

Reading Popular Islamic Literature: Continuity And Change In Indonesian Literature

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Mohammad Rokib

2016-01-01

Full Text Available In the last few years, literature on Islamic themes has become increasingly popular in Indonesia. It is commonly categorized as Islamic literature identified by Islamic texts and symbols on the book cover and its content. The literary works have been popular as reflected in the record sales figures. Previously, some literary works dealing with Islamic themes failed to gain public attention. Interestingly, those works are not mentioned by people as Islamic literature. This paper aims to discuss some questions on why are some literary works on Islamic theme mentioned as Islamic while others are not? Is there Islamic literature within Indonesian literature? What are the differences between Islamic literature and kitab literature (sastra kitab written by Muslim scholars in the Malay world? By exploring the social context of reader responses toward selected literary works on Islam, this study reveals that the label of Islamic literature is created to confront opposite themes in Indonesian literature. The term Islamic literature remains a problematic and debatable issue related to literature based on Islamic themes in both old and modern Indonesian literature.

Thinking through children's literature in the classroom

CERN Document Server

Reyes-Torres, Agustín; Soler-Pardo, Betlem

2014-01-01

This book is the result of understanding literature as a central part of children's education. Fiction and nonfiction literary works constitute a source to open young minds and to help them understand how and why people - themselves included - live as they do, or to question through critical lenses whether they could live otherwise. By integrating philological, cultural, and pedagogical inquiries, Thinking through Children's Literature in the Classroom approaches the use of literature as a crucial factor to motivate students not only to improve their literacy skills, but also to develop their

[How do authors of systematic reviews restrict their literature searches when only studies from Germany should be included?

Science.gov (United States)

Pieper, Dawid; Mathes, Tim; Palm, Rebecca; Hoffmann, Falk

2016-11-01

The use of search filters (e. g. for study types) facilitates the process of literature searching. Regional limits might be helpful depending on the research question. Regional search filters are already available for some regions, but not for Germany. Our aim is to give an overview of applied search strategies in systematic reviews (SRs) focusing on Germany. We searched Medline (via Pubmed) applying a focused search strategy to identify SRs focusing on Germany in January 2016. Study selection and data extraction were performed by two reviewers independently. The search strategies with a focus on Germany were analyzed in terms of reasonableness and completeness relying on the Peer Review of Electronic Search Strategies (PRESS) criteria. A narrative evidence synthesis was performed. In total, 36 SRs (13 written in English) were included. 78% were published in 2012 or later. The majority (89%) of SRs utilized at least two different sources for their search with databases and checking references being the most common. 17 SRs did not use any truncations, ten SRs did not restrict their search to Germany, six SRs reported to have searched for German OR Germany. Only ten articles searched for the term Germany (occasionally jointly with the term Deutschland) without any use of an adjective such as German. There is a high interest in regionally focused SRs. The identified search strategies revealed a need for improvement. It would be helpful to develop a regional search filter for Germany that is able to identify studies performed in Germany. Copyright © 2016. Published by Elsevier GmbH.

Searching the online biomedical literature from developing countries

African Journals Online (AJOL)

Administrator

This commentary highlights popular research literature databases and the use of the internet to obtain valuable research information. These literature retrieval methods include the use of the popular. PubMed as well as internet search engines. Specific websites catering to developing countries' information and journals' ...

Searching the online biomedical literature from developing countries ...

African Journals Online (AJOL)

This commentary highlights popular research literature databases and the use of the internet to obtain valuable research information. These literature retrieval methods include the use of the popular PubMed as well as internet search engines. Specific websites catering to developing countries' information and journals' ...

Integrative Literature Review: Ascertaining Discharge Readiness for Pediatrics After Anesthesia.

Science.gov (United States)

Whitley, Deborah R

2016-02-01

Unplanned hospital readmissions after the administration of general anesthesia for ambulatory procedures may contribute to loss of reimbursement and assessment of financial penalties. Pediatric patients represent a unique anesthetic risk. The purpose of this integrative literature review was to ascertain specific criteria used to evaluate discharge readiness for pediatric patients after anesthesia. This study is an integrative review of literature. An integrative literature search was conducted and included literature sources dated January 2008 to November 2013. Key words included pediatric, anesthesia, discharge, criteria, standards, assessment, recovery, postoperative, postanesthesia, scale, score, outpatient, and ambulatory. Eleven literature sources that contributed significantly to the research question were identified. Levels of evidence included three systematic reviews, one randomized controlled trial, three cohort studies, two case series, and two expert opinions. This integrative literature review revealed evidence-based discharge criteria endorsing home readiness for postanesthesia pediatric patients should incorporate consideration for physiological baselines, professional judgment with regard to infant consciousness, and professional practice standards/guidelines. Additionally, identifying and ensuring discharge to a competent adult was considered imperative. Nurses should be aware that frequently used anesthesia scoring systems originated in the 1970s, and this review was unable to locate current literature examining the reliability and validity of their use in conjunction with modern anesthesia-related health care practices. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Carcinoma vulvar

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Yamit Peñas Zayas

2015-11-01

Full Text Available El carcinoma de la vulva tiene una incidencia de aproximadamente un 3-5% dentro de todas las enfermedades ginecológicas malignas. El 90% de los tumores malignos de la vulva está constituido por carcinoma epidermoide, el resto son adenocarcinomas, carcinomas de células basales y melanomas. Se realiza la presentación de un caso de una paciente femenina de 25 años de edad con antecedentes  de Diabetes Mellitus tipo II y trombopatia, que ingresa en el servicio de ginecología con un cuadro cutáneo polimorfo, localizado en labios mayores y menores, dado por lesiones eritematoerosivas y vegetante, sospechándose clínicamente el diagnóstico  de un carcinoma epidermoide, corroborándose el mismo histológicamente al realizarse biopsia de piel. Se indicó tratamiento con quimioterapia. Por la edad de la paciente y ser menos frecuente en mucosa que en la piel,  motivo la presentación del caso.

Vulvar Cancer

Science.gov (United States)

... review all the options for surgery and the pros and cons of each option. Some people may also need ... BodyGenetic Testing: What You Should KnowRead Article >>Genetic Testing: What ... Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight ...

Electronic biomedical literature search for budding researcher.

Science.gov (United States)

Thakre, Subhash B; Thakre S, Sushama S; Thakre, Amol D

2013-09-01

Search for specific and well defined literature related to subject of interest is the foremost step in research. When we are familiar with topic or subject then we can frame appropriate research question. Appropriate research question is the basis for study objectives and hypothesis. The Internet provides a quick access to an overabundance of the medical literature, in the form of primary, secondary and tertiary literature. It is accessible through journals, databases, dictionaries, textbooks, indexes, and e-journals, thereby allowing access to more varied, individualised, and systematic educational opportunities. Web search engine is a tool designed to search for information on the World Wide Web, which may be in the form of web pages, images, information, and other types of files. Search engines for internet-based search of medical literature include Google, Google scholar, Scirus, Yahoo search engine, etc., and databases include MEDLINE, PubMed, MEDLARS, etc. Several web-libraries (National library Medicine, Cochrane, Web of Science, Medical matrix, Emory libraries) have been developed as meta-sites, providing useful links to health resources globally. A researcher must keep in mind the strengths and limitations of a particular search engine/database while searching for a particular type of data. Knowledge about types of literature, levels of evidence, and detail about features of search engine as available, user interface, ease of access, reputable content, and period of time covered allow their optimal use and maximal utility in the field of medicine. Literature search is a dynamic and interactive process; there is no one way to conduct a search and there are many variables involved. It is suggested that a systematic search of literature that uses available electronic resource effectively, is more likely to produce quality research.

Mapping evidence on the distribution of human papillomavirus-related cancers in sub-Saharan Africa: scoping review protocol

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Bridget K. M. Lekoane

2017-11-01

Full Text Available Abstract Background Despite the introduction of HPV vaccines, the incidence of HPV-related cancers (cervical, penile, anal, vulvar, vagina, head, and neck in sub-Saharan Africa has been rising. The increasing incidence of these HPV-related cancers has been attributed to changes in lifestyle-related risk factors, most notably sexual behavior. The main objective of this study is to map evidence on the distribution of HIV-related cancers in sub-Saharan Africa (SSA. Methods and analysis We will conduct a scoping review to explore, describe, and map literature on the distribution of HPV-related cancers in sub-Saharan Africa. The primary search will include peer-reviewed and review articles. The list of references from included studies will also be searched. The search will be performed using EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, PubMed, Science Direct, Google scholar and World Health Organization (WHO library databases, and gray literature. The researcher will search the articles using keywords, from the included studies; abstract and full articles will be screened by two independent reviewers. The screening will be guided by the inclusion and exclusion criteria. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo version 10. Discussion We anticipate finding relevant literature on the distribution of HPV-related cancers in sub-Saharan Africa. The study findings will help reveal research gaps to guide future research. Systematic review registration PROSPERO CRD42017062403.

Bibliography of the literature of the Health Physics Division through calendar year 1975

International Nuclear Information System (INIS)

Dixon, M.N.

1976-03-01

The literature of the Health Physics Division is documented. The bibliography contains open literature publications, report literature, and special literature. An author index and separate listings of theses and patents are included

Optimizing literature search in systematic reviews

DEFF Research Database (Denmark)

Aagaard, Thomas; Lund, Hans; Juhl, Carsten Bogh

2016-01-01

BACKGROUND: When conducting systematic reviews, it is essential to perform a comprehensive literature search to identify all published studies relevant to the specific research question. The Cochrane Collaborations Methodological Expectations of Cochrane Intervention Reviews (MECIR) guidelines...... of musculoskeletal disorders. METHODS: Data sources were systematic reviews published by the Cochrane Musculoskeletal Review Group, including at least five RCTs, reporting a search history, searching MEDLINE, EMBASE, CENTRAL, and adding reference- and hand-searching. Additional databases were deemed eligible...... if they indexed RCTs, were in English and used in more than three of the systematic reviews. Relative recall was calculated as the number of studies identified by the literature search divided by the number of eligible studies i.e. included studies in the individual systematic reviews. Finally, cumulative median...

Bibliography of the literature of the Health Physics Division through calendar year 1975

Energy Technology Data Exchange (ETDEWEB)

Dixon, M.N. (comp.)

1976-03-01

The literature of the Health Physics Division is documented. The bibliography contains open literature publications, report literature, and special literature. An author index and separate listings of theses and patents are included. (HLW)

Medieval Pictorial Art and Medieval Spanish Literature: A Case in Point for the Use of the Visual Arts in the Literature Class.

Science.gov (United States)

Bergstrom, Stanford E.

1991-01-01

An exploration of the connection between literature and the visual arts and its application in the foreign language literature class includes an illustration of how a medieval literary Spanish masterpiece becomes more clear when the text is compared with medieval pictorial art pieces. (four references) (Author/CB)

Literature Suggests Information Professionals Have Adopted New Roles

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Robin E. Miller

2017-03-01

Full Text Available Objective – To provide a systematic review of the emerging or newly adopted roles of information professionals, over the past 14 years, as described in the Library and Information Science (LIS professional literature. Design – Systematic review of the literature. Setting – Databases featuring information science content, including ACM Digital Library, Library, Information Science and Technology Abstracts (LISTA, Library and Information Science Abstracts (LISA, Citeseer, Google Scholar, e-prints in Library and Information Science (e-LiS, Digital Library of Information Science and Technology (DLIST, Scopus, and Science Direct. The database Library Literature & Information Science Index was not included. Subjects – Through a systematic literature search, the authors identified 114 peer-reviewed studies published between 2000-2014. Methods – The authors searched selected databases using the terms “librarian/s role” and “information professional/s role” to collect literature about the roles of information professionals. The authors searched the selected databases in two phases. The initial search yielded 600 search results and the authors included 100 articles about “roles” information professionals have adopted. The authors excluded articles focused on specific positions, health and medical libraries, librarians’ professional skills, and development of specific programs or initiatives within libraries. In the second phase of searching, the authors refined search terms to include phrases specifically related to the roles identified in the 100 articles initially included in the review. There were 48 articles identified in the second search and 14 were included in the final pool of articles. The authors also cross-checked the references of all included literature. Main Results – The authors identified six roles of information professionals described in the literature during the review period. The role of “embedded librarian�

Endometriosis in an episiotomy scar

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Mine islimye Taskin

2016-03-01

Full Text Available Endometriosis that is defined as the presence of functional endometrial tissue outside the uterine cavity is seen 5-10% of reproductive age women. Endometriosis can be seen any other site of the body; but the most frequently affected areas are ovaries, pelvic peritoneum, uterosacral ligament and Douglas pouche. Several teories exist for the development of endometriosis including retrograde menstruation, venous or lymphatic metastasis and immun dysfunction. Endometriosis of the perineum and vulva are extremely rare with the most common sites being episiotomy scars. Scar endometriosis is likely to be caused by mechanical transplantation of endometrium from the uterine cavity into the wound at the time of the surgery. The primary treatment for scar endometriosis is total surgical excision of the lesion. It is important not to leave residual tissue during surgery to prevent the recurrence. Here we present a patient who had her vaginal delivery 5 years ago, have a complaint of painful vulvar lump at the right mediolateral episiotomy scar since 1 year during her every menstruation period and whose final diagnosis was endometriosis after surgical removal and histopathologic examination. Althought vulvar endometrosis is rare, it should be considered in the patients who had a vaginal delivery and complaining painful vulvar lump with swelling in her mestrual cycle. [Cukurova Med J 2016; 41(1.000: 164-166

THE MAIN GENERAL HEALTH INDICATORS OF PRETERM NEWBORNS

OpenAIRE

Елена Николаевна Никулина; Светлана Ивановна Елгина; Юлия Александровна Липкова; Сергей Викторович Липков

2017-01-01

Objective – to determine the main health indicators in preterm newborns. Materials and Methods: Premature newborns and full-term newborns (160 and 1408, respectively) were investigated with clinical, instrumental, and statistical methods. Anthropometric parameters, somatic health, vulvar anatomy were considered to be the main criteria for general health. Results: The indicators of general health (physical development, somatic health, vulvar anatomy) in premature and full-term newborns...

Comparative survey of comprehensiveness of literature collection between two information systems, 2

International Nuclear Information System (INIS)

Narui, Shigeko; Habara, Tadashi; Izawa, Michiyo; Naramoto, Miyoko; Kajiro, Tadashi

1984-01-01

To make clear a feature of nuclear fusion area of the INIS database in comparison with the INSPEC, a survey has been made of overlap literature included in both databases, and of unique literature included only in the INSPEC. All of the 5,774 items in the categories a50.00 and a28.50R of the INSPEC in 1980 were checked on whether each item was also included in the fusion category A14 of the INIS during four years of 1979 to 1982 or not. The ratios of literature included in the INIS were 52 % and 84 % for journal and technical report, respectively. The ratio for journal was considered in connection with differences in the scope and coverage as well as input system between the two databases. High comprehensiveness for technical report is achievable in the INIS. Comparison of language of literature included in both databases, and time lags for publication are briefly described. (author)

Rubem Fonseca and Noir Literature

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Pere Comellas

2014-10-01

Full Text Available Rubem Fonseca is considered a key author in the introduction of crime fiction in Brazil. This article reviews his contribution to the genre and analyzes the specifics of his narrative in the context of Brazilian literature, in which Fonseca breaks from and exceeds the traditional dichotomies between high and popular literature. Fonseca becomes part of the distinct tradition of crime fiction, which he reinterprets differently in his short stories by giving voice to the marginalized, and in his novels by incorporating elements of hardboiled, noir fiction, and even whodunit. The character of Mandrake is situated in a context that increasingly includes paraliterary concerns.

Tire Crumb Research Study Literature Review / Gap ...

Science.gov (United States)

In order to more fully understand data gaps in human exposure and toxicity to tire crumb materials, ATSDR, CPSC and EPA undertook a collaborative effort in the form of a scientific literature review and subsequent gaps analysis. The first objective of the Literature Review and Gap Analysis (LRGA) collaboration was to identify the existing body of literature related specifically to human exposure to tire crumb materials through the use of synthetic turf athletic fields and playgrounds. The second objective was to characterize and summarize the relevant data from the scientific literature. The final objective was to review the summary information and identify data gaps to build on the current understanding of the state-of-the-science and inform the development of specific research efforts that would be most impactful in the near-term. Because of the need for additional information, the U.S. Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (ATSDR), and the U.S. Consumer Product Safety Commission (CPSC) launched a multi-agency action plan to study key environmental human health questions. The Federal Research Action Plan includes numerous activities, including research studies (U.S. EPA, 2016). A key objective of the Action Plan is to identify key knowledge gaps.

Literature review on medical incident command.

Science.gov (United States)

Rimstad, Rune; Braut, Geir Sverre

2015-04-01

It is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published. This comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders' performances be measured and assessed? A systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis. The literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders' tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted

1970 MLA International Bibliography of Books and Articles on the Modern Languages and Literatures, Volume I: General, English, American, Medieval and Neo-Latin, Celtic Literatures; and Folklore.

Science.gov (United States)

Meserole, Harrison T., Comp.

Volume 1 of the four-volume, international bibliography contains over 11,140 entries referring to books, Festschriften, analyzed collections, and articles which focus on General, English, American, medieval and neo-Latin, and Celtic literatures. A section of folklore is also included. The section on general literature includes: (1) aesthetics, (2)…

[Neurology and literature].

Science.gov (United States)

Iniesta, I

2010-10-01

Literature complements medical literature in the academic and clinical development of neurologists. The present article explores the contributions of writers of fiction on neurology. Literary works of fiction with particular reference to neurology. A symbiosis between writers of fiction and doctors has been well recognised. From Shakespeare to Cervantes by way of Dickens and Cela to writer - physicians such as Anton Chekhov or António Lobo Antunes have contributed through their medically informed literature to the better understanding of neurology. Some writers like Dostoevsky, Machado de Assis and Margiad Evans have written about their own experiences with disease thus bringing new insights to medicine. Furthermore, some neurological disorders have been largely based on literary descriptions. For instance, Dostoevsky's epilepsy has been retrospectively analysed by famous neurologists including Freud, Alajouanine or Gastaut, whilst his writings and biography have prompted others like Waxman and Geschwind to describe typical behavioural changes in temporal lobe epilepsy, finding their source of inspiration in Dostoevsky. Likewise, Cirignotta et al have named an unusual type of seizure after the Russian novelist. Inspired by Lewis Carroll, Todd introduced the term Alice in Wonderland Syndrome to refer to visual distortions generally associated with migraine. Writers of fiction offer a humanised perception of disease by contributing new insights into the clinical history, informing about the subjective experience of the illness and helping to eradicate the stigma associated to neurological disorders.

Cleanup and treatment of radioactively contaminated land including areas near nuclear facilities. A selected bibliography

International Nuclear Information System (INIS)

Fore, C.S.; Faust, R.A.; Brewster, R.H.

1982-09-01

This annotated bibliography of 337 references summarizes the literature published on the cleanup and treatment of radioactively contaminated land. Specifically, this bibliography focuses on literature concerned with the methods of cleanup and treatment being applied - chemical, physical, or vegetative stabilization; the types of equipment being used; and the influence of climatic conditions on the method selected for use. The emphasis in such literature is placed on hazardous site cleanup efforts that have been completed as well as those that are in progress and are being planned. Appendix A includes 135 additional references to literature identified but not included in the bibliography because of time and funding constraints. Appendix B consists of a table that identifies the cleanup and treatment research conducted at specific sites. All of the information included in this bibliography is stored in a computerized form that is readily available upon request

[Literature cited in a study of Yugoslav biomedical journals].

Science.gov (United States)

Brkić, S; Pejić, M; Cikić, B

1995-01-01

The paper reviews results of a research on literature cited in papers published in two most remarkable Yugoslav biomedical journals, Medicinski Pregled and Srpski arhiv za celokupno lekarstvo, in 1985 and 1992. The analysis included the following parameters: the amount of published papers, the quantity of cites out of the literature that has been used, frequency of citation of foreign and domestic literature as well as the quantity of self citations. According to the gathered results, foreign literature is remarkably more often cited than the domestic references, mostly in English, but the percentage of citing one's own papers is also high.

PENGUKURAN KONSERVATISME AKUNTANSI: SEBUAH LITERATUR REVIEW

Directory of Open Access Journals (Sweden)

Anggita Langgeng

2012-12-01

Full Text Available This research is a study of the literature that discusses the measurement of accounting conservatism. Research about accounting conservatism raises several alternative methods that can be used to measure the level of accounting conservatism in a company. With reference to some previous literature it can be conclude that conservatism can be measured by several methods, including: 1 the market model of Basu (1997, 2 market to book ratio approach, 3 operating income approach, 4 the accrual of cash flow approach, 5 non-operating accrual approach.

A survey of computer science capstone course literature

Science.gov (United States)

Dugan, Robert F., Jr.

2011-09-01

In this article, we surveyed literature related to undergraduate computer science capstone courses. The survey was organized around course and project issues. Course issues included: course models, learning theories, course goals, course topics, student evaluation, and course evaluation. Project issues included: software process models, software process phases, project type, documentation, tools, groups, and instructor administration. We reflected on these issues and thecomputer science capstone course we have taught for seven years. The survey summarized, organized, and synthesized the literature to provide a referenced resource for computer science instructors and researchers interested in computer science capstone courses.

Remote sensing of natural resources. Quarterly literature review, January--March 1979

Energy Technology Data Exchange (ETDEWEB)

1979-01-01

Information is presented under the following section headings: introduction; user guide; information sources; recent releases; and, literature review. The literature reviewed includes abstracts when available on the following subjects: general; geology; environmental quality; hydrology; vegetation; oceanography; regional planning and land use; data manipulation; and instrumentation and technology. An author index and document order form are included. (JGB)

Necrotizing Fasciitis of vulva: A report of two cases

Directory of Open Access Journals (Sweden)

Jamal A

2000-08-01

Full Text Available Vulvar necrotizing fascitis is an uncommon infectious disorder. Since the first reported cases almost 100 years, ago, necrotizing fasciitis continues to present a diagnostic and therapeutic challenge. What usually begins as a subtle infection can become life-threatening. We report two cases of vulvar necrotizing fasciitis, one after posterior colporrhaphy in a woman with four risk factors and the other in a young woman without any risk factor.

Estonian literature / Janika Kronberg

Index Scriptorium Estoniae

Kronberg, Janika, 1963-

2003-01-01

Sisu: Estonian literature - born on the margins of Europe ; Baltic German literature and its impact ; Seeking the contours of a 'truly' Estonian literature ; Literature and an independent Estonia ; Estonian literature in two cultural spheres ; The fifties and sixties ; Literature and congealed time ; A bold new Estonian literature

Essays and Explorations: Studies in Ideas, Language, and Literature.

Science.gov (United States)

Bloomfield, Morton W.

Seventeen reprinted essays and an unpublished one are contained in this collection and organized under five headings: History of Ideas, Approaches to Medieval Literature, Chaucer and Fourteenth-Century English Literature, Language and Linguistics, and Essay-Reviews. Topics discussed include the origin of the concept of the Seven Cardinal Sins;…

Teaching science through literature

Science.gov (United States)

Barth, Daniel

2007-12-01

The hypothesis of this study was that a multidisciplinary, activity rich science curriculum based around science fiction literature, rather than a conventional text book would increase student engagement with the curriculum and improve student performance on standards-based test instruments. Science fiction literature was chosen upon the basis of previous educational research which indicated that science fiction literature was able to stimulate and maintain interest in science. The study was conducted on a middle school campus during the regular summer school session. Students were self-selected from the school's 6 th, 7th, and 8th grade populations. The students used the science fiction novel Maurice on the Moon as their only text. Lessons and activities closely followed the adventures of the characters in the book. The student's initial level of knowledge in Earth and space science was assessed by a pre test. After the four week program was concluded, the students took a post test made up of an identical set of questions. The test included 40 standards-based questions that were based upon concepts covered in the text of the novel and in the classroom lessons and activities. The test also included 10 general knowledge questions that were based upon Earth and space science standards that were not covered in the novel or the classroom lessons or activities. Student performance on the standards-based question set increased an average of 35% for all students in the study group. Every subgroup disaggregated by gender and ethnicity improved from 28-47%. There was no statistically significant change in the performance on the general knowledge question set for any subgroup. Student engagement with the material was assessed by three independent methods, including student self-reports, percentage of classroom work completed, and academic evaluation of student work by the instructor. These assessments of student engagement were correlated with changes in student performance

Methodological challenges when doing research that includes ethnic minorities

DEFF Research Database (Denmark)

Morville, Anne-Le; Erlandsson, Lena-Karin

2016-01-01

minorities are included. Method: A thorough literature search yielded 21 articles obtained from the scientific databases PubMed, Cinahl, Web of Science and PsychInfo. Analysis followed Arksey and O’Malley’s framework for scoping reviews, applying content analysis. Results: The results showed methodological...

Human papillomavirus-associated cancers as acquired immunodeficiency syndrome defining illnesses

Directory of Open Access Journals (Sweden)

Shohreh Shahabi

2013-04-01

Full Text Available The Centers for Disease Control currently report cervical, vulvar, vaginal, anal and some head and neck cancers as human papillomavirus (HPV-associated cancers. Only cervical cancer is listed amongst acquired immunodeficiency syndrome (AIDS defining illnesses. All of these cancers may represent progression of the immunocompromised state with the inability to eradicate viral infection. This study reports the case of a 27-year old HIV positive female presenting with a persistent right vulvar exophytic lesion. High-risk HPV analysis and immunostaining for P16 were both positive. A biopsy of the lesion revealed invasive squamous cell carcinoma. The patient underwent neoadjuvant radiation and chemotherapy followed by a radical vulvectomy. During treatment, her CD4 T-lymphocyte count decreased to 120 advancing her condition from HIV to AIDS. This case suggests that all HPV-associated cancers should be included as AIDS defining illnesses.

The Literature of Poverty, the Poverty of Literature Classes

Science.gov (United States)

Marsh, John

2011-01-01

In this article, the author focuses on the possibilities--and the limits--of undergraduate courses on the literature of poverty. He describes an undergraduate course he has taught on U.S. literature about poverty, but he also expresses doubt that such courses can help produce major social change. He argues that something about the literature of…

Literature Suggests Information Professionals Have Adopted New Roles

OpenAIRE

Robin E. Miller

2017-01-01

Objective – To provide a systematic review of the emerging or newly adopted roles of information professionals, over the past 14 years, as described in the Library and Information Science (LIS) professional literature. Design – Systematic review of the literature. Setting – Databases featuring information science content, including ACM Digital Library, Library, Information Science and Technology Abstracts (LISTA), Library and Information Science Abstracts (LISA), Citeseer, Goo...

Synthesising the literature as part of a literature review.

Science.gov (United States)

Wakefield, Ann

2015-03-18

This article examines how to synthesise and critique research literature. To place the process of synthesising the research literature into context, the article explores the critiquing process by breaking it down into seven sequential steps. The article explains how and why these steps need to be kept in mind if a robust comprehensive literature search and analysis are to be achieved. The article outlines how to engage in the critiquing process and explains how the literature review needs to be assembled to generate a logical and reasoned debate to examine a topic of interest or research in more detail.

Latent class analysis of comorbidity patterns among women with generalized and localized vulvodynia: preliminary findings

Directory of Open Access Journals (Sweden)

Nguyen RHN

2013-04-01

Full Text Available Ruby HN Nguyen,1 Christin Veasley,2 Derek Smolenski1,3 1Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 2National Vulvodynia Association, Silver Spring, MD, 3National Center for Telehealth and Technology, Defense Centers of Excellence, Department of Defense, Tacoma, WA, USA Background: The pattern and extent of clustering of comorbid pain conditions with vulvodynia is largely unknown. However, elucidating such patterns may improve our understanding of the underlying mechanisms involved in these common causes of chronic pain. We sought to describe the pattern of comorbid pain clustering in a population-based sample of women with diagnosed vulvodynia. Methods: A total of 1457 women with diagnosed vulvodynia self-reported their type of vulvar pain as localized, generalized, or both. Respondents were also surveyed about the presence of comorbid pain conditions, including temporomandibular joint and muscle disorders, interstitial cystitis, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, endometriosis, and chronic headache. Age-adjusted latent class analysis modeled extant patterns of comorbidity by vulvar pain type, and a multigroup model was used to test for the equality of comorbidity patterns using a comparison of prevalence. A two-class model (no/single comorbidity versus multiple comorbidities had the best fit in individual and multigroup models. Results: For the no/single comorbidity class, the posterior probability prevalence of item endorsement ranged from 0.9% to 24.4%, indicating a low probability of presence. Conversely, the multiple comorbidity class showed that at least two comorbid conditions were likely to be endorsed by at least 50% of women in that class, and irritable bowel syndrome and fibromyalgia were the most common comorbidities regardless of type of vulvar pain. Prevalence of the multiple comorbidity class differed by type of vulvar pain: both

Outcome of patients with local recurrent gynecologic malignancies after resection combined with intraoperative electron radiation therapy (IOERT)

International Nuclear Information System (INIS)

Arians, Nathalie; Foerster, Robert; Rom, Joachim; Uhl, Matthias; Roeder, Falk; Debus, Jürgen; Lindel, Katja

2016-01-01

Treatment of recurrent gynecologic cancer is a challenging issue. Aim of the study was to investigate clinical features and outcomes of patients with recurrent gynecologic malignancies who underwent resection including IOERT (intraoperative electron radiation therapy) with regard to clinical outcome and potential predictive factors or subgroups that benefit most from this radical treatment regime. A total of 36 patients with recurrent gynecologic malignancies (cervical (n = 18), endometrial (n = 12) or vulvar cancer (n = 6)) were retrospectively identified through hospital databases in accordance with institutional ethical policies. Patient characteristics and outcomes were assessed. Survival data was analyzed using the Kaplan-Meier-method and log-rank-test, categorical variables were analyzed with chi-square-method. For the entire cohort 1-/2-/5-year Overall Survival (OS) was 65.3 %/36.2 %/21.7 %. Patients with endometrial, cervical, and vulvar carcinoma had a 1-/2-/5-year OS of 83.3 %/62.5 %/50 %, 44.5 %/25.4 %/6.4 %, and 83.3 %/16.7 %/16.7 %, respectively. Patients with endometrial carcinoma showed a significantly better OS (p = 0.038). 1-/2-/5-year Local Progression-free Survival (LPFS) for the entire cohort was 44.1 %/28 %/21 % with 76.2 %/61 %/40.6 % for endometrial, 17.2 %/0 %/0 % for cervical, and 40 %/20 %/20 % for vulvar cancer, respectively. Patients with endometrial cancer showed a significantly (p = 0.017) and older patients a trend (p = 0.059) for a better LPFS. 1-/2-/5-year Distant Progression-free Survival (DPFS) for the entire cohort was 53.1 %/46.5 %/38.7 % with 74.1 %/74.1 %/74.1 % for endometrial, 36.7 %/36.7 %/0 % for cervical, and 60 %/30 %/30 % for vulvar cancer, respectively. There was a significantly better DPFS for older patients (p = 0.015) and a trend for a better DPFS for patients with endometrial carcinoma (p = 0.075). The radical procedure of resection combined with IOERT seems to be a valid curative treatment option for patients with

Mathematics and Literature

Institute of Scientific and Technical Information of China (English)

田琳

2016-01-01

In both China and the West, mathematics is closely connected with literature. The maths thought implied in Chinese and western literature is worth our study, and the maths thought in the field of literature is also appear in aesthetics and philoso-phy, so literature, mathematics, aesthetics and philosophy become a network of interconnected.

Italian Literature in Russia. Some Recent Important Contributions

Directory of Open Access Journals (Sweden)

Claudia Lasorsa Siedina

2013-02-01

Full Text Available The paper presents an updated review of translations of contemporary Italian literature published in two issues of the popular Russian literary magazine “Inostrannaja literatura”. The first issue (2008, 10, entitled Italian Literature in Search of a Form, published translations by poets, prose writers, especially authors of stories, specimens of classic authors of the twentieth century: futurists, expressionists, surrealists, and writers of critical essays. Translation of some precious octaves of Ariosto’s poem Orlando furioso were also included. The second ‘special’ issue (2011, 8, entitled Italy: Seasons, is devoted to contemporary women writers of fiction. Particularly valuable is the Literature heritage section, which contains translations of Vivaldi’s sonnets by M. Amelin and of G.G. Belli’s Roman sonnets by E. Solonovič, both representatives of the excellence of the Russian school of translation. The two issues include a complete index of Italian authors translated into Russian between 1994 and 2011.

Comparative survey of comprehensiveness of literature collection between two information systems

International Nuclear Information System (INIS)

Narui, Shigeko; Habara, Tadashi; Izawa, Michiyo; Naramoto, Miyoko; Kajiro, Tadashi

1983-01-01

To make clear a feature of INIS database for the subject areas of plasma physics and thermonuclear reactions (the INIS category A14), the overlap literature was surveyedwhich had been collected into both INIS and INSPEC databases. All of 4,454 items of literature inputted into that category of INIS during 1980 were checked on whether they had also been included in INSPEC or not. The overlap ratio of the items to those in INIS was found to be 50 % and the ratios for types of literature were 96%, 42%, 28%, 3% and 0% for journals, books, pamphlets, technical reports, and patent dissertations, respectively. Journal articles not included into INSPEC were found to be derived from the journals which were not central to INSPEC. These facts show that INIS covers various types of literature, which INSPEC collected mainly journal literature. For more warrantable conclusion, it needs further survey on those items which are collected into INSPEC but not into INIS. (author)

Literature for Children and Adolescents.

Science.gov (United States)

Matthews, Dorothy, Ed.

1978-01-01

The 11 articles in this publication discuss many topics regarding literature for children and adolescents, including the following: the major problems facing teachers and writers alike as they strive to communicate with the young; E.B. White's "Charlotte's Web"; two views of the American Revolution found in "Johnny Tremain" and "My Brother Sam Is…

The management of change in public organisations: A literature review

NARCIS (Netherlands)

B.S. Kuipers (Ben); M.J. Higgs (Malcolm); W.J.M. Kickert (Walter); L.G. Tummers (Lars); J. Grandia (Jolien); J. van der Voet (Joris)

2013-01-01

textabstractThis article presents a review of the recent literature on change management in public organisations and sets out to explore the extent to which this literature has responded to earlier critiques regarding the lack of (public) contextual factors. The review includes 133 articles

Philosophy and Literature; Philosophy as Literature: Call for Papers

Directory of Open Access Journals (Sweden)

2013-11-01

to the essential story. •\tThe literary merit of philosophical writing: a secondary concern to the primary quest for truth? •\tThe dialectic of abstraction and embodiment. •\tThe literary form as the accurate expression of moral truths because of the embodied and particular nature of moral philosophy. (Nussbaum. •\tThe importance of fiction, poetry and song for guiding thought, strengthening observation, developing critical thinking. (Confucius. •\tAuthors who conceive of the novel as more than story; as a genre that ‘brings together every device and every form of knowledge in order to shed light on existence.’ (Kundera on Broch. Also, Musil, Calvino, Coetzee, George Eliot. •\tPhilosophy as performance and philosophical plays. •\tPhilosophers who also write literary fiction. We also invite: •\tCreative writing that investigates an original philosophical problem. •\tBook reviews of relevant creative and scholarly works that explore the above themes. Submission guidelines Articles should: •\tBe between 4000 and 6000 words in length, including footnotes. •\tConform to the journal’s style guide available here: http://fhrc.flinders.edu.au/transnational/submissions.html •\tBe accompanied by abstract of about 200 words. •\tBe accompanied by an author biography of 150 words. •\tBe attached as a Microsoft Word document to an email addressed to Kathryn Koromilas kathryn.koromilas@adelaide.edu.au. Please add subject line: Submission TNL Philosophy as literature. Deadline for submissions 30 June 2014.

An investigation of the international literature on nurse practitioner private practice models.

Science.gov (United States)

Currie, J; Chiarella, M; Buckley, T

2013-12-01

To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences. NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models. Integrative literature review. A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes. Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability. Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the

The Corpus Status of Literature in Teaching Sociology: Novels as "Sociological Reconstruction"

Science.gov (United States)

Carlin, Andrew P.

2010-01-01

Using fiction in teaching sociology involves what Harvey Sacks calls "sociological reconstruction". Numerous comments on teaching sociology provide advice and suggestions on the use of literature and "what counts" as "sociological" literature, including specific titles. This paper goes further: while the use of literature is a routine feature of…

On European Religious Literature

Institute of Scientific and Technical Information of China (English)

张丽娟

2016-01-01

Since ancient time,literature has being a hot topic that scholars concern.Latin religious literature is the mainstream of medieval literature.This paper analyzes medieval literature from three aspects which are the religious cultural background,main characteristics and achievements.What’s more,the thesis summarizes its influence to literature afterwards,and provides suggestion to the contemporary literature in China.

Botanical Literature in India 1973-1983.

Science.gov (United States)

Maheswarappa, B. S.; Nagaraju, A.

1988-01-01

Describes a study that used bibliometrics to examine botanical research activity in India. The findings discussed include the growth of botanical literature, authorship patterns and collaborative research, important research centers and their rankings, journals preferred by Indian botanists, subfields of research, and the applicability of…

A Survey of Computer Science Capstone Course Literature

Science.gov (United States)

Dugan, Robert F., Jr.

2011-01-01

In this article, we surveyed literature related to undergraduate computer science capstone courses. The survey was organized around course and project issues. Course issues included: course models, learning theories, course goals, course topics, student evaluation, and course evaluation. Project issues included: software process models, software…

Culturally Diverse Literature: Enriching Variety in an Era of Common Core State Standards

Science.gov (United States)

Boyd, Fenice B.; Causey, Lauren L.; Galda, Lee

2015-01-01

The authors argue for the overwhelming importance of finding and including culturally diverse literature into the curricula teachers are authorized to teach. They discuss the implications of use and offer ideas on how to identify quality literature to include in classroom and school libraries.

Organizational downsizing: a review of literature for planning and research.

Science.gov (United States)

Davis, Jullet A; Savage, Grant; Stewart, R Thomas

2003-01-01

The use of downsizing as management's strategic response to environmental and institutional changes is prevalent in all U.S. industries, including healthcare. The popular and research literature is inundated with reports on companies undergoing various stages of restructuring, which often include one or more staff reductions. This article provides a review of downsizing literature published from 1985 to 2002. Although the findings and conclusions of these articles are generally inconsistent, the prevailing opinion is that for downsizing to be successful, effective planning must occur long before, during, and after downsizing. Additionally, a downsizing plan should be included in the strategic management plan of all organizations, regardless of whether they plan to downsize or not. By including such a plan, the organization will be better prepared to begin the staff-reduction process should it be forced to do so in response to environmental changes. Finally, providing ample support and protection for staff is key to the organization's recovery and growth. The lessons provided in this literature review should assist healthcare managers in deciding how to plan and structure potential staff reductions.

Irradiating the groin nodes without breaking a leg: A comparison of techniques for groin node irradiation

International Nuclear Information System (INIS)

Gilroy, Jeffrey S.; Amdur, Robert J.; Louis, Debbie A.; Li, Jonathan G.; Mendenhall, William M.

2004-01-01

The purpose of this study was to determine the optimal technique for delivering postoperative radiotherapy for vulvar cancer and other tumors requiring treatment of the inguinal nodes. This project compared tumor coverage and normal tissue sparing for the 5 main radiotherapy techniques that are used to treat vulvar cancer. The intensity-modulated radiation therapy (IMRT) plan was undesirable because it resulted in an excessive dose to portions of the central pelvic structures. The photon thunderbird with skin match was unacceptable because it underdosed a portion of the groin region. The electron thunderbird was ideal for thin patients but was not applicable for most patients because of excessive dose to the skin and subcutaneous tissues. The photon through-and-through and the photon thunderbird with deep match were acceptable in most situations. In thin patients, where the depth of the inguinal vessels is less than 3 cm, the electron thunderbird is the technique of choice. In the average-sized patient, both the photon through-and-through and the photon thunderbird with deep match are reasonable options. The available literature suggests that the risk of femoral neck fracture or necrosis of the femoral head is approximately 11% at 5 years using the photon through-and-through technique. In our opinion, this is an acceptable price to pay for reliable node coverage, setup simplicity, and zero risk of overdose at field junctions

Using Restaurant Reviews to Teach How to Write Literature Reviews

Science.gov (United States)

Smith, Kelli Jean K.; Ferris, Sharmila Pixy

2017-01-01

Courses: Any communication course requiring a literature review, including, but is not limited to, Communication Research Methods and Communication Theory. Objectives: After completing this activity, students should be able to write better literature reviews by (1) locating a range of resources; (2) identifying a variety of relevant information…

Online Counseling: Reviewing the Literature from a Counseling Psychology Framework

Science.gov (United States)

Mallen, Michael J.; Vogel, David L.; Rochlen, Aaron B.; Day, Susan X.

2005-01-01

This article reviews the online-counseling literature with an emphasis on current applications and considerations for future research. It focuses on primary themes of counseling psychology including the history of process-outcome research and multiculturalism. It explores current gaps in the literature from a counseling psychology framework,…

Ways That Preservice Teachers Integrate Children's Literature into Mathematics Lessons

Science.gov (United States)

Rogers, Rachelle Meyer; Cooper, Sandi; Nesmith, Suzanne M.; Purdum-Cassidy, Barbara

2015-01-01

Children's literature involving mathematics provides a common, natural context for the sharing of mathematics. To learn more about how preservice teachers included children's literature in their mathematics lessons, a study was conducted over two semesters during a required field experience component of an undergraduate teacher education program.…

A hitchhiker's guide to the older literature of descriptive teratology.

Science.gov (United States)

Beckwith, J Bruce

2007-12-15

Though relatively neglected in the age of molecular biology, the older literature of teratology includes superb illustrations and descriptions of malformations, and other information of permanent value to science and medicine. Accessing that literature can be challenging, as most is in works that are rare, published in languages other than English, and not available in digital form. This article describes some valuable sources of information concerning the antiquarian literature of descriptive teratology. (c) 2007 Wiley-Liss, Inc.

The Experiences of First-Year Music Teachers: A Literature Review

Science.gov (United States)

Conway, Colleen

2015-01-01

The purpose of this literature review is to examine research focused on first-year music educators in an effort to present recommendations for preservice music teacher education and research. The three bodies of literature presented include the following: challenges faced by beginning music teachers, views of beginning music teachers concerning…

Chronic pelvic floor dysfunction.

Science.gov (United States)

Hartmann, Dee; Sarton, Julie

2014-10-01

The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vulvar pain and sexual dysfunction. Though the studies have yet to prove a specific protocol, physical therapists trained in pelvic dysfunction are reporting success with restoring tissue normalcy and reducing vulvar and sexual pain. A review of pelvic anatomy and common findings are presented along with suggested physical therapy management. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pleasure and pain: the effect of (almost) having an orgasm on genital and nongenital sensitivity.

Science.gov (United States)

Paterson, Laurel Q P; Amsel, Rhonda; Binik, Yitzchak M

2013-06-01

The effect of sexual arousal and orgasm on genital sensitivity has received little research attention, and no study has assessed sensation pleasurableness as well as painfulness. To clarify the relationship between sexual arousal, orgasm, and sensitivity in a healthy female sample. Twenty-six women privately masturbated to orgasm and almost to orgasm at two separate sessions, during which standardized pressure stimulation was applied to the glans clitoris, vulvar vestibule, and volar forearm at three testing times: (i) baseline; (ii) immediately following masturbation; and (iii) following a subsequent 15-minute rest period. Touch thresholds (tactile detection sensitivity), sensation pleasurableness ratings (pleasurable sensitivity), and pain thresholds (pain sensitivity). Pleasurableness ratings were higher on the glans clitoris than the vulvar vestibule, and at most testing times on the vulvar vestibule than the volar forearm; and at baseline and immediately after masturbation than 15 minutes later, mainly on the genital locations only. Pain thresholds were lower on the genital locations than the volar forearm, and immediately and 15 minutes after masturbation than at baseline. After orgasm, genital pleasurableness ratings and vulvar vestibular pain thresholds were lower than after masturbation almost to orgasm. Post-masturbation pleasurableness ratings were positively correlated with pain thresholds but only on the glans clitoris. Hormonal contraception users had lower pleasurableness ratings and pain thresholds on all locations than nonusers. There were no significant effects for touch thresholds. Masturbation appears to maintain pleasurable genital sensitivity but increase pain sensitivity, with lower genital pleasurable sensitivity and higher vulvar vestibular pain sensitivity when orgasm occurs. Findings suggest that enhancing stimulation pleasurableness, psychological sexual arousal and lubrication mitigate normative increases in pain sensitivity during

The "Canadian" in Canadian Children's Literature.

Science.gov (United States)

Bainbridge, Joyce; Wolodko, Brenda

2001-01-01

Notes that a rich body of Canadian children's literature exists that reflects the country's literary and socio-cultural values, beliefs, themes and images, including those of geography, history, language and identity. Discusses how Canadians tend to identify themselves first by region or province and then by nation. (SG)

JOB SATISFACTION OF MIDWIVES: A LITERATURE REVIEW

Directory of Open Access Journals (Sweden)

Daniela Nedvědová

2017-05-01

Full Text Available Aim: The aims of the literature review were to identify and analyze factors affecting job satisfaction of midwives. Design: A literature review. Methods: Included in the literature review were full texts of papers published in English language from 1990 to 2014. The search for relevant data was performed using the electronic databases CINAHL, Medline, Science Direct and Wiley Online Library. From a total of 43 studies found, 11were analyzed as quantitative studies that fulfilled the specified criteria. Results: Job satisfaction of midwives is affected by a lack of support from the management of healthcare facilities, low salary, understaffing, insufficient time for professional activities, work-family imbalance, high workload, physical demands, inadequate professional development, working environment, stress and low autonomy at work. Midwives showed signs of exhaustion, fatigue, hostility and depression, contributing to job turnover. Conclusion: The literature review presents the factors influencing job satisfaction of midwives. This is affected by many variable determinants, which create a feeling of job satisfaction of midwives, but can also lead to job dissatisfaction and, consequently, high turnover. Keywords: midwives, job satisfaction.

Organizational change tactics: the evidence base in the literature.

Science.gov (United States)

Packard, Thomas; Shih, Amber

2014-01-01

Planned organizational change processes can be used to address the many challenges facing human service organizations (HSOs) and improve organizational outcomes. There is massive literature on organizational change, ranging from popular management books to academic research on specific aspects of change. Regarding HSOs, there is a growing literature, including increasing attention to implementation science and evidence-based practices. However, research which offers generalizable, evidence-based guidelines for implementing change is not common. The purpose of the authors was to assess the evidence base in this organizational change literature to lay the groundwork for more systematic knowledge development in this important field.

Expanding Comparative Literature into Comparative Sciences Clusters with Neutrosophy and Quad-stage Method

Directory of Open Access Journals (Sweden)

Fu Yuhua

2016-08-01

Full Text Available By using Neutrosophy and Quad-stage Method, the expansions of comparative literature include: comparative social sciences clusters, comparative natural sciences clusters, comparative interdisciplinary sciences clusters, and so on. Among them, comparative social sciences clusters include: comparative literature, comparative history, comparative philosophy, and so on; comparative natural sciences clusters include: comparative mathematics, comparative physics, comparative chemistry, comparative medicine, comparative biology, and so on.

Southern Gothic Literature

DEFF Research Database (Denmark)

Bjerre, Thomas Ærvold

2017-01-01

Provides an outline of Southern Gothic Literature, offers an argument about its history and shape, and discusses the scholarly literature surrounding Southern Gothic. Oxford Research Encyclopedia is an online peer-reviewed encyclopedia for researchers, teachers, and students interested in all...... facets of the study of literature...

Pheromone dispensers, including organic polymer fibers, described in the crop protection literature: comparison of their innovation potential.

Science.gov (United States)

Hummel, Hans E; Langner, S S; Eisinger, M-T

2013-01-01

parameters, they hold considerable promise for future pest control against a variety of pest insects. In combination with well known synthetic sex pheromones, they can be used for communication disruption studies. One example, the pheromone of the European grape vine moth Lobesia botrana (Lepidoptera: Tortricidae), in combination with Ecoflex fibers, has been thoroughly tested in vineyards of Freiburg, Southwest Germany, with promising results. Seven weeks of communication disruption have been achieved, long enough to cover any one of several flights of this multivoltine grape pest. Disruption effects of around 95% have been achieved which are statistically indistinguishable from positive controls tested simultaneously with Isonet LE fibers, while an untreated negative control is significantly different. Ecoflex is a cheap organic co-polyester and completely biodegradable within half a year. Thus, an extra recovery step as with some other dispensers is unnecessary. This co-polyester is also of proven non-toxicity. The extension of the seven week disruption period towards half a year (the entire duration of all 3 Lobesia flights combined) is desirable and is under additional investigation in the near future. The discovery of suitable mesofibers is protected by European and US patents. The pheromone literature appearing between 1959 and today contains more than 25,000 references. This wealth of information is immediately applicable to pest management. It has major impacts on chemical ecology and IPM. In this paper, an attempt is made to compare the systems described in the literature and to derive some predictions about their prospective innovation potential. Special emphasis is given to the new development of organic biodegradable microfibers. To this end, a new electronic searching algorithm is introduced for reviewing the entries to be found in 4 specific databases. Its prominent features will be described. Surprisingly we found no previous entries in the literature linking

Literature review of environmental qualification of safety-related electric cables: Literature analysis and appendices. Volume 2

International Nuclear Information System (INIS)

Lofaro, R.; Bowerman, B.; Carbonaro, J.

1996-04-01

In support of the US NRC Environmental Qualification (EQ) Research Program, a literature review was performed to identify past relevant work that could be used to help fully or partially resolve issues of interest related to the qualification of low-voltage electric cable. A summary of the literature reviewed is documented in Volume 1 of this report. In this, Volume 2 of the report, dossiers are presented which document the issues selected for investigation in this program, along with recommendations for future work to resolve the issues, when necessary. The dossiers are based on an analysis of the literature reviewed, as well as expert opinions. This analysis includes a critical review of the information available from past and ongoing work in thirteen specific areas related to EQ. The analysis for each area focuses on one or more questions which must be answered to consider a particular issue resolved. Results of the analysis are presented, along with recommendations for future work. The analysis is documented in the form of a dossier for each of the areas analyzed

Literatura Oral Hispanica (Hispanic Oral Literature).

Science.gov (United States)

McAlpine, Dave

As part of a class in Hispanic Oral Literature, students collected pieces of folklore from various Hispanic residents in the region known as "Siouxland" in Iowa. Consisting of some of the folklore recorded from the residents, this paper includes 18 "cuentos y leyendas" (tales and legends), 48 "refranes" (proverbs), 17…

A student's guide to searching the literature using online databases

Science.gov (United States)

Miller, Casey W.; Belyea, Dustin; Chabot, Michelle; Messina, Troy

2012-02-01

A method is described to empower students to efficiently perform general and specific literature searches using online resources [Miller et al., Am. J. Phys. 77, 1112 (2009)]. The method was tested on multiple groups, including undergraduate and graduate students with varying backgrounds in scientific literature searches. Students involved in this study showed marked improvement in their awareness of how and where to find scientific information. Repeated exposure to literature searching methods appears worthwhile, starting early in the undergraduate career, and even in graduate school orientation.

Studying the Identity of Iranian Classical Effective Literature and Contemporary Impressible Literature

Directory of Open Access Journals (Sweden)

Abdolmajid Mohaqeqi

2014-11-01

Full Text Available After the advent of Islam in Iran, Persian Literature has always been considered as one of the major characteristics of Iranian culture and identity to the extent that some people believe whatever western has achieved in terms of literature – especially English literature – and honors to them originate from rich Persian literature. However, Persian literature has severely been influenced by works of western writers in contemporary era so that even modern Persian story and poem is divided based on western styles. Unfortunately, this situation – that a part of identity of Iranian culture has been drastically affected by alien culture – offends each educated Iranian. Today, a flashback to Iranian classical styles does not meet the need for a development created in literary works. However, it is necessary that tasteful and patriotic people create novel works in Iran’s contemporary literature against the decades-old literary identity of the west through adaptation of past-targeted literature and under the effect of conditions of today modern society in order to recover the lost identity of Iranian literature which other fields are considered as its subset. Therefore, this paper is going to present solutions for modeling the identity of Iranian literature for the next two decades in line with Islamization of universities in order to divide the pure academic literature into pure and applied sub-branches and develop academic literary activities. As a result, the international works would be established based on the columns of Persian literature whose kernel will not to be damaged in the rain and wind of alien cultures.

Assessment of the quality of pharmacoeconomic evaluation literature in China.

Science.gov (United States)

Zhang, Fang; He, Xu; Xiang, Wei; Li, Shu Chuen

2017-05-01

To evaluate the quality of Chinese pharmacoeconomic-evaluation literature published between 2012-2014 retrieved from the Chinese National Knowledge Infrastructure (CNKI) in order to assess their adherence to recommendations of the Chinese Pharmacoeconomic Guidelines. Identified literature was screened according to pre-specified criteria to access legibility for inclusion. Each included piece of literature was systematically compared against the recommendations proposed by the relevant Chinese guidelines. After culling, 259 studies were included in the comparative analysis. When compared to a previous study evaluating the quality of similar literature published between 1997-2007, the results showed improvements in certain technical aspects over the years. Particularly, an improvement was observed in more diverse evaluation methods being used, increased use of cost-utility analysis (2.43% in 2012-2014 vs 0.26% in 1997-2007) and use of discounting (45% in 2012-2014 vs 4.35% in 1997- 2007). In addition, a small number of studies were starting to apply modeling. The quality of economic evaluation literature has improved in recent years, with more researchers realizing the importance and necessity of using discounting, sensitivity analysis, and modeling when conducting economic evaluation. This study also highlights certain important areas needing further attention when conducting economic evaluations in China. These include the ICER threshold of economic analysis, more detailed guidance in performing sensitivity analysis and modeling, as well as transferability of cost data across different regions. Overall, the results would support the positive contribution of the Chinese Economic Guideline in promoting economic evaluations in China.

Rethinking the Role of Grey Literature in the Fourth Industrial Revolution

OpenAIRE

Savić, Dobrica

2017-01-01

This paper examines the potential impact of the emerging Fourth Industrial Revolution on grey literature and the challenges it will bring to the information management profession. Based on analysis of the most prevalent current trends and developments, it appears we will need to rethink the defi nition of grey literature, its creation and types, processing, storage, sustainability and usability. Information professionals, including the grey literature ones, will require training and new knowl...

Mortality at Music Festivals: Academic and Grey Literature for Case Finding.

Science.gov (United States)

Turris, Sheila A; Lund, Adam

2017-02-01

Deaths at music festivals are not infrequently reported in the media; however, the true mortality burden is difficult to determine as the deaths are not yet systematically documented in the academic literature. This was a literature search for case examples using academic and gray literature sources, employing both retrospective and prospective searches of media sources from 1999-2014. The gray literature documents a total of 722 deaths, including traumatic (594/722; 82%) and non-traumatic (128/722; 18%) causes. Fatalities were caused by trampling (n=479), motor-vehicle-related (n=39), structural collapses (n=28), acts of terror (n=26), drowning (n=8), assaults (n=6), falls (n=5), hanging (n=2), and thermal injury (n=2). Non-traumatic deaths included overdoses (n=96/722; 13%), environmental causes (n=8/722; 1%), natural causes (n=10/722; 1%), and unknown/not reported (n=14/722; 2%). The majority of non-trauma-related deaths were related to overdose (75%). The academic literature documents trauma-related deaths (n=368) and overdose-related deaths (n=12). One hundred percent of the trauma-related deaths reported in the academic literature also were reported in the gray literature (n=368). Mortality rates cannot be reported as the total attendance at events is not known. The methodology presented in this manuscript confirms that deaths occur not uncommonly at music festivals, and it represents a starting point in the documentation and surveillance of mortality. Turris SA , Lund A . Mortality at music festivals: academic and grey literature for case finding. Prehosp Disaster Med. 2017;32(1):58-63.

Geological literature on the San Joaquin Valley of California

Science.gov (United States)

Maher, J.C.; Trollman, W.M.; Denman, J.M.

1973-01-01

The following list of references includes most of the geological literature on the San Joaquin Valley and vicinity in central California (see figure 1) published prior to January 1, 1973. The San Joaquin Valley comprises all or parts of 11 counties -- Alameda, Calaveras, Contra Costa, Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare (figure 2). As a matter of convenient geographical classification the boundaries of the report area have been drawn along county lines, and to include San Benito and Santa Clara Counties on the west and Mariposa and Tuolumne Counties on the east. Therefore, this list of geological literature includes some publications on the Diablo and Temblor Ranges on the west, the Tehachapi Mountains and Mojave Desert on the south, and the Sierra Nevada Foothills and Mountains on the east.

Vulvar Cancer Overview

Science.gov (United States)

... to Content ASCO.org Conquer Cancer Foundation ASCO Journals Donate eNews Signup f Cancer.net on Facebook t Cancer.net on Twitter q Cancer.net on YouTube g Cancer.net on Google Menu Home Types of Cancer Navigating Cancer Care Coping With Cancer Research and Advocacy Survivorship Blog About ...

Passive prosthetic hands and tools: A literature review.

Science.gov (United States)

Maat, Bartjan; Smit, Gerwin; Plettenburg, Dick; Breedveld, Paul

2018-02-01

The group of passive prostheses consists of prosthetic hands and prosthetic tools. These can either be static or adjustable. Limited research and development on passive prostheses has been performed although many people use these prosthesis types. Although some publications describe passive prostheses, no recent review of the peer-reviewed literature on passive prostheses is available. Review the peer-reviewed literature on passive prostheses for replacement of the hand. Literature review. Four electronic databases were searched using a Boolean combination of relevant keywords. English-language articles relevant to the objective were selected. In all, 38 papers were included in the review. Publications on passive prosthetic hands describe their users, usage, functionality, and problems in activities of daily living. Publications on prosthetic tools mostly focus on sport, recreation, and vehicle driving. Passive hand prostheses receive little attention in prosthetic research and literature. Yet one out of three people with a limb deficiency uses this type of prosthesis. Literature indicates that passive prostheses can be improved on pulling and grasping functions. In the literature, ambiguous names are used for different types of passive prostheses. This causes confusion. We present a new and clear classification of passive prostheses. Clinical relevance This review provides information on the users of passive prosthetic hands and tools, their usage and the functionality. Passive prostheses receive very little attention and low appreciation in literature. Passive prosthetic hands and tools show to be useful to many unilateral amputees and should receive more attention and higher acceptance.

What Work Do the Concepts of "Language" and "Literature" Do for Michael Rosenak?

Science.gov (United States)

Levisohn, Jon A.

2014-01-01

Michael Rosenak uses the twin metaphors of "language" and "literature," borrowed from Oakeshott and Peters, to argue that the goal of education is initiation into a language. This goal transcends the study of literature in that language. It includes, as well, the development of the capacity both to critique literature and to…

Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses?

Science.gov (United States)

McAuley, L; Pham, B; Tugwell, P; Moher, D

2000-10-07

The inclusion of only a subset of all available evidence in a meta-analysis may introduce biases and threaten its validity; this is particularly likely if the subset of included studies differ from those not included, which may be the case for published and grey literature (unpublished studies, with limited distribution). We set out to examine whether exclusion of grey literature, compared with its inclusion in meta-analysis, provides different estimates of the effectiveness of interventions assessed in randomised trials. From a random sample of 135 meta-analyses, we identified and retrieved 33 publications that included both grey and published primary studies. The 33 publications contributed 41 separate meta-analyses from several disease areas. General characteristics of the meta-analyses and associated studies and outcome data at the trial level were collected. We explored the effects of the inclusion of grey literature on the quantitative results using logistic-regression analyses. 33% of the meta-analyses were found to include some form of grey literature. The grey literature, when included, accounts for between 4.5% and 75% of the studies in a meta-analysis. On average, published work, compared with grey literature, yielded significantly larger estimates of the intervention effect by 15% (ratio of odds ratios=1.15 [95% CI 1.04-1.28]). Excluding abstracts from the analysis further compounded the exaggeration (1.33 [1.10-1.60]). The exclusion of grey literature from meta-analyses can lead to exaggerated estimates of intervention effectiveness. In general, meta-analysts should attempt to identify, retrieve, and include all reports, grey and published, that meet predefined inclusion criteria.

Dimensions of Ideology. A Review of Social-Psychological Literature

Directory of Open Access Journals (Sweden)

Bojan Todosijević

2014-01-01

Full Text Available In social psychological literature, ideology is typically conceived as a relatively stable and organized set of general orientations that include interrelated attitudes grouped according to various sources of constraint, such as psychological disposition, general values, or ideological traditions. The paper reviews social-psychological literature on the organization of social attitudes. Research on this topic started nearly eight decades ago, inspired by the research on the structure of intellectual abilities. Since then, a large body of literature has been generated, which has not been systematically reviewed. Despite the long tradition, this literature has not resulted in proportional cumulative scientific development. The review should help improving this situation by listing the relevant studies, examining the research methodology and the main findings. The review ends with the critical summary of the man findings and methodological problems, and recommendations for the future research.

MASSIVE VULVAR EDEMA IN A WOMAN WITH SEVERE ...

African Journals Online (AJOL)

2010-06-11

Jun 11, 2010 ... The biophysical profile was normal. The diagnosis of severe preeclampsia was made. Conservative treatment was initiated. This included bed rest, antihypertensive treatment with methyldopa and atenolol, and magnesium sulphate was administered for. 24hours to prevent convulsions. Steroids were also.

Bengal Literature and History.

Science.gov (United States)

Dimock, Edward C., Jr., Ed.

The unifying theme of the papers in this book is the use of creative literature as source material for the study of cultural history. Titles and authors of the papers are: "Encounter and Growth in Bengali Literature, A Survey of Medieval Bengali Literature" by T.W. Clark; "The Hindu Chiefdom in Middle Bengali Literature" by…

The Gift of Literature

Directory of Open Access Journals (Sweden)

Todor Hristov

2015-01-01

Full Text Available The traumatic question “what has Bulgarian literature given to the world” acquired particular intensity in periods of crisis such as the Balkan Wars, and after 1989 and the subsequent Bulgarian EU accession. It is generally accepted that the value that Bulgarian literature transmits to the world lies in the identity it represented. The goal of the paper is to show that Bulgarian literature was constituted as a gift responding to the gift of world literature, yet ever unable to repay the debt incurred by its initial gift, and trying to alleviate its indebtedness by means of a specific language of exchange. Hristov believes that studying the literature on the value of Bulgarian literature will demonstrate that the notions of identity, recognition, value, translation, national and world literature have been inscribed in a scriptural economy blending gift and exchange in a peculiar way. He hopes that this economy emerged as a modification of the scriptural economy in which the notion of world literature had been embedded, and that it has been globalised into a universal literary economy.

High-throughput literature mining to support read-across ...

Science.gov (United States)

Building scientific confidence in the development and evaluation of read-across remains an ongoing challenge. Approaches include establishing systematic frameworks to identify sources of uncertainty and ways to address them. One source of uncertainty is related to characterizing biological similarity. Many research efforts are underway such as structuring mechanistic data in adverse outcome pathways and investigating the utility of high throughput (HT)/high content (HC) screening data. A largely untapped resource for read-across to date is the biomedical literature. This information has the potential to support read-across by facilitating the identification of valid source analogues with similar biological and toxicological profiles as well as providing the mechanistic understanding for any prediction made. A key challenge in using biomedical literature is to convert and translate its unstructured form into a computable format that can be linked to chemical structure. We developed a novel text-mining strategy to represent literature information for read across. Keywords were used to organize literature into toxicity signatures at the chemical level. These signatures were integrated with HT in vitro data and curated chemical structures. A rule-based algorithm assessed the strength of the literature relationship, providing a mechanism to rank and visualize the signature as literature ToxPIs (LitToxPIs). LitToxPIs were developed for over 6,000 chemicals for a varie

Afriphone Literature as a Prototypical Form of African Literature: Insights from Prototype Theory

Science.gov (United States)

Bodomo, Adams

2016-01-01

What is the most prototypical form of African literature? Shouldn't we be using African languages to produce African literary texts, shouldn't we produce more Afriphone African literature compared to Europhone African literature or Afro-Europhone literature? This issue underlies the reality that the vast majority of African writers presumably…

Job Satisfaction of Academic Librarians: A Review of Literature.

Science.gov (United States)

Mirfakhrai, Mohammad H.

This literature review on job satisfaction of academic librarians is divided into two sections. The first section deals with the conceptual framework which includes two theoretical approaches to job satisfaction. These theories include Maslow's Needs Hierarchy Theory and Herzberg's Two-Factor (Motivation/Hygiene) Theory. Criticisms of these…

Readability of Early Intervention Program Literature

Science.gov (United States)

Pizur-Barnekow, Kris; Patrick, Timothy; Rhyner, Paula M.; Cashin, Susan; Rentmeester, Angela

2011-01-01

Accessibility of early intervention program literature was examined through readability analysis of documents given to families who have a child served by the Birth to 3 program. Nine agencies that serve families in Birth to 3 programs located in a county in the Midwest provided the (n = 94) documents. Documents were included in the analysis if…

Pros, cons, and ethics of HPV vaccine in teens?Why such controversy?

OpenAIRE

White, Mark Donald

2014-01-01

Introduction Human papillomavirus (HPV) infection remains one of the most commonly sexually transmitted infections in both females and males. HPV viruses are associated with several manifestations including genital warts, but more importantly for urology practitioners, cervical and penile carcinomas and recurrent genital condylomata in both sexes. The incidence of HPV-related carcinomas has increased in cervical, oropharyngeal, vulvar, penile, and anal cancers. Effective vaccines have been av...

[Vulvovaginitis in young girls].

Science.gov (United States)

Olejek, Anita; Kellas-Sleczka, Sylwia; Kozak-Darmas, Iwona; Bilska, Anna; Zamłyński, Jacek; Horak, Stanisław; Nowak, Leszek

2009-12-01

Vulvovaginitis is the most common cause of gynecological complaints in young girls. Factors which cause vulvovaginitis include, among other things, low level of sexual hormones (hypoestrogenism), the anatomical proximity of the rectum and delicate vulvar skin and vaginal mucosa. Usually vulvovaginitis in young girls is caused by non-specific factors. The aim of the study was to present the most frequent causes of vulvovaginitis in young girls.

Predictors and Patterns of Local, Regional, and Distant Failure in Squamous Cell Carcinoma of the Vulva.

Science.gov (United States)

Bogani, Giorgio; Cromi, Antonella; Serati, Maurizio; Uccella, Stefano; Donato, Violante Di; Casarin, Jvan; Naro, Edoardo Di; Ghezzi, Fabio

2017-06-01

To identify factors predicting for recurrence in vulvar cancer patients undergoing surgical treatment. We retrospectively evaluated data of consecutive patients with squamous cell vulvar cancer treated between January 1, 1990 and December 31, 2013. Basic descriptive statistics and multivariable analysis were used to design predicting models influencing outcomes. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed using the Cox model. The study included 101 patients affected by vulvar cancer: 64 (63%) stage I, 12 (12%) stage II, 20 (20%) stage III, and 5 (5%) stage IV. After a mean (SD) follow-up of 37.6 (22.1) months, 21 (21%) recurrences occurred. Local, regional, and distant failures were recorded in 14 (14%), 6 (6%), and 3 (3%) patients, respectively. Five-year DFS and OS were 77% and 82%, respectively. At multivariate analysis only stromal invasion >2 mm (hazard ratio: 4.9 [95% confidence interval, 1.17-21.1]; P=0.04) and extracapsular lymph node involvement (hazard ratio: 9.0 (95% confidence interval, 1.17-69.5); P=0.03) correlated with worse DFS, although no factor independently correlated with OS. Looking at factors influencing local and regional failure, we observed that stromal invasion >2 mm was the only factor predicting for local recurrence, whereas lymph node extracapsular involvement predicted for regional recurrence. Stromal invasion >2 mm and lymph node extracapsular spread are the most important factors predicting for local and regional failure, respectively. Studies evaluating the effectiveness of adjuvant treatment in high-risk patients are warranted.

USING LITERATURE IN GEOGRAPHY LESSONS

Directory of Open Access Journals (Sweden)

ROXANA HOBAI

2015-01-01

Full Text Available Including in a novel information about relief, climate, vegetation, fauna and various aspects of socio-economic life can make literature a real source of geographical information. Using realistic literary works in Geography lessons has multiple benefits, which are not limited only to geographical knowledge. In this paper there are some fragments from literature, suggestions of activities about how to integrate the fragments during Geography lessons and the results of these activities. The activities are from fifth to twelfth grade, passing through a first example of water pollution resulting from a Hercules labour, through the lyricism of the aurora borealis description, through the dramatic life of a refugee from Darfur, through the Dobrudgea winter landscape, through the grey urban landscape of Bucharest in the 90s and so on. Students were put into learning situations that stimulated their creativity, developed communication competencies and enriched their general knowledge.

Moral education through literature

Directory of Open Access Journals (Sweden)

Pantić Nataša

2006-01-01

Full Text Available This paper examines a variety of perspectives on the role of literature in moral education. These proceed from general considerations to more specific issues that remain contested to the present day, such as distinction between individual and social morality. Others bring any literature under suspicion in the post-structuralist era, such as the cultural relativity of morality, distinctions between aesthetic and moral dimensions of literary works, and between moral awareness and behavior. The discussion is illustrated through considerations of the place of literature in English moral education from the Victorians to the present day. The discussion of dilemmas that policy makers and educators face today focuses on three dilemmas that often serve to question a possibility of justifying the morally educative power of literature: cultural relativism in literature and ideology (and its implications for the canon, the distinction between an aesthetic and moral power of literature, and finally, the doubts about the transferability of moral awareness acquired through literature to actual moral conduct. .

A bibliography of literature pertaining to plague (Yersinia pestis)

Science.gov (United States)

Ellison, Laura E.; Frank, Megan K. Eberhardt

2011-01-01

Plague is an acute and often fatal zoonotic disease caused by the bacterium Yersinia pestis. Y. pestis mainly cycles between small mammals and their fleas; however, it has the potential to infect humans and frequently causes fatalities if left untreated. It is often considered a disease of the past; however, since the late 1800s, plagueis geographic range has expanded greatly, posing new threats in previously unaffected regions of the world, including the Western United States. A literature search was conducted using Internet resources and databases. The keywords chosen for the searches included plague, Yersinia pestis, management, control, wildlife, prairie dogs, fleas, North America, and mammals. Keywords were used alone or in combination with the other terms. Although this search pertains mostly to North America, citations were included from the international research community, as well. Databases and search engines used included Google (http://www.google.com), Google Scholar (http://scholar.google.com), SciVerse Scopus (http://www.scopus.com), ISI Web of Knowledge (http://apps.isiknowledge.com), and the USGS Library's Digital Desktop (http://library.usgs.gov). The literature-cited sections of manuscripts obtained from keyword searches were cross-referenced to identify additional citations or gray literature that was missed by the Internet search engines. This Open-File Report, published as an Internet-accessible bibliography, is intended to be periodically updated with new citations or older references that may have been missed during this compilation. Hence, the authors would be grateful to receive notice of any new or old papers that the audience (users) think need to be included.

Literature survey of redox reactions in the near field

International Nuclear Information System (INIS)

Miki, Takahito; Chiba, Tamotsu; Inagaki, Manabu; Sasamoto, Hiroshi; Yui, Mikazu

2000-01-01

This report presents a summary of literature survey about geochemical reactions which are important to evaluate the redox conditions in the near field rock mass and buffer. The results of literature survey are summarized as follows; Minerals including ferrous iron and organic materials in the rock mass are important reductants. Initial stage after closure of repository, oxygen will be consumed by pyrite, because the reaction rate between pyrite and oxygen is relatively fast. It is possible to estimate the redox capacity for reductants by rock (mineral)-water interaction experiment in a laboratory. And it is expected that the ferrous iron-rich rock and higher porosity rock may have bigger redox capacity. It is impossible to estimate the oxygen consumption rate by reductants such as minerals including ferrous iron. The rate law and rate constant for the oxidation reaction of ferrous iron in the solution are also determined. As a conclusion, it seems that we can evaluate kinetically the evolution of geochemical conditions in the near field rock mass and buffer by excavation of drifts, based on data derived from these existing literatures. (author)

Bruxism: A Literature Review

Science.gov (United States)

Reddy, S Varalakshmi; Kumar, M Praveen; Sravanthi, D; Mohsin, Abdul Habeeb Bin; Anuhya, V

2014-01-01

Parafunctional activities associated with the stomatognathic system include lip and cheek chewing, nail biting, and teeth clenching. Bruxism can be classified as awake or sleep bruxism. Patients with sleep bruxism are more likely to experience jaw pain and limitation of movement, than people who do not experience sleep bruxism. Faulty occlusion is one of the most common causes of bruxism that further leads to temporomandibular joint pain. Bruxism has been described in various ways by different authors. This article gives a review of the literature on bruxism since its first description. PMID:25628497

Bruxism: a literature review.

Science.gov (United States)

Reddy, S Varalakshmi; Kumar, M Praveen; Sravanthi, D; Mohsin, Abdul Habeeb Bin; Anuhya, V

2014-01-01

Parafunctional activities associated with the stomatognathic system include lip and cheek chewing, nail biting, and teeth clenching. Bruxism can be classified as awake or sleep bruxism. Patients with sleep bruxism are more likely to experience jaw pain and limitation of movement, than people who do not experience sleep bruxism. Faulty occlusion is one of the most common causes of bruxism that further leads to temporomandibular joint pain. Bruxism has been described in various ways by different authors. This article gives a review of the literature on bruxism since its first description.

Literature Teaching in ELT

Institute of Scientific and Technical Information of China (English)

无

2007-01-01

To show the importance of literature teaching in English language teaching (ELT),this paper explores the relations between language, culture and literature,examines the present problems in literature teaching and possible solutions are suggested as well.

Clinical nursing and midwifery research: grey literature in African countries.

Science.gov (United States)

Sun, C; Dohrn, J; Omoni, G; Malata, A; Klopper, H; Larson, E

2016-03-01

This study reviewed grey literature to assess clinical nursing and midwifery research conducted in southern and eastern African countries over the past decade. The shortage of published nursing research from African countries severely limits the ability of practicing nurses and midwives to base clinical decisions on solid evidence. However, little is known regarding unpublished or unindexed clinical research ('grey literature'), a potentially rich source of information. Identifying these sources may reveal resources to assist nurses in providing evidence-based care. This scoping review of grey literature on clinical nursing and midwifery research in southern and eastern African countries helped to identify gaps in research and assess whether these gaps differ from published research. Systematic searches of grey literature were performed. Research was included if it was conducted by nurses in 1 of 25 southern or eastern African countries, between 2004 and 2014 and included patient outcomes. Data were extracted on location, institution, research topic, institutional connections and author information. Chi-square tests were performed to compare differences between indexed and non-indexed literature. We found 262 studies by 287 authors from 17 southern and eastern African countries covering 13 topics. Although all topics were also found in indexed literature and there were statistically significant differences between the number of times, fewer topics were covered in grey literature vs. indexed. Patient satisfaction and experience and traditional health practices were more likely to be published, whereas chronic disease, assault and paediatric-related research were less often published. Generally, there is a paucity of clinical nursing research in this region. This could reflect the shortage of nurses prepared to conduct research in this region. Nurses may find additional resources for evidence in the grey literature. A complete understanding of the state of nursing

Children's Literature: An Issues Approach. Third Edition.

Science.gov (United States)

Rudman, Masha Kabakow

Introducing children from kindergarten through junior high school to the joy and benefits of reading, this book examines children's literature and its treatment of important, sometimes controversial issues. Focusing on the personal and societal concerns of today's youth--including sexuality, divorce, heritage, abuse, and death--the book offers…

The importance of species name synonyms in literature searches

Science.gov (United States)

Guala, Gerald

2016-01-01

The synonyms of biological species names are shown to be an important component in comprehensive searches of electronic scientific literature databases but they are not well leveraged within the major literature databases examined. For accepted or valid species names in the Integrated Taxonomic Information System (ITIS) which have synonyms in the system, and which are found in citations within PLoS, PMC, PubMed or Scopus, both the percentage of species for which citations will not be found if synonyms are not used, and the percentage increase in number of citations found by including synonyms are very often substantial. However, there is no correlation between the number of synonyms per species and the magnitude of the effect. Further, the number of citations found does not generally increase proportionally to the number of synonyms available. Users looking for literature on specific species across all of the resources investigated here are often missing large numbers of citations if they are not manually augmenting their searches with synonyms. Of course, missing citations can have serious consequences by effectively hiding critical information. Literature searches should include synonym relationships and a new web service in ITIS, with examples of how to apply it to this issue, was developed as a result of this study, and is here announced, to aide in this.

The Importance of Species Name Synonyms in Literature Searches.

Science.gov (United States)

Guala, Gerald F

2016-01-01

The synonyms of biological species names are shown to be an important component in comprehensive searches of electronic scientific literature databases but they are not well leveraged within the major literature databases examined. For accepted or valid species names in the Integrated Taxonomic Information System (ITIS) which have synonyms in the system, and which are found in citations within PLoS, PMC, PubMed or Scopus, both the percentage of species for which citations will not be found if synonyms are not used, and the percentage increase in number of citations found by including synonyms are very often substantial. However, there is no correlation between the number of synonyms per species and the magnitude of the effect. Further, the number of citations found does not generally increase proportionally to the number of synonyms available. Users looking for literature on specific species across all of the resources investigated here are often missing large numbers of citations if they are not manually augmenting their searches with synonyms. Of course, missing citations can have serious consequences by effectively hiding critical information. Literature searches should include synonym relationships and a new web service in ITIS, with examples of how to apply it to this issue, was developed as a result of this study, and is here announced, to aide in this.

The Importance of Species Name Synonyms in Literature Searches.

Directory of Open Access Journals (Sweden)

Gerald F Guala

Full Text Available The synonyms of biological species names are shown to be an important component in comprehensive searches of electronic scientific literature databases but they are not well leveraged within the major literature databases examined. For accepted or valid species names in the Integrated Taxonomic Information System (ITIS which have synonyms in the system, and which are found in citations within PLoS, PMC, PubMed or Scopus, both the percentage of species for which citations will not be found if synonyms are not used, and the percentage increase in number of citations found by including synonyms are very often substantial. However, there is no correlation between the number of synonyms per species and the magnitude of the effect. Further, the number of citations found does not generally increase proportionally to the number of synonyms available. Users looking for literature on specific species across all of the resources investigated here are often missing large numbers of citations if they are not manually augmenting their searches with synonyms. Of course, missing citations can have serious consequences by effectively hiding critical information. Literature searches should include synonym relationships and a new web service in ITIS, with examples of how to apply it to this issue, was developed as a result of this study, and is here announced, to aide in this.

Methodology for gathering nuclear energy literature

International Nuclear Information System (INIS)

Lambert, Maria B.M.A.

1996-01-01

Several activities related to gathering information and documents -conventional and non-conventional primary literature - to include in a bibliographic nuclear energy database are described and arranged, using as model the communication and information process in science and technology and the analysis of the indexed documents in the database. Methodological steps are identified and a collecting system model is presented. 112 refs., 4 tabs

Teaching English Through Literature

Directory of Open Access Journals (Sweden)

Murat Hişmanoğlu

2005-04-01

Full Text Available This paper aims at emphasizing the use of literature as a popular technique for teaching both basiclanguage skills (i.e. reading, writing, listening and speaking and language areas (i.e. vocabulary,grammar and pronunciation in our times. Reasons for using literary texts in foreign language classroomand main criteria for selecting suitable literary texts in foreign language classes are stressed so as tomake the reader familiar with the underlying reasons and criteria for language teachers’ using andselecting literary texts. Moreover, literature and the teaching of language skills, benefits of differentgenres of literature (i.e. poetry, short fiction, drama and novel to language teaching and some problemsencountered by language teachers within the area of teaching English through literature (i.e. lack ofpreparation in the area of literature teaching in TESL / TEFL programs, absence of clear-cut objectivesdefining the role of literature in ESL / EFL, language teachers’ not having the background and trainingin literature, lack of pedagogically-designed appropriate materials that can be used by language teachersin a classroom context are taken into account.

Bisphenol A and human health: a review of the literature.

Science.gov (United States)

Rochester, Johanna R

2013-12-01

There is growing evidence that bisphenol A (BPA) may adversely affect humans. BPA is an endocrine disruptor that has been shown to be harmful in laboratory animal studies. Until recently, there were relatively few epidemiological studies examining the relationship between BPA and health effects in humans. However, in the last year, the number of these studies has more than doubled. A comprehensive literature search found 91 studies linking BPA to human health; 53 published within the last year. This review outlines this body of literature, showing associations between BPA exposure and adverse perinatal, childhood, and adult health outcomes, including reproductive and developmental effects, metabolic disease, and other health effects. These studies encompass both prenatal and postnatal exposures, and include several study designs and population types. While it is difficult to make causal links with epidemiological studies, the growing human literature correlating environmental BPA exposure to adverse effects in humans, along with laboratory studies in many species including primates, provides increasing support that environmental BPA exposure can be harmful to humans, especially in regards to behavioral and other effects in children. Copyright © 2013 Elsevier Inc. All rights reserved.

School Uniforms: A Critical Review of the Literature. From Inquiry to Practice.

Science.gov (United States)

Brunsma, David L.

The debate surrounding the effectiveness of school-uniform policies, as well as discussions concerning when and how to implement them, is rooted in anecdote. This review summarizes anecdotal literature on which the current debate is based and critically reviews the empirical literature, including theoretical underpinnings, findings, and…

Vulvovaginectomy and neo-urethrostomy for the treatment of haemangiosarcoma of the vulva and vagina : case report

Directory of Open Access Journals (Sweden)

T.P. Hill

2000-07-01

Full Text Available Vulvovaginectomy and neo-urethrostomy were performed in a 9-year-old German shepherd dog following a diagnosis of infiltrative vulvar and vestibulovaginal haemangiosarcoma. The dog was presented for intermittent vulvar haemorrhage over a 3-month period. On examination the vulva and vestibulovagina were distended and firm. Vaginal discharge and fine needle aspiration cytology detected anaplastic cells. Haemangiosarcoma was diagnosed on biopsy. A new urethral opening was created in the floor of the vagina allowing resection of the vulva and caudal vestibulovagina. Urinary continence was preserved and healing was without complications.

Evaluating trauma nursing education: An integrative literature review.

Science.gov (United States)

Ding, Min; Metcalfe, Helene; Gallagher, Olivia; Hamdorf, Jeffrey M

2016-09-01

A review of the current literature evaluating trauma nursing education. A variety of trauma nursing courses exist, to educate nurses working in trauma settings, and to maintain their continuing professional development. Despite an increase in the number of courses delivered, there appears to be a lack of evidence to demonstrate the effectiveness of trauma nursing education and in particular the justification for this resource allocation. Integrative literature review. A search of international literature on trauma nursing education evaluation published in English from 1985 to 2015 was conducted through electronic databases CINAHL Plus, Google Scholar, PubMed, Austhealth, Science Citation Index Expanded (Web of Science), Sciverse Science Direct (Elsevier) & One file (Gale). Only peer reviewed journal articles identifying trauma course and trauma nursing course evaluation have been included in the selection criteria. An integrative review of both quantitative and qualitative literature guided by Whittemore and Knafl's theoretical framework using Bowling's and Pearson's validated appraisal checklists, has been conducted for three months. Only 17 studies met the inclusion criteria, including 14 on trauma course evaluation and 3 on trauma nursing course evaluation. Study findings are presented as two main themes: the historical evolution of trauma nursing education and evaluation of trauma nursing education outcomes. Trauma nursing remains in its infancy and education in this specialty is mainly led by continuing professional development courses. The shortage of evaluation studies on trauma nursing courses reflects the similar status in continuing professional development course evaluation. A trauma nursing course evaluation study will address the gap in this under researched area. Copyright © 2016 Elsevier Ltd. All rights reserved.

Literature and series

OpenAIRE

Wells-Lassagne, Shannon

2017-01-01

The study of “literature on screen” is not new: indeed, this terminology has long been used for the study of adaptation, perhaps most notably in Deborah Cartmell and Imelda Whelehan’s Cambridge Companion to Literature on Screen. What is less widespread, however, is the association of literature with television’s “small screen” – because of its serial storytelling, television adaptation has long been relegated to limited-run miniseries (what I’ve called short-form adaptations), and the study o...

Enhancing Access To Classic Children’s Literature

NARCIS (Netherlands)

Hauff, C.; Trieschnigg, Rudolf Berend

2010-01-01

Project Gutenberg is a digital library that contains mostly public domain books, including a large number of works that belong to children’s literature. Many of these classic books are offered in a text-only format, which does not make them appealing for children to read. Moreover, stories that were

Connecting to Special Collections of Children's Literature

Science.gov (United States)

Brodie, Carolyn S.

2013-01-01

The Kent State University School of Library and Information Science serves as the home for two children's literature special collections. The Reinberger Children's Library Center is located on the third floor of Kent State's University Library and includes the Marantz Picturebook Collection for the Study of Picturebook Art. The Reinberger…

Tetralogy of Fallot: work of literature review

International Nuclear Information System (INIS)

Campos Alfaro, Franklin R.

2010-01-01

A literature search was conducted in PubMed and Medline data base, under the theme Tetralogyan Fallot. The publications before 2000 or without full text were excluded. A total of 30 items were used on tetralogy of Fallot are included; the emphasis with pulmonary artery is treated without deepening [es

Supplier Development Literature Review and Key Future Research Areas

Directory of Open Access Journals (Sweden)

Muddassir Ahmed

2012-10-01

Full Text Available The purpose of this paper is to develop a Supplier Development (SD literature framework and identify the main focus areas in SD research. To this end, a comprehensive review of the existing SD academic literature has been undertaken, which includes 62 research papers. These papers are classified according to their research content and the research methodology employed. A comprehensive list of future research areas is also presented. Thus, this paper will also briefly explore proposed future research. The review of the SD literature presented here identifies the following main areas of focus: Supplier Development Activities, Practices and Success Factors; Direct or Indirect Supplier Development; Supplier Development as a Reactive or Strategic Process; Supplier Development in a Lean Six Sigma & SME context.

Exploring the Concept of Browsing from the Literature Analysis

Directory of Open Access Journals (Sweden)

Shan-Ju L. Chang

1997-12-01

Full Text Available Browsing as a concept and an activity appears to be a fundamental part of human information behavior, which takes place in diverse contexts in our daily life. At the theoretical level, research on browsing can extend and develop theories of human information behavior. Practically, there could be suggestions for better organization and representation of information and material displayed as well as for effective information seeking and retrieval. This thesis attempts to explore the browsing phenomenon as it appears in the library and information science literature and end-user computing literature. Topics included for discussion are the definitions of the browsing concept, potential consequences, topology and influential factors of browsing as being identified from the literature analysis.[Article content in Chinese

Lysimeter literature review

International Nuclear Information System (INIS)

Rogers, R.D.; McConnell, J.W. Jr.

1993-08-01

Many reports have been published concerning the use of lysimeters to obtain data on the performance of buried radioactive waste. This document presents a review of some of those reports. This review includes lysimeter studies using radioactive waste forms at Savannah River Site, Hanford Site, Argonne National Laboratory, and Oak Ridge National Laboratory; radionuclide tracer studies at Whiteshell Nuclear Research Establishment and Los Alamos National Laboratory; and water movement studies at the Nuclear Regulatory Commission's Beltsville, Maryland site, at the Hanford Site, and at New Mexico State University. The tests, results, and conclusions of each report are summarized, and conclusions concerning lysimeter technology are presented from an overall analysis of the literature. 38 refs., 44 figs., 9 tabs

Longitudinal analysis of meta-analysis literatures in the database of ISI Web of Science.

Science.gov (United States)

Zhu, Changtai; Jiang, Ting; Cao, Hao; Sun, Wenguang; Chen, Zhong; Liu, Jinming

2015-01-01

The meta-analysis is regarded as an important evidence for making scientific decision. The database of ISI Web of Science collected a great number of high quality literatures including meta-analysis literatures. However, it is significant to understand the general characteristics of meta-analysis literatures to outline the perspective of meta-analysis. In this present study, we summarized and clarified some features on these literatures in the database of ISI Web of Science. We retrieved the meta-analysis literatures in the database of ISI Web of Science including SCI-E, SSCI, A&HCI, CPCI-S, CPCI-SSH, CCR-E, and IC. The annual growth rate, literature category, language, funding, index citation, agencies and countries/territories of the meta-analysis literatures were analyzed, respectively. A total of 95,719 records, which account for 0.38% (99% CI: 0.38%-0.39%) of all literatures, were found in the database. From 1997 to 2012, the annual growth rate of meta-analysis literatures was 18.18%. The literatures involved in many categories, languages, fundings, citations, publication agencies, and countries/territories. Interestingly, the index citation frequencies of the meta-analysis were significantly higher than that of other type literatures such as multi-centre study, randomize controlled trial, cohort study, case control study, and cases report (Panalysis has been becoming more and more prominent in recent years. In future, in order to promote the validity of meta-analysis, the CONSORT and PRISMA standard should be continuously popularized in the field of evidence-based medicine.

Mapping the literature of nursing administration.

Science.gov (United States)

Galganski, Carol J

2006-04-01

As part of Phase I of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies the core literature cited in nursing administration and the indexing services that provide access to the core journals. The results of this study will assist librarians and end users searching for information related to this nursing discipline, as well as database producers who might consider adding specific titles to their indexing services. Using the common methodology described in the overview article, five source journals for nursing administration were identified and selected for citation analysis over a three-year period, 1996 to 1998, to identify the most frequently cited titles according to Bradford's Law of Scattering. From this core of most productive journal titles, the bibliographic databases that provide the best access to these titles were identified. Results reveal that nursing administration literature relies most heavily on journal articles and on those titles identified as core nursing administrative titles. When the indexing coverage of nine services is compared, PubMed/MEDLINE and CINAHL provide the most comprehensive coverage of this nursing discipline. No one indexing service adequately covers this nursing discipline. Researchers needing comprehensive coverage in this area must search more than one database to effectively research their projects. While PubMed/MEDLINE and CINAHL provide more coverage for this discipline than the other indexing services, none is sufficiently broad in scope to provide indexing of nursing, health care management, and medical literature in a single file. Nurse administrators using the literature to research current work issues need to review not only the nursing titles covered by CINAHL but should also include the major weekly medical titles, core titles in health care administration, and general business sources if they wish to

World Literature - World Culture

DEFF Research Database (Denmark)

Offering their own twenty-first-century perspectives - across generations, nationalities and disciplines -, the contributors to this anthology explore the idea of world literature for what it may add of new connections and itineraries to the study of literature and culture today. Covering a vast...... historical material these essays, by a diverse group of scholars, examine the pioneers of world literature and the roles played by translation, migration and literary institutions in the circulation and reception of both national and cosmopolitan literatures....

A Systematic Literature Mining of Sponge City: Trends, Foci and Challenges Standing Ahead

Directory of Open Access Journals (Sweden)

Zongmin Li

2018-04-01

Full Text Available Sponge City research has been attracting extensive attention both in practical and theoretical research field, as the increased threat of flood risk and environmental safety due to urbanization. Varies names of Sponge City prevalent in different countries, which leads to disconnection of literature in the same field of Sponge City. In this paper, a systematic literature mining of Sponge City is presented. A literature analysis system is created, which includes literature export from Web of Sciences and systematic analysis via NoteExpress and CiteSpace. Based on the final document storage which contains 962 articles, general trends are identified. Literature is classified into 9 theme types. Research foci of Sponge City are detected by citation and keywords burst detection. Further, some future research directions of Sponge City are anticipated, including trans-disciplinary approaches, a comprehensive design framework, application of information technology, and case studies of Sponge City in more parts of the world. The significance of this paper lies in summarizing past research, identifying research types, foci and anticipating some future research directions.

Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review.

Science.gov (United States)

Pentland, Duncan; Forsyth, Kirsty; Maciver, Donald; Walsh, Mike; Murray, Richard; Irvine, Linda; Sikora, Simon

2011-07-01

This paper presents the results of a review of literature relating to knowledge transfer and exchange in healthcare. Treatment, planning and policy decisions in contemporary nursing and healthcare should be based on sound evidence wherever possible, but research knowledge remains generally underused. Knowledge transfer and exchange initiatives aim to facilitate the accessibility, application and production of evidence and may provide solutions to this challenge. This review was conducted to help inform the design and implementation of knowledge transfer and exchange activities for a large healthcare organization. Databases: ASSIA, Business Source Premier, CINAHL, PsychInfo, Medline and the Cochrane Database of Systematic Reviews. An integrative literature review was carried out including an extensive literature search. English language systematic reviews, literature reviews, primary quantitative and qualitative papers and grey literature of high relevance evaluating, describing or discussing knowledge transfer or exchange activities in healthcare were included for review (January 1990-September 2009). Thirty-three papers were reviewed (four systematic reviews, nine literature reviews, one environmental scan, nine empirical studies and ten case studies). Robust research into knowledge transfer and exchange in healthcare is limited. Analysis of a wide range of evidence indicates a number of commonly featured characteristics but further evaluation of these activities would benefit their application in facilitating evidence-based practice in nursing. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

The Concept of Islamic Literature and Islamization of Literature through the Different ages(Arabic

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Dr. Sanāullah al Azhari

2017-07-01

Full Text Available Islamic literature is a term referring to the school of thought who believes that a good literary work should view God, man and the world through the lens of Islam. It is conceived that the style of such literature must be of high quality with the Qur’ān, Ḥadith and the legacy of the Islamic scholars being its model. Islamic literature is a universal literature and can be written in any language. However, most of what has been written on the theory and practice of Islamic literature is in Arabic. This study discusses the model of Islamic literature in era of Islam, Umayyad period, Abbasid period, and Modern world. Topics of Islamic literature in modern times are dealing with the moral values in the Qur’ān and the Sunnah of the Prophet, peace be upon him. It discusses Jurisprudence in worship Biography of the Prophet and Praise of the Prophet and his companions God bless them all. The deep knowledge of Arabic language and Islamic literature solves the social and cultural problems around the world.

An annotated bibliography of scientific literature on managing forests for carbon benefits

Science.gov (United States)

Sarah J. Hines; Linda S. Heath; Richard A. Birdsey

2010-01-01

Managing forests for carbon benefits is a consideration for climate change, bioenergy, sustainability, and ecosystem services. A rapidly growing body of scientific literature on forest carbon management includes experimental, modeling, and synthesis approaches, at the stand- to landscape- to continental-level. We conducted a search of the scientific literature on the...

LITERATURE AND IDENTITY

Directory of Open Access Journals (Sweden)

Dragana Litričin Dunić

2015-04-01

Full Text Available Literature can represent, on the one hand, the establishment of cultural and national identity, and, on the other hand, a constant indicator of the differences. Self-image and the image of the Other in literature is very important not only for understanding national character and preservation of cultural identity, but also for the release from ideological reading and stereotyping. Analyzing the image of the Other, research into the representation of the Balkans symbolically represents in the popular literature of the West, study of the cultural context and the processes that formed the writer’s perceptions that determine the establishment of stereotypes about Homo Balcanicus and many others, are all important tasks of imagological research, as well as the key research tasks conducted nowadays. In this paper we shall discuss some of these issues in the field of comparative literature.

Vaginal microbiota of adolescent girls prior to the onset of menarche resemble those of reproductive-age women.

Science.gov (United States)

Hickey, Roxana J; Zhou, Xia; Settles, Matthew L; Erb, Julie; Malone, Kristin; Hansmann, Melanie A; Shew, Marcia L; Van Der Pol, Barbara; Fortenberry, J Dennis; Forney, Larry J

2015-03-24

Puberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight into the timing and sequence of changes that occur in the vaginal and vulvar microbiota during puberty. The study enrolled 31 healthy, premenarcheal girls between the ages of 10 and 12 years and collected vaginal and vulvar swabs quarterly for up to 3 years. Bacterial composition was characterized by Roche 454 pyrosequencing and classification of regions V1 to V3 of 16S rRNA genes. Contrary to expectations, lactic acid bacteria, primarily Lactobacillus spp., were dominant in the microbiota of most girls well before the onset of menarche in the early to middle stages of puberty. Gardnerella vaginalis was detected at appreciable levels in approximately one-third of subjects, a notable finding considering that this organism is commonly associated with bacterial vaginosis in adults. Vulvar microbiota closely resembled vaginal microbiota but often exhibited additional taxa typically associated with skin microbiota. Our findings suggest that the vaginal microbiota of girls begin to resemble those of adults well before the onset of menarche. This study addresses longitudinal changes in vaginal and vulvar microbial communities prior to and immediately following menarche. The research is significant because microbial ecology of the vagina is an integral aspect of health, including resistance to infections. The physiologic changes of puberty and initiation of cyclic menstruation are likely to have profound effects on vaginal microbiota, but almost nothing is known about changes that normally occur during this time. Our understanding has been especially hampered by the lack of thorough characterization of microbial communities using techniques

Literature and Cartography

DEFF Research Database (Denmark)

Literary authors have frequently called on elements of cartography to ground fictional space, to visualize sites, and to help readers get their bearings in the imaginative world of the text. Today, the convergence of digital mapping and globalization has spurred a cartographic turn in literature...... but represents a set of relations and tensions that raise questions about representation, fiction, and space. Is literature even mappable? In exploring the cartographic components of literature, the contributors have not only brought literary theory to bear on the map but have also enriched the vocabulary...... fictions....

Aggressive Angiomyxoma of the Vulva: a Distinct Clinical Entity

Directory of Open Access Journals (Sweden)

Sevgi Bakaris

2015-12-01

Full Text Available Aggressive angiomyxoma is a rare mesenchmal tumour arising from connective tissue of the perineum or the lower pelvis, and affect predominantly young women. Our case was 20-year-old female who was operated for a vulvar mass clinically misdiagnosed as Polyp . Histopathological examination of the surgical specimen revealed, haphazardly scattered spindle or stellate shaped mesenchymal cells and vessels of medium size having dilated lumens within a loose hyposellular myxoid stroma No mitoses were evident.The spindle-or stellate-shaped tumor cells were diffusely positive for vimentin, but negative for cytokeratin, S-100 protein, and myoglobin and and #945;-smooth muscle actin by immunohistochemistry. These histologic and immunohistochemical findings were compatible with diagnosis of AA. Clinically AA is mixed with Bartholin's duct cyst, vulvar abscess, lipoma, vaginal cysts in diagnosis AA of the vulva must be distinguished from the more common benign and malignant myxoid tumors including myxoma, myxoid neurofibroma, pseudosarcoma, myxoid liposarcoma, myxoid leiomyosarcoma and other soft tissue tumors with secondary myxoid changes. [Cukurova Med J 2015; 40(4.000: 803-806

Smart Farming: Including Rights Holders for Responsible Agricultural Innovation

OpenAIRE

Kelly Bronson

2018-01-01

This article draws on the literature of responsible innovation to suggest concrete processes for including rights holders in the “smart” agricultural revolution. It first draws upon historical agricultural research in Canada to highlight how productivist values drove seed innovations with particular consequences for the distribution of power in the food system. Next, the article uses document analysis to suggest that a similar value framework is motivating public investment in smart farming i...

Theology and Literature

DEFF Research Database (Denmark)

A collection of essays published in the journal Literature and Theology based on selected papers from the 2012 international conference of the International Society of Religion, Literature and Culture: Cultures of Transition: Presence, Absence, Memory, held at the Faculty of Theology in Copenhagen...

Interprofessional non-technical skills for surgeons in disaster response: a literature review.

Science.gov (United States)

Willems, Anneliese; Waxman, Bruce; Bacon, Andrew K; Smith, Julian; Kitto, Simon

2013-09-01

Natural disasters impose a significant burden on society. Current disaster training programmes do not place an emphasis on equipping surgeons with non-technical skills for disaster response. This literature review sought to identify non-technical skills required of surgeons in disaster response through an examination of four categories of literature: "disaster"; "surgical"; "organisational management"; and "interprofessional". Literature search criteria included electronic database searches, internet searches, hand searching, ancestry searching and networking strategies. Various potential non-technical skills for surgeons in disaster response were identified including: interpersonal skills such as communication, teamwork and leadership; cognitive strategies such flexibility, adaptability, innovation, improvisation and creativity; physical and psychological self-care; conflict management, collaboration, professionalism, health advocacy and teaching. Such skills and the role of interprofessionalism should be considered for inclusion in surgical disaster response training course curricula.

Fatigue following Acute Q-Fever: A Systematic Literature Review

Science.gov (United States)

Delsing, Corine E.; Bleijenberg, Gijs; Langendam, Miranda; Timen, Aura; Bleeker-Rovers, Chantal P.

2016-01-01

Background Long-term fatigue with detrimental effects on daily functioning often occurs following acute Q-fever. Following the 2007–2010 Q-fever outbreak in the Netherlands with over 4000 notified cases, the emphasis on long-term consequences of Q-fever increased. The aim of this study was to provide an overview of all relevant available literature, and to identify knowledge gaps regarding the definition, diagnosis, background, description, aetiology, prevention, therapy, and prognosis, of fatigue following acute Q-fever. Design A systematic review was conducted through searching Pubmed, Embase, and PsycInfo for relevant literature up to 26th May 2015. References of included articles were hand searched for additional documents, and included articles were quality assessed. Results Fifty-seven articles were included and four documents classified as grey literature. The quality of most studies was low. The studies suggest that although most patients recover from fatigue within 6–12 months after acute Q-fever, approximately 20% remain chronically fatigued. Several names are used indicating fatigue following acute Q-fever, of which Q-fever fatigue syndrome (QFS) is most customary. Although QFS is described to occur frequently in many countries, a uniform definition is lacking. The studies report major health and work-related consequences, and is frequently accompanied by nonspecific complaints. There is no consensus with regard to aetiology, prevention, treatment, and prognosis. Conclusions Long-term fatigue following acute Q-fever, generally referred to as QFS, has major health-related consequences. However, information on aetiology, prevention, treatment, and prognosis of QFS is underrepresented in the international literature. In order to facilitate comparison of findings, and as platform for future studies, a uniform definition and diagnostic work-up and uniform measurement tools for QFS are proposed. PMID:27223465

Angiofibroma of the vulva.

Science.gov (United States)

Ahmadnia, Hassan; Kamalati, Ali; Dolati, Mahmood; Akhavan Rezayat, Alireza; Katebi, Mehrdad

2014-01-01

Cellular angiofibroma is a benign and rare tumor. It usually arises in middle-aged women and involves the vulva. Complete local excision of the tumor is the best cure, and, usually, there is no recurrence after surgery. We describe a 20-year-old woman with a painless, growing vulvar mass who presented about 3 years ago. Her past medical history was negative for oral contraceptives, tobacco, and alcohol, and there were no similar lesions in her family history. A physical examination revealed two masses on the right and the left labia majora and similar lesions on the left axilla and both breasts. An uncomplicated simple resection of the vulvar masses was done in the operating room. There was no evidence of recurrence 12 months after surgery. Histopathologic examination revealed that the findings were consistent with the diagnosis of the cellular angiofibroma. Based on our knowledge, this patient is the youngest case of vulvar angiofibroma. The lesions were large and symmetrical (on both labia majora), although they differed in size. Extravulvar (breast and axilla) lesions were also noteworthy in this patient.

Vulvodynia – still a challenging therapeutic problem

Directory of Open Access Journals (Sweden)

Magdalena Pawlaczyk

2017-04-01

Full Text Available Introduction . Vulvodynia is a chronic condition characterized by pain and burning in the vulvar area without any abnormalities in clinical and laboratory examinations. The diagnosis is based on detailed assessment of medical history, physical examination and exclusion of other potential causes of vulvar pain. As yet, no definitive treatment algorithm has been universally accepted for vulvodynia. Objective . To present a case of successful treatment of generalized spontaneous vulvodynia with low doses of amitriptyline. Case report . A 42-year-old patient presented to a dermatology outpatient clinic with chronic generalized vulvar pain of 2 years’ duration. She was diagnosed with generalized spontaneous vulvodynia. Amitriptyline treatment was introduced and supported by topical application of lignocaine gel. After 13 months of amitriptyline therapy a complete remission was achieved. Conclusions . Vulvodynia is a complex disease with numerous presentations, the symptoms of which often overlap. Since the diagnosis of vulvodynia requires the exclusion of other abnormalities, it is fundamental to raise the awareness of the disease among clinicians, so as to enable early correct diagnosis and adequate treatment.

Evolution of Modularity Literature

DEFF Research Database (Denmark)

Frandsen, Thomas

2017-01-01

Purpose The purpose of this paper is to review and analyze the modularity literature to identify the established and emerging perspectives. Design/methodology/approach A systematic literature search and review was conducted through the use of bibliometrics and network analysis. The analysis...... identified structure within the literature, which revealed how the research area evolved between 1990 and 2015. Based on this search, the paper establishes the basis for analyzing the structure of modularity literature. Findings Factors were identified within the literature, demonstrating how it has evolved...... from a primary focus on the modularity of products to a broader view of the applicability of modularity. Within the last decade, numerous research areas have emerged within the broader area of modularity. Through core-periphery analysis, eight emerging sub-research areas are identified, of which one...

The Experiences of Students without Disabilities in Inclusive Physical Education Classrooms: A Review of Literature

Science.gov (United States)

Ruscitti, Robert Joseph; Thomas, Scott Gordon; Bentley, Danielle Christine

2017-01-01

The purpose of this literature review was to analyse studies of the experiences of students without disabilities (SWOD) in inclusive physical education (PE) classes. The literature published from 1975 to 2015 was compiled from three online databases (PsycInfo, Physical Education Index and ERIC). Included literature met inclusion criteria focussed…

A grey literature review of special events for promoting cancer screenings.

Science.gov (United States)

Escoffery, Cam; Rodgers, Kirsten C; Kegler, Michelle C; Ayala, Mary; Pinsker, Erika; Haardörfer, Regine

2014-06-19

Cancer remains the second leading cause of mortality in the United States. Special events such as health fairs, screening days or cultural festivals are employed often for community education about cancer screening. A previous systematic review of the published literature was conducted in 2012-2013. The purpose of this study was to conduct a grey literature component of special events that promote breast, cervical and colorectal cancer screening in the U.S. We conducted a grey literature search of dissertations/theses and conference abstracts. The theses/dissertations were restricted to those: 1) written in English, 2) published from January 1990 to December 2011, 3) examined at least one of the predefined categories of special events, 4) involved cancer screening for breast, cervical, and/or colorectal cancer, 5) included outcome data, and 6) conducted in the United States. A review of U.S. public health and cancer conference abstracts, that were readily available and had focused on at least of 3 cancer types and included outcome data, was conducted. Data were abstracted on the purpose, location, primary audience(s), activities conducted, screening provided onsite or referrals, and evaluation results. The grey literature review found 6 special events. The types of events found added to the numbers found in the systematic review, especially receptions or parties and cultural festivals/events. All focused on increasing breast and cervical cancer screening except one that focused on breast cancer only. The reach of these events was targeted at mostly minorities or underserved communities. Common evidence-based strategies were group education, small media, and reducing structural barriers. Group education involved presentations from physicians, lay-health advisors, or cancer survivors, while reducing structural barriers included activities such as providing screening appointment sign-ups at the event or providing transportation for event participants. Mammogram

Suggested Guidelines for Conducting Music Therapy Literature Reviews & an Introduction to Systematic Reviews in Music Therapy

DEFF Research Database (Denmark)

O'Callaghan, Clare; Bonde, Lars Ole; Rickson, Daphne

2014-01-01

This paper describes the kinds of literature reviews found in music therapy writings and offers ideas for authors preparing literature reviews related to their clinical practice and research. It includes a description of systematic review and lists samples of literature reviews and systematic...

A literature review to explore integrated care for older people

Directory of Open Access Journals (Sweden)

Jan Reed

2005-01-01

Full Text Available Purpose: This paper reports on some of the findings of a literature review commissioned to explore integrated care for older people. Methods: The process of revising included finding and selecting literature from multidisciplinary sources, and encompassed both published papers and ‘grey’ literature, i.e. material which had not been reviewed for publication. Results: The study found that thinking has moved on from a focus on the problems of accessing services to exploring ways in which they may function in an integrated way. Conclusions: The study shows how thinking on integrated care for older people has developed, and knowledge of micro, mezzo and macro strategies is now more available.

Peer Mentoring and Peer Tutoring among K-12 Students: A Literature Review

Science.gov (United States)

Goodrich, Andrew

2018-01-01

The purpose of this literature review is to examine research on peer mentoring among K-12 students to assist practitioners with how to incorporate these instructional techniques into their own music programs. Primary themes across the music education literature of peer mentoring include the role of music teachers, the role of students as they…

Primary Identity in Literature

DEFF Research Database (Denmark)

Graham, Brian Russell

In our times, literary criticism, as well as larger political and cultural developments, is characterized by identity politics, meaning that our discourses are structured around the notion of different socially identifiable populations in society. In relation to literature, this results in our...... viewing the characters in literature in terms of these political identities. Literature is consequently discussed in relation to political causes. Literary criticism is animated by the same causes, and is viewed as having a direct intervention in society in relation to them. In this paper, I will discuss......, in relation to Frye’s works, the idea that the primary identities of characters in literature were and, to a considerable extent, continue to be those of family-member identities. As such, literature should not be appropriated to a political context too readily. Whereas viewing characters in terms of...

Engagement at work: a review of the literature.

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Simpson, Michelle R

2009-07-01

Engagement at work has emerged as a potentially important employee performance and organizational management topic, however, the definition and measurement of engagement at work, and more specifically, nurse engagement, is poorly understood. The objective of this paper is to examine the current state of knowledge about engagement at work through a review of the literature. This review highlights the four lines of engagement research and focuses on the determinants and consequences of engagement at work. Methodological issues, as identified in the current research, and recommendations for future nurse-based engagement research are provided. A systematic review of the business, organizational psychology, and health sciences and health administration literature about engagement at work (1990-2007) was performed. The electronic databases for Health Sciences and Health Administration (CINAHL, MEDLINE), Business (ABI INFORM), and Psychology (PsycINFO) were systematically searched. Due to the limited amount of research that has examined engagement among the nursing workforce, published research that included varying employee types were included in this review. The selection criteria for this review include those studies that were: (1) written in English and (2) examined engagement at work in employee populations of any type within any work setting. The literature review identified four distinct lines of research that has focused on engagement within the employee work role. Of the 32 engagement-based articles referenced in this paper, a sample of 20 studies report on the examination of antecedents and/or consequences of engagement at work among varying employee types and work settings. Key findings suggest organizational factors versus individual contributors significantly impact engagement at work. A common implication in this body of research was that of the performance-based impact. The study of nurses' work engagement and its relationship to nurses' organizational

Transcutaneous electrical nerve stimulation as an additional treatment for women suffering from therapy-resistant provoked vestibulodynia: a feasibility study.

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Vallinga, Marleen S; Spoelstra, Symen K; Hemel, Inge L M; van de Wiel, Harry B M; Weijmar Schultz, Willibrord C M

2015-01-01

The current approach to women with provoked vestibulodynia (PVD) comprises a multidimensional, multidisciplinary therapeutic protocol. As PVD is considered to be a chronic pain disorder, transcutaneous electrical nerve stimulation (TENS) can be used as an additional therapy for women with otherwise therapy-resistant PVD. The aims of this study were to evaluate whether TENS has a beneficial effect on vulvar pain, sexual functioning, and sexually-related personal distress in women with therapy-resistant PVD and to assess the effect of TENS on the need for vestibulectomy. A longitudinal prospective follow-up study was performed on women with therapy-resistant PVD who received additional domiciliary TENS. Self-report questionnaires and visual analog scales (VASs) were completed at baseline (T1), post-TENS (T2), and follow-up (T3). Vulvar pain, sexual functioning, and sexually-related personal distress were the main outcome measures. Thirty-nine women with therapy-resistant PVD were included. Mean age was 27 ± 5.6 years (range: 19 to 41); mean duration between TENS and T3 follow-up was 10.1 ± 10.7 months (range: 2 to 32). Vulvar pain VAS scores directly post-TENS (median 3.4) and at follow-up (median 3.2) were significantly (P pain and the need for vestibulectomy. The long-term effect was stable. These results not only support our hypothesis that TENS constitutes a feasible and beneficial addition to multidimensional treatment for therapy-resistant PVD, but also the notion that PVD can be considered as a chronic pain syndrome. © 2014 International Society for Sexual Medicine.

Text analysis with R for students of literature

CERN Document Server

Jockers, Matthew L

2014-01-01

Text Analysis with R for Students of Literature is written with students and scholars of literature in mind but will be applicable to other humanists and social scientists wishing to extend their methodological tool kit to include quantitative and computational approaches to the study of text. Computation provides access to information in text that we simply cannot gather using traditional qualitative methods of close reading and human synthesis. Text Analysis with R for Students of Literature provides a practical introduction to computational text analysis using the open source programming language R. R is extremely popular throughout the sciences and because of its accessibility, R is now used increasingly in other research areas. Readers begin working with text right away and each chapter works through a new technique or process such that readers gain a broad exposure to core R procedures and a basic understanding of the possibilities of computational text analysis at both the micro and macro scale. Each c...

Sobre la ensenanza de la literatura hispanoamericana (The Teaching of Hispanoamerican Literature).

Science.gov (United States)

Ellis, Keith

There are three main problems in teaching Latin American literature: (1) It is difficult to maintain a regional overview, while, at the same time, including a sense of the literary history of Latin America; (2) It is necessary to teach literature so that the material seems worthwhile in its own right and not only as a complement to other…

Mindfulness in mood and anxiety disorders: a review of the literature

Directory of Open Access Journals (Sweden)

Michele F. Rodrigues

2017-07-01

Full Text Available Abstract Introduction The objective of this study was to conduct a review of the literature covering the use of different mindfulness-based therapy approaches in treatment of mood and anxiety disorders, including mindfulness skills and mindfulness linked to emotional regulation and fear of negative appraisal. Methods A review was conducted of literature identified by searching the scientific databases PubMed and PsycINFO with the following keywords: mindfulness, mood disorders, and anxiety disorders. The search covered the past 10 years. The search returned 532 articles, 24 were selected, their full texts were read, and 16 were included in this review. Results Six articles about mindfulness-based stress reduction, four about mindfulness-based cognitive therapy, and three about fear of negative appraisal and emotional regulation were reviewed. All of the articles covered mindfulness in relation to mood and anxiety disorders. Conclusions The literature in this field suggests that mindfulness is an effective strategy for the treatment of mood and anxiety disorders and is effective in therapy protocols with different structures including virtual modalities. Use of mindfulness in scientific models continues to expand.

Spaceflight and Neurosurgery: A Comprehensive Review of the Relevant Literature.

Science.gov (United States)

Swinney, Christian C; Allison, Zain

2018-01-01

Spaceflight and the associated gravitational fluctuations may impact various components of the central nervous system. These include changes in intracranial pressure, the spine, and neurocognitive performance. The implications of altered astronaut performance on critical spaceflight missions are potentially significant. The current body of research on this important topic is extremely limited, and a comprehensive review has not been published. Herein, the authors address this notable gap, as well as the role of the neurosurgeon in optimizing potential diagnostic and therapeutic modalities. A literature search was conducted using the PubMed, EMBASE, and Google Scholar databases, with no time constraints. Significant manuscripts on physiologic changes associated with spaceflight and microgravity were identified and reviewed. Manifestations were separated into 1 of 3 general categories, including changes in intracranial pressure, the spine, and neurocognitive performance. A comprehensive literature review yielded 27 studies with direct relevance to the impact of microgravity and spaceflight on nervous system physiology. This included 7 studies related to intracranial pressure fluctuations, 17 related to changes in the spinal column, and 3 related to neurocognitive change. The microgravity environment encountered during spaceflight impacts intracranial physiology. This includes changes in intracranial pressure, the spinal column, and neurocognitive performance. Herein, we present a systematic review of the published literature on this issue. Neurosurgeons should have a key role in the continued study of this important topic, contributing to both diagnostic and therapeutic understanding. Copyright © 2017 Elsevier Inc. All rights reserved.

Major publications in the critical care pharmacotherapy literature: January-December 2016.

Science.gov (United States)

Horner, Deanna; Altshuler, Diana; Droege, Chris; Feih, Joel; Ferguson, Kevin; Fiorenza, Mallory; Greathouse, Kasey; Hamilton, Leslie; Pfaff, Caitlin; Roller, Lauren; Stollings, Joanna; Wong, Adrian

2018-02-01

To summarize select critical care pharmacotherapy guidelines and studies published in 2016. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 31 journals monthly for relevant pharmacotherapy articles and selected 107 articles for review over the course of 2016. Of those included in the monthly CCPLU, three guidelines and seven primary literature studies are reviewed here. The guideline updates included are as follows: hospital-acquired pneumonia and ventilator-associated pneumonia management, sustained neuromuscular blocking agent use, and reversal of antithrombotics in intracranial hemorrhage (ICH). The primary literature summaries evaluate the following: dexmedetomidine for delirium prevention in post-cardiac surgery, dexmedetomidine for delirium management in mechanically ventilated patients, high-dose epoetin alfa after out-of-hospital cardiac arrest, ideal blood pressure targets in ICH, hydrocortisone in severe sepsis, procalcitonin-guided antibiotic de-escalation, and empiric micafungin therapy. The review provides a synopsis of select pharmacotherapy publications in 2016 applicable to clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Text mining applications in psychiatry: a systematic literature review.

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Abbe, Adeline; Grouin, Cyril; Zweigenbaum, Pierre; Falissard, Bruno

2016-06-01

The expansion of biomedical literature is creating the need for efficient tools to keep pace with increasing volumes of information. Text mining (TM) approaches are becoming essential to facilitate the automated extraction of useful biomedical information from unstructured text. We reviewed the applications of TM in psychiatry, and explored its advantages and limitations. A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE, PsycINFO and Cochrane databases. In this review, 1103 papers were screened, and 38 were included as applications of TM in psychiatric research. Using TM and content analysis, we identified four major areas of application: (1) Psychopathology (i.e. observational studies focusing on mental illnesses) (2) the Patient perspective (i.e. patients' thoughts and opinions), (3) Medical records (i.e. safety issues, quality of care and description of treatments), and (4) Medical literature (i.e. identification of new scientific information in the literature). The information sources were qualitative studies, Internet postings, medical records and biomedical literature. Our work demonstrates that TM can contribute to complex research tasks in psychiatry. We discuss the benefits, limits, and further applications of this tool in the future. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Nonhuman primate dermatology: a literature review

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Bernstein, Joseph A.; Didier, Peter J.

2015-01-01

In general, veterinary dermatologists do not have extensive clinical experience of nonhuman primate (NHP) dermatoses. The bulk of the published literature does not provide an organized evidence-based approach to the NHP dermatologic case. The veterinary dermatologist is left to extract information from both human and veterinary dermatology, an approach that can be problematic as it forces the clinician to make diagnostic and therapeutic decisions based on two very disparate bodies of literature. A more cohesive approach to NHP dermatology – without relying on assumptions that NHP pathology most commonly behaves similarly to other veterinary and human disease – is required. This review of the dermatology of NHP species includes discussions of primary dermatoses, as well as diseases where dermatologic signs represent a significant secondary component, provides a first step towards encouraging the veterinary community to study and report the dermatologic diseases of nonhuman primates. PMID:19490576

Shared Communications: Volume 1. A Summary and Literature Review

Energy Technology Data Exchange (ETDEWEB)

Franzese, O

2004-09-22

This paper provides a review of examples from the literature of shared communication resources and of agencies and/or organizations that share communication resources. The primary emphasis is on rural, intelligent transportation system communications involving transit. Citations will not be limited, however, to rural activities, or to ITS implementation, or even to transit. In addition, the term ''communication'' will be broadly applied to include all information resources. Literature references to issues that contribute to both successful and failed efforts at sharing communication resources are reviewed. The findings of this literature review indicate that: (1) The most frequently shared communication resources are information/data resources, (2) Telecommunications infrastructure and technologies are the next most frequently shared resources, (3) When resources are successfully shared, all parties benefit, (4) A few unsuccessful attempts of sharing resources have been recorded, along with lessons learned, (5) Impediments to sharing include security issues, concerns over system availability and reliability, service quality and performance, and institutional barriers, (6) Advantages of sharing include financial benefits to agencies from using shared resources and benefits to the public in terms of congestion mitigation, information transfer (e.g., traveler information systems), mobility (e.g., welfare-to-work paratransit), and safety (e.g., speed of incident response, incident avoidance), (7) Technology-based solutions exist to address technology-based concerns, and (8) Institutional issues can be addressed through leadership, enhanced knowledge and skills, open communication, responsiveness, and attractive pricing structures.

Survey of Artificial Intelligence and Expert Systems in Library and Information Science Literature.

Science.gov (United States)

Hsieh, Cynthia C.; Hall, Wendy

1989-01-01

Examines the definition and history of artificial intelligence (AI) and investigates the body of literature on AI found in "Library Literature" and "Library and Information Science Abstracts." The results reported include the number of articles by year and per journal, and the percentage of articles dealing with library…

Undergraduate Nursing Students' Understandings of Mental Health: A Review of the Literature.

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Barry, Sinead; Ward, Louise

2017-02-01

The purpose of this literature review was to identify research and current literature surrounding nursing students' understandings of mental health. The aim is to share findings from an extensive international and national literature review exploring undergraduate nurse education specific to mental health content. Data were collected utilising a comprehensive search of electronic databases including CINAHL (EBSCO), MEDLINE, and PsycINFO 1987-(Ovid) from 2008 to 2016. The initial search terms were altered to include undergraduate, mental health, nursing, education, experience, and knowledge. Three content themes emerged which included: 1. Undergraduate nursing students' knowledge has been considered compromised due to concerns relating to the variation and inconsistencies within the comprehensive nursing curriculums representation of mental health, 2. Undergraduate nursing students knowledge of mental health is thought to be compromised due to the quality of mental health theoretical and experiential learning opportunities, and 3. Research indicates that nursing students' knowledge of mental health was influenced by their experience of undertaking mental health content. Based on these findings greater consideration of students' understandings of mental health is required.

Appraisal of the quality of assessment of memory in anesthesia and psychopharmacology literature.

Science.gov (United States)

Ghoneim, M M; Ali, M A; Block, R I

1990-11-01

To test the hypothesis that there are important differences between studies on memory published in anesthesia literature and those published in the psychopharmacology literature, we compared the two from the period January 1978 through May 1988 to identify deficiencies in the design and methodologies used and to provide guidelines for future experiments. Eight-eight articles in each discipline were reviewed. The sample sizes were larger in the articles in anesthesia journals than in those in psychopharmacology journals (medians 52.5 vs. 18 subjects, respectively). Most (85%) of the studies in the anesthesia literature used patients, who had a median age of 38.9 yr and included a median of 28 women among the subjects per study. In contrast, the majority (60%) of the studies in the psychopharmacology literature used healthy volunteers, who had a median age of 23.6 yr and included a median of only 3.5 females among the subjects per study. Characteristics more common in the psychopharmacology than in the anesthesia literature, respectively, were use of a control or placebo group (90% vs. 42%), double-blind design (80% vs. 47%), use of pre- and posttreatment memory measurements (64% vs. 23%), use of multiple memory tests with distinct equated stimuli (83% vs. 8%), relation of methodology to some theoretical model of memory (72% vs. 17%), and use of other behavioral tests (68% vs. 48%). Relative to the psychopharmacology literature, the anesthesia literature used pictures as stimuli for the memory tests more often (44% vs. 14%, respectively) and words less often (11% vs. 67%) and relied heavily on questions about recall of perioperative events (41% vs. 0%). There is room for improvement in both types of literature, and more so in the anesthesia literature.

Cinema and Literature.

Science.gov (United States)

Eidsvik, Charles Vernon

The cinema stemmed from aesthetic and formal quests within printed literature, and restored to literature the traditions of performance which had been submerged by traditions of print. The literary identity of the cinema has been obscured by a lack of visible similarities between the cinema and modern writing. Differences between modern writing…

Youth literature reading and storytelling

Directory of Open Access Journals (Sweden)

Milena Mileva Blažić

2013-09-01

Full Text Available ABSTRACTPurpose: The aim of the study is to update the definition of Slovenian children’s literature from the perspective of literary criticism, audiences and reception. The paper researches the adult’s literature and characters which have become a part of the children’s literature canon.Methodology/approach: The method of textual analysis, the analytical-descriptive research method, and data processing based on the text analysis were used.Results: The survey results in a new definition of the youth literature from the perspective of literary studies, the addressee and the purpose.Research limitation: The study focused on the most representative texts and authors, and international and Slovenian literature, which have become a part of the youth literature canon.Originality/practical implications: The study is based on a diachronic and synchronic analysis of various readings (for adults and children of literary texts when the text and / characters of inter/national adult’s literature canon have become a part of the youth reading.

Case report and literature review of adamantinoma of long bone

International Nuclear Information System (INIS)

Gao Zhenhua; Chen Yingming; Guan Jian; Meng Junfei

2010-01-01

Objective: To analyze the clinical, imaging and pathological features of adamantinoma of long bone to aid preoperative diagnosis. Methods: A case of adamantinoma of long bone was reported and the related literature was reviewed. Results: Literature review showed that long bone ameloblastoma was more common in young adults older than 20 years of age (86.3%) and occurred mainly in the tibial shaft (90%). The clinical, imaging and pathological features in our patient were consistent with those reported in the literature. Among 39 cases in the Chinese literature, radiographic findings included uni-or multi-cystic bone destruction with well-defined borders (87.2%), bone expansion (61.8%), partial loss of cortical bone (26.5%), bone sclerosis (38.2%), and no periosteal new bone reaction (100%). Pathology showed epithelial and fibrous differentiation. Conclusion: Adamantinoma of long bone should be considered in patients older than 20 years of age with tibial lesions that have imaging characteristics of benign bone tumors or some malignant features. (authors)

Military Enlistment of Hispanic Youth: Obstacles and Opportunities

Science.gov (United States)

2008-01-01

V22). (10) Uterus, congenital absence of (752.3), or enlargement due to any cause (621.2). (11) Vulvar or vaginal ulceration (616.5), including...when accompanied by evidence of infection of the urinary tract, or if clothing is soiled when voiding. (3) Undiagnosed enlargement or mass of...testicle or epididymis (608.9). (4) Undescended testicle(s) (752.5). (5) Orchitis (604), acute or chronic epididymitis. (6) Penis , amputation of (878), if

Leadership in literature.

Science.gov (United States)

2006-03-01

Business students nowadays are not, for the most part, poets. A growing proportion come to business school with a background in investment banking or management consulting and an undergraduate business major, rather than a degree in the arts and sciences. MBA students are already very familiar with business. A number of scholars and businesspeople have begun to question the scientific model that dominates business research and teaching. Formalized management tools work well enough if you're studying techniques for financial valuation, but less so when you're studying leadership and organizational behavior. Some argue that students could learn a lot more about these subjects if they took a course in literature. Examples from fiction can be as instructive as any business textbook. HBR senior editor Diane Coutu recently met with Joseph Badaracco, Jr., for a wide-ranging discussion of what leaders can learn from literature. For the past decade, Badaracco, the John Shad Professor of Business Ethics at Harvard Business School, has used classical literature to provide well-rounded, complex pictures of leaders in all walks of life-particularly leaders whose psychological and emotional challenges parallel those of senior executives. Fiction provides some of the most powerful and engaging case studies ever written. Unlike contemporary management literature, which is relentlessly upbeat, classical literature is unsparingly realist. Leaders often struggle and sometimes fail-and the stakes are high. When business leaders read about the conflicts of literary characters, they can better understand their own circumstances. We pay far too little attention to the inner lives of leaders. Business school courses seem to suggest that you can treat executives like lab animals and control their behavior through their environment. But behaviorism is not enough. Literature suggests that leaders should learn more about themselves if they want to succeed.

Angioleiomyoma of nasal septum: Case report and literature review

Directory of Open Access Journals (Sweden)

Varun V. Varadarajan, M.D.

2016-12-01

Conclusion: Angioleiomyoma of the nasal septum is a rare and challenging clinical diagnosis that requires detailed histopathologic examination. The differential diagnosis includes a variety of epithelial and mesenchymal derived tumors. Literature review suggests a female predilection with possible hormonal influence.

Whistleblowing: An integrative literature review of data-based studies involving nurses.

Science.gov (United States)

Jackson, Debra; Hickman, Louise D; Hutchinson, Marie; Andrew, Sharon; Smith, James; Potgieter, Ingrid; Cleary, Michelle; Peters, Kath

2014-01-01

Abstract Aim: To summarise and critique the research literature about whistleblowing and nurses. Whistleblowing is identified as a crucial issue in maintenance of healthcare standards and nurses are frequently involved in whistleblowing events. Despite the importance of this issue, to our knowledge an evaluation of this body of the data-based literature has not been undertaken. An integrative literature review approach was used to summarise and critique the research literature. A comprehensive search of five databases including Medline, CINAHL, PubMed and Health Science: Nursing/Academic Edition, and Google, were searched using terms including: 'Whistleblow*,' 'nurs*.' In addition, relevant journals were examined, as well as reference lists of retrieved papers. Papers published during the years 2007-2013 were selected for inclusion. Fifteen papers were identified, capturing data from nurses in seven countries. The findings in this review demonstrate a growing body of research for the nursing profession at large to engage and respond appropriately to issues involving suboptimal patient care or organisational wrongdoing. Nursing plays a key role in maintaining practice standards and in reporting care that is unacceptable although the repercussions to nurses who raise concerns are insupportable. Overall, whistleblowing and how it influences the individual, their family, work colleagues, nursing practice and policy overall, requires further national and international research attention.

Self-weighing in weight management: a systematic literature review.

Science.gov (United States)

Zheng, Yaguang; Klem, Mary Lou; Sereika, Susan M; Danford, Cynthia A; Ewing, Linda J; Burke, Lora E

2015-02-01

Regular self-weighing, which in this article is defined as weighing oneself regularly over a period of time (e.g., daily, weekly), is recommended as a weight loss strategy. However, the published literature lacks a review of the recent evidence provided by prospective, longitudinal studies. Moreover, no paper has reviewed the psychological effects of self-weighing. Therefore, the objective is to review the literature related to longitudinal associations between self-weighing and weight change as well as the psychological outcomes. Electronic literature searches in PubMed, Ovid PsycINFO, and Ebscohost CINAHL were conducted. Keywords included overweight, obesity, self-weighing, etc. Inclusion criteria included trials that were published in the past 25 years in English; participants were adults seeking weight loss treatment; results were based on longitudinal data. The results (N=17 studies) revealed that regular self-weighing was associated with more weight loss and not with adverse psychological outcomes (e.g., depression, anxiety). Findings demonstrated that the effect sizes of association between self-weighing and weight change varied across studies and also that the reported frequency of self-weighing varied across studies. The findings from prospective, longitudinal studies provide evidence that regular self-weighing has been associated with weight loss and not with negative psychological outcomes. © 2014 The Obesity Society.

Osteosarcoma: A Meta-Analysis and Review of the Literature.

Science.gov (United States)

Friebele, Jill C; Peck, Jeffrey; Pan, Xueliang; Abdel-Rasoul, Mahmoud; Mayerson, Joel L

2015-12-01

Over the past 30 years, treatment advances and the addition of neoadjuvant chemotherapy have led to improved 5-year survival in patients with osteosarcoma. More recent literature suggests the overall prognosis remains highly variable, with little improvement since the introduction of neoadjuvant chemotherapy. Tumor necrosis is an important predictor of patient prognosis. Necrosis of more than 90% correlates with overall survival (OS) approaching 75%. We reviewed the history of osteosarcoma treatment and survival and performed a meta-analysis of the 2000-2011 literature. Forty articles were included in the study. Five-year OS was 63% (95% confidence interval, 60%-66%) in studies that included patients with metastatic and nonmetastatic disease and 71% (95% confidence interval, 67%-76%) in studies that included only patients with nonmetastatic disease. Fifty percent of the patients in the studies of those with nonmetastatic osteosarcoma achieved 90% necrosis on histology. Five-year OS and number of patients achieving 90% necrosis are consistent with previous reports. Research is needed to improve treatment regimens and patient outcomes.

Literature database aid

International Nuclear Information System (INIS)

Wanderer, J.A.

1991-01-01

The booklet is to help with the acquisition of original literature either after a conventional literature search or in particular after a database search. It bridges the gap between abbreviated (short) and original (long) titel. This, together with information on the holdings of technical/scientific libraries, facilitates document delivery. 1500 short titles are listed alphabetically. (orig.) [de

The Structure of Medical Informatics Journal Literature

Science.gov (United States)

Morris, Theodore A.; McCain, Katherine W.

1998-01-01

Abstract Objective: Medical informatics is an emergent interdisciplinary field described as drawing upon and contributing to both the health sciences and information sciences. The authors elucidate the disciplinary nature and internal structure of the field. Design: To better understand the field's disciplinary nature, the authors examine the intercitation relationships of its journal literature. To determine its internal structure, they examined its journal cocitation patterns. Measurements: The authors used data from the Science Citation Index (SCI) and Social Science Citation Index (SSCI) to perform intercitation studies among productive journal titles, and software routines from SPSS to perform multivariate data analyses on cocitation data for proposed core journals. Results: Intercitation network analysis suggests that a core literature exists, one mark of a separate discipline. Multivariate analyses of cocitation data suggest that major focus areas within the field include biomedical engineering, biomedical computing, decision support, and education. The interpretable dimensions of multidimensional scaling maps differed for the SCI and SSCI data sets. Strong links to information science literature were not found. Conclusion: The authors saw indications of a core literature and of several major research fronts. The field appears to be viewed differently by authors writing in journals indexed by SCI from those writing in journals indexed by SSCI, with more emphasis placed on computers and engineering versus decision making by the former and more emphasis on theory versus application (clinical practice) by the latter. PMID:9760393

Computed tomography shielding methods: a literature review.

Science.gov (United States)

Curtis, Jessica Ryann

2010-01-01

To investigate available shielding methods in an effort to further awareness and understanding of existing preventive measures related to patient exposure in computed tomography (CT) scanning. Searches were conducted to locate literature discussing the effectiveness of commercially available shields. Literature containing information regarding breast, gonad, eye and thyroid shielding was identified. Because of rapidly advancing technology, the selection of articles was limited to those published within the past 5 years. The selected studies were examined using the following topics as guidelines: the effectiveness of the shield (percentage of dose reduction), the shield's effect on image quality, arguments for or against its use (including practicality) and overall recommendation for its use in clinical practice. Only a limited number of studies have been performed on the use of shields for the eyes, thyroid and gonads, but the evidence shows an overall benefit to their use. Breast shielding has been the most studied shielding method, with consistent agreement throughout the literature on its effectiveness at reducing radiation dose. The effect of shielding on image quality was not remarkable in a majority of studies. Although it is noted that more studies need to be conducted regarding the impact on image quality, the currently published literature stresses the importance of shielding in reducing dose. Commercially available shields for the breast, thyroid, eyes and gonads should be implemented in clinical practice. Further research is needed to ascertain the prevalence of shielding in the clinical setting.

Psychogeriatric inpatient unit design: a literature review.

Science.gov (United States)

Dobrohotoff, John T; Llewellyn-Jones, Robert H

2011-03-01

In many parts of the world the provision of psychogeriatric inpatient units (PGUs) remains limited. More units will be required over coming decades given rapid population aging. Medline (1950-2010), psycINFO (1806-2009), EMBASE (1980-2009) and CINAHL (1982-2009) were searched for papers about PGU design. Selected non-peer reviewed literature such as government reports and unpublished academic dissertations were also reviewed. Data were also obtained from the literature related to general adult psychiatry inpatient units where there was limited information from studies of units designed for older people. Over 200 papers were reviewed and 130 were included. There are few good quality studies to guide the design of acute PGUs and much of the existing literature is based on opinion and anecdote or, at best, based on observational studies. Randomized controlled studies comparing different designs and assessing outcomes are virtually non-existent. Several studies have identified violence and trauma resulting from hospitalization as significant problems with current acute PGU care. Despite its limitations the available literature provides useful guidance on how PGU design can optimize patient and staff safety and improve clinical outcomes. There are significant problems with current acute PGUs, and patient mix on existing units is an important issue. Future research should examine patient and staff perceptions of different PGU ward environments, the relationship between ward design and clinical outcomes, the effects of segregating patients with challenging behaviors in dementia and the benefits or otherwise of gender segregation.

Searching and synthesising 'grey literature' and 'grey information' in public health: critical reflections on three case studies.

Science.gov (United States)

Adams, Jean; Hillier-Brown, Frances C; Moore, Helen J; Lake, Amelia A; Araujo-Soares, Vera; White, Martin; Summerbell, Carolyn

2016-09-29

Grey literature includes a range of documents not controlled by commercial publishing organisations. This means that grey literature can be difficult to search and retrieve for evidence synthesis. Much knowledge and evidence in public health, and other fields, accumulates from innovation in practice. This knowledge may not even be of sufficient formality to meet the definition of grey literature. We term this knowledge 'grey information'. Grey information may be even harder to search for and retrieve than grey literature. On three previous occasions, we have attempted to systematically search for and synthesise public health grey literature and information-both to summarise the extent and nature of particular classes of interventions and to synthesise results of evaluations. Here, we briefly describe these three 'case studies' but focus on our post hoc critical reflections on searching for and synthesising grey literature and information garnered from our experiences of these case studies. We believe these reflections will be useful to future researchers working in this area. Issues discussed include search methods, searching efficiency, replicability of searches, data management, data extraction, assessing study 'quality', data synthesis, time and resources, and differentiating evidence synthesis from primary research. Information on applied public health research questions relating to the nature and range of public health interventions, as well as many evaluations of these interventions, may be predominantly, or only, held in grey literature and grey information. Evidence syntheses on these topics need, therefore, to embrace grey literature and information. Many typical systematic review methods for searching, appraising, managing, and synthesising the evidence base can be adapted for use with grey literature and information. Evidence synthesisers should carefully consider the opportunities and problems offered by including grey literature and information

Dextromethorphan, chlorphenamine and serotonin toxicity: case report and systematic literature review

Science.gov (United States)

Monte, Andrew A; Chuang, Ryan; Bodmer, Michael

2010-01-01

The aim of this review was to describe a patient with serotonin toxicity after an overdose of dextromethorphan and chlorphenamine and to perform a systematic literature review exploring whether dextromethorphan and chlorphenamine may be equally contributory in the development of serotonin toxicity in overdose. A Medline literature review was undertaken to identify cases of serotonin toxicity due to dextromethorphan and/or chlorphenamine. Case reports were included if they included information on the ingested dose or plasma concentrations of dextromethorphan and/or chlorphenamine, information about co-ingestions and detailed clinical information to evaluate for serotonin toxicity. Cases were reviewed by two toxicologists and serotonin toxicity, defined by the Hunter criteria, was diagnosed when appropriate. The literature was then reviewed to evaluate whether chlorphenamine may be a serotonergic agent. One hundred and fifty-five articles of dextromethorphan or chlorphenamine poisoning were identified. There were 23 case reports of dextromethorphan, of which 18 were excluded for lack of serotonin toxicity. No cases were identified in which serotonin toxicity could be solely attributed to chlorphenamine. This left six cases of dextrometorphane and/or chlorphenamine overdose, including our own, in which serotonin toxicity could be diagnosed based on the presented clinical information. In three of the six eligible cases dextromethorphan and chlorphenamine were the only overdosed drugs. There is substantial evidence from the literature that chlorphenamine is a similarly potent serotonin re-uptake inhibitor when compared with dextrometorphan. Chlorphenamine is a serotonergic medication and combinations of chlorphenamine and dextromethorphan may be dangerous in overdose due to an increased risk of serotonin toxicity. PMID:21175434

Literature search on the use of resins for treatment of radioactive wastes

International Nuclear Information System (INIS)

AlMahamid, I.; Smith, B.M.

1997-10-01

Over 100 commercial providers with mixed-waste treatability capabilities exist in the US. The maturity level of these technologies varies from a bench scale to a pilot or a commercial scale. The techniques include deactivation, chemical oxidation, recovery of metals, stabilization, vitrification, incineration, biodegradation, and chemical extraction. This report focuses on the use of resins to remove actinides and heavy metals from aqueous waste streams. Only the literature that described resins with high removing efficiency are presented here. The majority of the literature reviewed are proceedings and national or international reports ordered through the Berkeley Lab Library. Some of the reports that the authors requested have not yet arrived. Only a few papers were found in the open literature (journals or magazines). Although this report does not include all existing references, it provides an accurate assessment of efficient resins to be considered for waste minimization procedures. 70 refs

Strengthening the role of the ward manager: a review of the literature.

Science.gov (United States)

Pegram, Anne M; Grainger, Michelle; Sigsworth, Janice; While, Alison E

2014-09-01

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. To identify initiatives that have strengthened the ward manager role. A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems. © 2013 John Wiley & Sons Ltd.

IncobotulinumtoxinA in clinical literature.

Science.gov (United States)

Lorenc, Z Paul; Kenkel, Jeffrey M; Fagien, Steven; Hirmand, Haideh; Nestor, Mark S; Sclafani, Anthony P; Sykes, Jonathan M; Waldorf, Heidi A

2013-03-01

IncobotulinumtoxinA is the third neurotoxin type A to be approved for aesthetic use in the United States. Because incobotulinumtoxinA has been in use in Europe for some time, the clinical literature is fairly replete with references to its properties and characteristics, as well as its safety and efficacy. In North America, 2 pivotal trials, referred to as GL-1 and GL-2, investigated the safety and efficacy of incobotulinumtoxinA in the glabellar region; both are currently in press with another journal. Other published studies of incobotulinumtoxinA are also described in depth in this article, including reports on aesthetic indications, diffusion, therapeutic indications, and studies pertaining to the preclinical and clinical pharmacology of incobotulinumtoxinA. Topics addressed include potency variability, mean concentration, stability and dissociation, and endopeptide immunoassay.

Endometrial Osseous Metaplasia: Case Report with Literature Review

African Journals Online (AJOL)

Endometrial osseous metaplasia is a rare entity[1] and Nearly. 80 cases have been reported in the world literature including, nine from India[2] and it is the presence of mature or immature bone in the endometrium.[1] Osseous metaplasia of the endometrium has also been incorrectly named as endometrial ossification ...

Gynecomastia and psychological functioning: A review of the literature.

Science.gov (United States)

Ordaz, D Luis; Thompson, J Kevin

2015-09-01

Gynecomastia is defined as excess glandular growth of breast tissue in males. It is a noticeable physical difference that commonly affects males in adolescence and old age. While often transient in nature, gynecomastia persists indefinitely in 10% of cases. Much of the literature on gynecomastia has focused on etiology and management. Little research has been done regarding the impact of gynecomastia on one's mental health and quality of life; however, some studies have suggested various psychosocial and psychological consequences related to gynecomastia. These consequences include but are not limited to depression, anxiety, disordered eating, body dissatisfaction, and reduced self-esteem. The aims of this paper are to review the current gynecomastia literature, bring awareness to an understudied but troubled population, and discuss directions for future work, including offering extant models of body image to guide researchers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Predatory Publishing: An Emerging Threat to the Medical Literature.

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Harvey, H Benjamin; Weinstein, Debra F

2017-02-01

The quality of medical literature is increasingly threatened by irresponsible publishing, leading to rising retraction rates, irreproducible results, and a flood of inconsequential publications that distract readers from more meaningful scholarship. "Predatory publishers" offer rapid publication with loose peer review, exploiting a system in which faculty seek longer bibliographies to achieve academic promotion. In this Commentary, the authors highlight some of the evidence that this problem exists and suggest actions to address it. Recommendations for protecting the medical literature include preventing predatory journals from being indexed by the National Library of Medicine; encouraging academic promotions committees to ensure that they prioritize value over volume of publications and that faculty understand that priority; excluding publications from predatory journals on curricula vitae and requiring that retractions are included; developing sanctions for repeated retractions or duplicate publications; and convening an expert panel to better elucidate this problem and determine strategies to combat it.

POCHVENNICHESTVO IN RUSSIAN LITERATURE: THE METAPHOR AS IDEOLOGEME

Directory of Open Access Journals (Sweden)

Vladimir Nikolaevich Zakharov

2012-11-01

Full Text Available Original as it was, the phenomenon of pochvennichestvo (roughly translated as «native soil» in Russian thought and literature is often accompanied by a number of myths, misperceptions and erroneous commonplaces. It is not infrequent that those who never shared the ideas of pochvennichestvo are described as its adepts, and those who did, are often misquoted, with some notions, ideas and phrases misattributed to them. The ideological and literary agenda of pochvennichestvo was formed by the Vremya (1861-1863 and Epokha (1864-1865 magazines published by the brothers Dostoevsky — Fedor and Mikhail. Their outlook and vigorous action, discussions of submitted articles at board meetings, polemics with other periodicals — all of these factors contributed to the general trend of pochvennichestvo with its typical mutual influence of all its members. Fedor Dostoevsky's role on its development was decisive, as he kept consistently substantiating ideas which were new for Russian literature. Our article analyses the pochva (soil metaphor in the ideology of new school of literature and political movements which Dostoevsky helped set up in 1860s-1870s. According to him, pochva includes everything that gives birth and unites: people, homeland, native language and mother earth. They are all linked together by the mystery of Russia as the keeper of Orthodox faith and Christ as the «ideal of the people». One has to reunite with the pochva by becoming one with the people and strive to see all estates united. To be a pochvennik meant to love Russia and its people, to be a Russian and identify as one, to follow the faith of the fathers and honour the native land. In the 20th century, pochvennichestvo resolved the old argument between the Westernizers and Slavophiles. The word pochvennik was applied to the authors who stayed loyal to Russian traditional values, rural communities and traditions of Russian literature. Various authors and critics have been

Literature review, Denmark

DEFF Research Database (Denmark)

Vestergaard, Jens; Linneberg, Mai Skjøtt; Nielsen, Robert Green

2001-01-01

Gives an overvie of the situation with respect to organic and conversion markets in Denmark based on exsisting literature. The following subjects are covered. National Policies. Agricultural Production. Conversion. Agricultural Marketing......Gives an overvie of the situation with respect to organic and conversion markets in Denmark based on exsisting literature. The following subjects are covered. National Policies. Agricultural Production. Conversion. Agricultural Marketing...

Intertextuality in the Literature

Directory of Open Access Journals (Sweden)

Mustafa Albay

2017-06-01

Full Text Available Literature is not the product of a specific nation; rather it is a combination of the experiences of all nations. So to speak, there is inheritance amongst the literary texts all over the world literature. Thinking of the global changes and technological development, it is quite easy to see the issue of interaction between the nations which is called “intertextuality”. This concept appears in a literary work within different interactions. Especially the religions, trade, wars, social and or economic movement, internet and technology have significant roles in this because this interaction is provided through these factors in the society. Now that, the society is mirrored up in the literature, these affects necessarily will be seen in the literature and the scholars deal with finding formic, contently and stylistic resemblances among the cultures and literary areas in a literary work. In this study, two aspects of these interactions in the literature will be handled as theme-based and form-based. The stylistic resemblances will be treated under the form-based part.

Return to work among breast cancer survivors: A literature review.

Science.gov (United States)

Sun, Yuanlu; Shigaki, Cheryl L; Armer, Jane M

2017-03-01

Breast cancer survivors in their employment years are likely to try to go back to work after the primary treatment. Because the literature on return to work among breast cancer survivors is limited, we have undertaken a review of the literature to summarize what is known, including identifying important contributing variables and outcomes. This knowledge may be used to develop hypotheses and potential interventions to support breast cancer survivors who wish to return to work. We searched the following databases: CINAHL, MEDLINE, SCOUP, and PUBMED, within a 10-year timeframe (2004 to 2014). The majority of reviewed articles (N = 25) focused on three outcomes: return-to-work period, work ability, and work performance. The most frequently studied independent variables were collapsed into the following groups: health and well-being, symptoms and functioning, work demands and work environment, individual characteristics, and societal and cultural factors. Gaps in the literature include evidence of effective interventions to support return to work among breast cancer survivors and research to better understand the roles of government and business-related policy. All the studies reported a reduced work engagement and work ability. Employment status and work performance is associated with a combination of individual factors, work environment, culture, and resources. Significant gaps are apparent in the literature addressing breast cancer survivorship and return to work. This is a complex problem and it will likely require interdisciplinary research teams to develop effective and feasible interventions for this population.

Healthcare Scheduling by Data Mining: Literature Review and Future Directions

Directory of Open Access Journals (Sweden)

Maria M. Rinder

2012-01-01

Full Text Available This article presents a systematic literature review of the application of industrial engineering methods in healthcare scheduling, with a focus on the role of patient behavior in scheduling. Nine articles that used mathematical programming, data mining, genetic algorithms, and local searches for optimum schedules were obtained from an extensive search of literature. These methods are new approaches to solve the problems in healthcare scheduling. Some are adapted from areas such as manufacturing and transportation. Key findings from these studies include reduced time for scheduling, capability of solving more complex problems, and incorporation of more variables and constraints simultaneously than traditional scheduling methods. However, none of these methods modeled no-show and walk-ins patient behavior. Future research should include more variables related to patient and/or environment.

Violent video game effects on children and adolescents. A review of the literature.

Science.gov (United States)

Gentile, D A; Stone, W

2005-12-01

Studies of violent video games on children and adolescents were reviewed to: 1) determine the multiple effects; 2) to offer critical observations about common strengths and weaknesses in the literature; 3) to provide a broader perspective to understand the research on the effects of video games. The review includes general theoretical and methodological considerations of media violence, and description of the general aggression model (GAM). The literature was evaluated in relation to the GAM. Published literature, including meta-analyses, are reviewed, as well as relevant unpublished material, such as conference papers and dissertations. Overall, the evidence supports hypotheses that violent video game play is related to aggressive affect, physiological arousal, aggressive cognitions, and aggressive behaviours. The effects of video game play on school performance are also evaluated, and the review concludes with a dimensional approach to video game effects. The dimensional approach evaluates video game effects in terms of amount, content, form, and mechanics, and appears to have many advantages for understanding and predicting the multiple types of effects demonstrated in the literature.

Nuclear fuel cycle risk assessment: survey and computer compilation of risk-related literature

International Nuclear Information System (INIS)

Yates, K.R.; Schreiber, A.M.; Rudolph, A.W.

1982-10-01

The US Nuclear Regulatory Commission has initiated the Fuel Cycle Risk Assessment Program to provide risk assessment methods for assistance in the regulatory process for nuclear fuel cycle facilities other than reactors. Both the once-through cycle and plutonium recycle are being considered. A previous report generated by this program defines and describes fuel cycle facilities, or elements, considered in the program. This report, the second from the program, describes the survey and computer compilation of fuel cycle risk-related literature. Sources of available information on the design, safety, and risk associated with the defined set of fuel cycle elements were searched and documents obtained were catalogued and characterized with respect to fuel cycle elements and specific risk/safety information. Both US and foreign surveys were conducted. Battelle's computer-based BASIS information management system was used to facilitate the establishment of the literature compilation. A complete listing of the literature compilation and several useful indexes are included. Future updates of the literature compilation will be published periodically. 760 annotated citations are included

The impact of PICO as a search strategy tool on literature search quality

DEFF Research Database (Denmark)

Eriksen, Mette Brandt; Frandsen, Tove Faber

2018-01-01

Objective: This review aimed to determine, if the use of the PICO model (Patient Intervention Comparison Outcome) as a search strategy tool affects the quality of the literature search. Methods: A comprehensive literature search was conducted in: PubMed, Embase, CINAHL, PsycInfo, Cochrane Library...... and three studies were included, data was extracted, risk of bias was assessed and a qualitative analysis was conducted. The included studies compared PICO to PIC or link to related articles in PubMed; PICOS and SPIDER. One study compared PICO to unguided searching. Due to differences in intervention...

Ethnic diversity in the nurse workforce: a literature review.

Science.gov (United States)

Otto, Laureen A; Gurney, Cindy

2006-01-01

In the 2000-2003 New York State Nurses Association Strategic Plan, the Board of Directors called for an assessment of the progress made toward achieving an ethnically diverse nursing workforce as reflected in the literature. In this paper the authors have responded to that request and offer a snapshot of progress as well as standstills in the journey toward diversity. Although the literature has tended to focus on cultural competency of the healthcare worker, and includes numerous calls for action to diversify the nurse workforce, very little scholarly work has been conducted that rigorously evaluates such diversification activities. The purpose of this literature review is to explore existing scholarly work in ethnic diversity at three levels: in the general workforce, the healthcare workforce, and the nursing workforce. The authors explored the literature as it addresses two aspects: academic and career factors influencing diversity; and recruitment, retention, and other strategies employed to diversify the workforce. By exploring the existing research, gaps can be identified in order to either direct further research, or target funding to recruitment strategies to effectively enhance a more ethnically diverse nurse workforce.

Use of wildlife webcams - Literature review and annotated bibliography

Science.gov (United States)

Ratz, Joan M.; Conk, Shannon J.

2010-01-01

The U.S. Fish and Wildlife Service National Conservation Training Center requested a literature review product that would serve as a resource to natural resource professionals interested in using webcams to connect people with nature. The literature review focused on the effects on the public of viewing wildlife through webcams and on information regarding installation and use of webcams. We searched the peer reviewed, published literature for three topics: wildlife cameras, virtual tourism, and technological nature. Very few publications directly addressed the effect of viewing wildlife webcams. The review of information on installation and use of cameras yielded information about many aspects of the use of remote photography, but not much specifically regarding webcams. Aspects of wildlife camera use covered in the literature review include: camera options, image retrieval, system maintenance and monitoring, time to assemble, power source, light source, camera mount, frequency of image recording, consequences for animals, and equipment security. Webcam technology is relatively new and more publication regarding the use of the technology is needed. Future research should specifically study the effect that viewing wildlife through webcams has on the viewers' conservation attitudes, behaviors, and sense of connectedness to nature.

Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature.

Science.gov (United States)

Sharma, Animesh

2017-11-27

The coexistence of functional thyroid nodules and Graves' disease (GD) is a rare condition known as Marine-Lenhart syndrome. Thyroid cancer has been described in several adults, but never in children, with Marine-Lenhart syndrome. This paper discusses the challenges in diagnosis and the unique management of this condition in children, in the context of extant literature. In this case report, two adolescent female patients with Marine-Lenhart syndrome, aged 15 and 16 years, exhibited biochemical evidence of hyperthyroidism, and were found to have unilateral hyperfunctioning thyroid nodules via thyroid scintigraphy. Additionally, both patients showed elevated thyroid-stimulating immunoglobulins (TSI) and increased glandular activity, confirming background GD. Notably, one patient was also diagnosed with intranodular thyroid cancer upon preoperative examination. Both patients were treated via surgical resection. Summary and outlook: Diagnosis of Marine-Lenhart syndrome can be made in patients with functional thyroid nodules and increased glandular activity on thyroid scintigraphy. Standard doses of radioiodine ablation are not effective in the majority of patients and should be avoided due to the increased risk for thyroid cancer, making thyroidectomy the preferred treatment.

How to search for and use 'grey literature' in research.

Science.gov (United States)

Coad, Jane; Hardicre, Jayne; Devitt, Patric

An ever-growing amount of grey literature is available to nurses, including oral presentations, personal communication, leaflets, newspapers and magazines, unpublished research, internal reports and minutes of meetings. It can be an invaluable research resource.

Decision-making in nursing practice: An integrative literature review.

Science.gov (United States)

Nibbelink, Christine W; Brewer, Barbara B

2018-03-01

To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient

A literature review of idea management

DEFF Research Database (Denmark)

Jensen, Anna Rose Vagn

2012-01-01

The objective of the paper is primarily to conduct a state-of-the-art literature review of Idea Management and secondary to point out unanswered questions which are left behind in the reviewed literature. Scientific knowledge is primarily represented in innovation management literature but also...... considerably in literature on software and IT. On the background of the literature review, there are some weaknesses in the literature to be considered. These weaknesses concern the understanding of how people interact with idea management in their daily work practices and how different types of ideas...

Emotionally intelligent nurse leadership: a literature review study.

Science.gov (United States)

Akerjordet, Kristin; Severinsson, Elisabeth

2008-07-01

To establish a synthesis of the literature on the theoretical and empirical basis of emotional intelligence and it's linkage to nurse leadership, focusing on subjective well-being and professional development. Emotional intelligence has been acknowledged in the literature as supporting nurse leadership that fosters a healthy work environment, creating inspiring relationships based on mutual trust. Nurse leaders who exhibit characteristics of emotional intelligence enhance organizational, staff and patient outcomes. A literature search was undertaken using international data bases covering the period January 1997 to December 2007. Eighteen articles were included in this integrative review and were thoroughly reviewed by both authors. Emotional intelligence was associated with positive empowerment processes as well as positive organizational outcomes. Emotionally intelligent nurse leadership characterized by self-awareness and supervisory skills highlights positive empowerment processes, creating a favourable work climate characterized by resilience, innovation and change. Emotional intelligence cannot be considered a general panacea, but it may offer new ways of thinking and being for nurse leaders, as it takes the intelligence of feelings more seriously by continually reflecting, evaluating and improving leadership and supervisory skills.

Medicinal Behavior in Persian Literature by Emphasis on Ibn-Sina Popular Literature

Science.gov (United States)

Kolahdouzan, Akbar; Vahabi, Fataneh

2013-01-01

Content of Persian literature comes from innocents, has special effect on social and individual people life. We understand worth of medical science, physician and sick people relationship in society and impact of religion behavior in treatment. Persian literature contains some recommendation that improve belief, trust, and secretary in medical society. In this article we chose some Persian literature about medicinal behavior and discuss trough: physician relationship with GOD and its impact on treatment, and sick people with others. We hope by studying this article physician can work better and sick people obey their orders more. PMID:23687466

Traditional Chinese Medicine Syndromes for Essential Hypertension: A Literature Analysis of 13,272 Patients

Directory of Open Access Journals (Sweden)

Jie Wang

2014-01-01

Full Text Available Background. To simplify traditional Chinese medicine syndrome differentiation and allow researchers to master syndrome differentiation for hypertension, this paper retrospectively studied the literature and analyzed syndrome elements corresponding to hypertension syndromes. Methods. Six databases including PubMed, EMBASE, Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data were searched from 1/January/2003 to 30/October/2013. We included all clinical literature testing hypertension syndromes and retrospectively studied the hypertension literature published from 2003 to 2013. Descriptive statistics calculated frequencies and percentages. Results. 13,272 patients with essential hypertension were included. Clinical features of hypertension could be attributed to 11 kinds of syndrome factors. Among them, seven syndrome factors were excess, while four syndrome factors were deficient. Syndrome targets were mainly in the liver and related to the kidney and spleen. There were 33 combination syndromes. Frequency of single-factor syndromes was 31.77% and frequency of two-factor syndromes was 62.26%. Conclusions. Excess syndrome factors of hypertension patients include yang hyperactivity, blood stasis, phlegm turbidity, internal dampness, and internal fire. Deficient syndrome factors of hypertension patients are yin deficiency and yang deficiency. Yin deficiency with yang hyperactivity, phlegm-dampness retention, and deficiency of both yin and yang were the three most common syndromes in clinical combination.

HAMLET. LITERATURE CURRICULUM VI, TEACHER AND STUDENT VERSIONS.

Science.gov (United States)

KITZHABER, ALBERT R.

THIS CULMINATING UNIT OF THE 12TH-GRADE OREGON LITERATURE CURRICULUM IS BASED UPON ONE WORK, "HAMLET." THE TEACHER VERSION INCLUDES DISCUSSIONS OF (1) THE RELEVANCE OF HAMLET'S CHARACTER TO MODERN TIMES, (2) THE PROBLEMS IN THE CHARACTERIZATIONS OF THE GHOST, CLAUDIUS, AND HAMLET, (3) THE PLAY'S THREE-PHASE STRUCTURE, (4) THE PLAY'S…

1979-80 Literature Electives Survey.

Science.gov (United States)

Young, Art

1980-01-01

A group of 66 college English departments was surveyed regarding their most popular literature courses. Most popular were courses in Shakespeare, science fiction, film, fiction, United States literature, and modern and contemporary literature. The most popular writing courses were creative, technical/business, and advanced composition. (DF)

Effectiveness of brachytherapy in treating carcinoma of the vulva

International Nuclear Information System (INIS)

Pohar, Surjeet; Hoffstetter, Sylvette; Peiffert, Didier; Luporsi, Elisabeth; Pernot, Monique

1995-01-01

Purpose: Radical radiotherapeutic management of vulvar cancer often incorporates brachytherapy as a portion of the treatment regimen. However, few studies using this modality alone to manage vulvar cancer have been published. Methods and Materials: Thirty four patients were treated with iridium-192 ( 192 Ir) brachytherapy for vulvar cancer between 1975 and 1993 at Centre Alexis Vautrin. Twenty-one patients were treated at first presentation when surgery was contraindicated or declined. Of these patients, 12 had International Federation of Gynecology and Obstetrics Classification Stage III or IV disease, 8 were Stage II, 1 was Stage I, and 1 was Stage 0. Thirteen patients were treated for recurrent disease. Paris system rules for implantation and dose prescription were followed. The median reference dose was 60 Gy (range 53 to 88 Gy). At the time of analysis, 10 of 34 patients were alive. Median follow-up in these 10 patients was 31 months (range: 21 months to 107 months). Fourteen of the 24 deaths were from causes other than vulvar cancer. Results: Kaplan-Meier actuarial 5-year local control was 47% (95% confidence interval (CI) = 23 to 73%) and 5-year actuarial loco-regional control was 45% (95% CI = 21 to 70%). Kaplan-Meier actuarial 5-year disease-specific survival was 56% (95% CI = 33 to 76%) and actuarial 5-year survival was 29% (95% CI = 15 to 49%). Median time to death was 14 months. Subset analysis revealed a higher actuarial 5-year local control in patients treated at first presentation than those treated for recurrence (80 vs. 19%, log rank, p = 0.04). Similarly, actuarial 5-year loco-regional control was higher in patients treated at first presentation (80 vs. 16%, log rank, p 0.01). The two groups did not differ significantly in disease-specific or overall survival. The actuarial 5-year disease specific survival of 56% is somewhat less than the expected 5-year disease-specific survival after surgery in a group having a similar proportion of early stage

Evaluation of hospital staff's perceived quality of librarian-mediated literature searching services.

Science.gov (United States)

McKeown, Sandra; Konrad, Shauna-Lee; McTavish, Jill; Boyce, Erin

2017-04-01

The research evaluated the perceived quality of librarian-mediated literature searching services at one of Canada's largest acute care teaching hospitals for the purpose of continuous quality improvement and investigation of relationships between variables that can impact user satisfaction. An online survey was constructed using evidence-based methodologies. A systematic sample of staff and physicians requesting literature searches at London Health Sciences Centre were invited to participate in the study over a one-year period. Data analyses included descriptive statistics of closed-ended questions and coding of open-ended questions. A range of staff including clinicians, researchers, educators, leaders, and analysts submitted a total of 137 surveys, representing a response rate of 71%. Staff requested literature searches for the following "primary" purposes: research or publication (34%), teaching or training (20%), informing a policy or standard practice (16%), patient care (15%), and "other" purposes (15%). While the majority of staff (76%) submitted search requests using methods of written communication, including email and search request forms, staff using methods of verbal communication, including face-to-face and telephone conversations, were significantly more likely to be extremely satisfied with the librarian's interpretation of the search request ( p =0.004) and to rate the perceived quality of the search results as excellent ( p =0.005). In most cases, librarians followed up with staff to clarify the details of their search requests (72%), and these staff were significantly more likely to be extremely satisfied with the librarian's interpretation of the search request ( p =0.002). Our results demonstrate the limitations of written communication in the context of librarian-mediated literature searching and suggest a multifaceted approach to quality improvement efforts.

Overview. Rethinking the grey literature's definition

International Nuclear Information System (INIS)

Ikeda, Kiyoshi

2012-01-01

Grey literature said to do difficult to obtain through commercial publishers. Recently, according to the spread of institutional repositories, grey literature is published on the Web and its full text is open to the public, then it has become easily accessible. Yet, the accessibility of grey literature has not been fully resolved. In this paper, the author introduces the definition of grey literature based on the discussion of the International Conference on Grey Literature (International Conference on Grey literature) and tries to reorganize and discuss on issues concerning the problems of grey literature accessibility. The author indicates that there are still many challenges in this field, also indicates that stable access to the sources on the Web is not always guaranteed. It is concluded that expertises and experiences of a librarian should be leveraged to get solutions regarding the accessibility of grey literature. (author)

Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations.

Science.gov (United States)

Williams-Whitt, Kelly; Bültmann, Ute; Amick, Benjamin; Munir, Fehmidah; Tveito, Torill H; Anema, Johannes R

2016-12-01

Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by

Genetic and Medical Considerations of Autism: A Literature Review.

Science.gov (United States)

Silver, Kathi O.

This literature review, from 1990 to the present, discusses the characteristics of autism and the comorbidity of mental retardation and autism. Specific medical syndromes that complement the heterogeneity concept are described, including epilepsy, fragile X syndrome, Rett syndrome, tuberous sclerosis, and Asperger syndrome. The paper presents some…

Stages of Vulvar Cancer

Science.gov (United States)

... A to Z List of Cancer Drugs Complementary & Alternative Medicine (CAM) Questions to Ask about Your Treatment Research ... Treatment Side Effects Clinical Trials Cancer Drugs Complementary & Alternative Medicine Coping Feelings & Cancer Adjusting to Cancer Self Image & ...

The Argonauts in Slovenian Literature for Children and Youth

Directory of Open Access Journals (Sweden)

Milena Mileva Blažić

2015-12-01

Full Text Available Ljubljana has been associated with literature since its beginning. The founda- tion of the city Emona, for example, which – according to myth – dates back to the 13th  century BC, is associated with the myth of the Argonauts, Jason and the Golden Fleece. In the process of literary reception, the ancient myth evolved into the fairy tale type ATU 513A, according to H.-J. Uther’s motif index of fairy tales. The motif of the Golden Fleece became a symbol of mythic search beyond time and space in Slovenian literature, including children’s literature: in the picture books by Dane Zajc and Miroslav Šuput: The Argonauts (Argonavti, Anton Komat: The Lake Fairy (Vila Jezerka, Desa Muck: The Giant Hen (Kokoš velikanka, Andreja Peklar: The Boy with the Red Cap (Fant z rdečo kapico. It is used with different meanings and in combination with various mythic, fabulous and realistic animal symbols.

Selective Bibliography of Translingual Literature

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Kellman, Steven G.; Lvovich, Natasha

2015-01-01

Translingual Literature is literature written in a language not native to the author, in two languages, or in a mix of languages. This bibliography is the very first attempt to create and publish such an academic tool for researchers of multilingualism, second-language acquisition, comparative literature, and other fields. It contains only books…

Literature as a Mode of Knowing: Rationale for the Teaching of Literature.

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Probst, Robert Edward

This thesis proposes a philosophical foundation for literary instruction, based on several theories and philosophies of language and literature and on studies of student response to literature. Burke submits that literary art and common language uses find their origins in man's unique proclivity for creating symbols. Church agrees, arguing that…

A Literature Map of Dropout Prevention Interventions for Students with Disabilities

Science.gov (United States)

Wilkins, Julia; Huckabee, Sloan

2014-01-01

This paper presents a review of the literature on dropout prevention interventions for students with disabilities. A variety of search methods, including electronic library searches, hand searches of journals, and Internet searches were used to acquire the widest possible set of research studies. To be included in this review, the studies must…

Public Health's Approach to Systemic Racism: a Systematic Literature Review.

Science.gov (United States)

Castle, Billie; Wendel, Monica; Kerr, Jelani; Brooms, Derrick; Rollins, Aaron

2018-05-04

Recently, public health has acknowledged racism as a social determinant of health. Much evidence exists on the impact of individual-level racism and discrimination, with little to no examination of racism from the standpoint of systems and structures. The purpose of this systematic literature review is to analyze the extent to which public health currently addresses systemic racism in the published literature. Utilizing the PRISMA guidelines, this review examines three widely used databases to examine published literature covering the topic as well as implications for future research and practice. A total of 85 articles were included in the review analysis after meeting study criteria. Across numerous articles, the terms racism and systemic racism are largely absent. A critical need exists for an examination of the historical impact of systemic racism on the social determinants of health and health of marginalized populations.

Clinical leadership in pre-registration nursing programmes--an international literature review.

Science.gov (United States)

Brown, Angela; Crookes, Patrick; Dewing, Jan

2015-01-01

Clinical leadership and the safety, quality and efficiency of patient/client care are inextricably linked in government reports, major inquiries and the professional literature. This review explores the literature on clinical leadership development within pre-registration nursing programmes. The literature retrieved from a scoping review was evaluated to identify what is already published on the development of clinical leadership within pre-registration nursing programmes. Twenty-seven publications matched the inclusion criteria and were included in this review, 14 journal articles, one thesis and 11 chapters within one book were analysed and three themes were identified: clinical leadership; curriculum content and pedagogy. RESULTS AND MAIN OUTCOMES: This review identified a paucity of literature specifically relating to clinical leadership and pre-registration nursing programmes and what is available is inconclusive and unconvincing. Academics, curriculum development leaders and accreditation bodies have a responsibility to influence how nurses are prepared for the profession as such clinical leadership and the new graduate should be considered an area of greater importance.

Allergies and suicidal behaviors: a systematic literature review.

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Kõlves, Kairi; Barker, Emma; De Leo, Diego

2015-01-01

Allergies are among the most common chronic conditions. In addition to physical and social impacts, a number of studies have consistently linked allergies to poor psychological outcomes, including depression and anxiety. The aim of the present systematic literature review was to analyze the existing literature about the relationship between allergies and fatal and nonfatal suicidal behaviors. Data sources include articles retrieved from Scopus, PubMed, ProQuest, and Web of Knowledge. Search terms: "suicid* and (allerg* or hay fever or atop* or eczema or aeroallergen*)" in English-language peer-reviewed journals between 1990 and 2014. Original research articles that provide empiric evidence about the potential link between allergies and suicidal behaviors. The initial search identified a total of 769 articles with 17 original research articles that present empiric evidence. Nine articles analyzed the relationship between allergies and fatal suicidal behavior, and nine analyzed nonfatal suicidal behaviors (one article included both). There currently is little research into the relationship between allergies and suicidal behavior. The review was restricted to English-language articles published within the chosen time period; other limitations included the small number of articles that involve suicide mortality, and the fact that the majority of articles originated from the United States and Scandinavia. Analysis of the results indicates a link between allergies and suicidality, particularly suicide mortality; however, results for nonfatal suicidal behaviors are mixed. It is important that further research by using more rigorous study designs be carried out to lend strength to these findings.

Fertility and Occupational hazards: Review of the Literature | Ashiru ...

African Journals Online (AJOL)

Workplace exposures and hazards have detrimental effects on many organ systems in the body including the reproductive system. The evidence of the reproductive effects of occupational hazards is obtained through a synthesis of the available literature. These effects vary and overlap due to the multiple nature of ...

Intersections of Spirituality, Religion and Gender in Children's Literature

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Trousdale, Ann M.

2005-01-01

This paper explores the intersections of spirituality, religion and gender in contemporary children's books published in the United States. Background for the discussion includes a history of religion in children's literature and the history of women's roles in the Christian tradition. Representative works of realistic fiction--historical and…

Empowering Students through Literature.

Science.gov (United States)

Cukras, Grace-Ann Gorga

2000-01-01

A literary club formed a community of readers among underserved and nontraditional community college students. Members meet to discuss literature and host authors' visits. The environment enables students to share their perspectives and develop deeper understanding of literature and of themselves. (SK)

A Literature Review of the Effect of Malaria on Stunting.

Science.gov (United States)

Jackson, Bianca D; Black, Robert E

2017-11-01

Background: The current version of the Lives Saved Tool (LiST) maternal and child health impact modeling software does not include an effect of malaria on stunting. Objective: This literature review was undertaken to determine whether such a causal link should be included in the LiST model. Methods: The PubMed, Embase, and Scopus databases were searched by using broad search terms. The searches returned a total of 4281 documents. Twelve studies from among the retrieved documents were included in the review according to the inclusion and exclusion criteria. Results: There was mixed evidence for an effect of malaria on stunting among longitudinal observational studies, and none of the randomized controlled trials of malaria interventions found an effect of the interventions on stunting. Conclusions: There is insufficient evidence to include malaria as a determinant of stunting or an effect of malaria interventions on stunting in the LiST model. The paucity and heterogeneity of the available literature were a major limitation. In addition, the studies included in the review consistently fulfilled their ethical responsibility to treat children under observation for malaria, which may have interfered with the natural history of the disease and prevented any observable effect on stunting or linear growth. © 2017 American Society for Nutrition.

Homonormativity in Children's Literature: An Intersectional Analysis of Queer-Themed Picture Books

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Lester, Jasmine Z.

2014-01-01

Effective social justice movements, including those at the level of children's literature, address the ways different forms of oppression intersect and affect the experiences of diverse queer identities. Children's literature can help combat heteronormative discourse by instilling at a young age the inherent value of all people.…

Literature in EFL/ESL Classroom

Science.gov (United States)

Khatib, Mohammad; Rezaei, Saeed; Derakhshan, Ali

2011-01-01

This paper is a review of literature on how literature can be integrated as a language teaching material in EFL/ESL classes. First, it tracks down the place of literature in language classes from the early Grammar Translation Method (GTM) to Communicative Language Teaching (CLT) era. The paper then discusses the reasons for the demise and…

Pulmonary rehabilitation programs in lung transplant: a literature review

Directory of Open Access Journals (Sweden)

Juliana Maria de Sousa Pinto

2015-09-01

Full Text Available Objective: To analyze, using a literature review, Pulmonary Rehabilitation (RP Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periódicos Capes, BVS and Science Direct data bases using descriptors in English (“lung transplantation”, “lung transplant” AND/OR “rehabilitation” and Portuguese (“reabilitação” AND/OR “transplante pulmonar”. The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results: The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients.

Mentoring models in neurosurgical training: Review of literature.

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Akhigbe, Taiwo; Zolnourian, Ardalan; Bulters, Diederik

2017-11-01

Effective mentoring is an invaluable element in the development of next generation of neurosurgeons. A mentor helps to develop professional core values, technical and non-technical skills, attitudes and disposition required to be qualified and competent neurosurgeon. Giving the invaluable significance of mentoring in neurosurgery, we undertook this literature review to identify mentoring models evaluating its success and relative benefit. Literature search identified using MeSH word 'mentor', mentoring, mentorship, mentoring model, neurosurgery' in MEDLINE, EMBASE and Scopus databases from 1990 to 2016. Literature reviewed to identify status of mentoring in neurosurgery, potential barriers, pitfalls and future framework for mentoring in neurosurgery. Additional articles identified through manual search of reference lists. A total of 247 studies were obtained from electronic databases, after removing duplicates, abstracts, letters to the editor and non-neurosurgery papers. Sixteen full text articles retrieved out of which five met the inclusion criteria. Generally, there is paucity of articles regarding mentoring in neurosurgery, all included papers were written in English Language, all of them described mentoring model used including simulation, distance, collaborative, facilitative tele-mentoring and peer mentoring. Mentoring in Neurosurgery is an important aspect of personal and professional development of neurosurgical trainees, currently there is decline in traditional apprenticeship due to increase demand for modern use of specialised technology, simulation and tele-medicine in neurosurgery practice. Effective and efficient mentoring will be an interplay of six mentoring models (collaborative, facilitative, distance, simulation, tele mentoring and peer mentoring) identified. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Photodynamic therapy in clinical practice

Directory of Open Access Journals (Sweden)

E. V. Filonenko

2016-01-01

Full Text Available The review is on opportunities and possibilities of application of photodynamic therapy in clinical practice. The advantages of this method are the targeting of effect on tumor foci and high efficiency along with low systemic toxicity. The results of the set of recent Russian and foreign clinical trials are represented in the review. The method is successfully used in clinical practice with both radical (for early vulvar, cervical cancer and pre-cancer, central early lung cancer, esophageal and gastric cancer, bladder cancer and other types of malignant tumors, and palliative care (including tumor pleuritis, gastrointestinal tumors and others. Photodynamic therapy delivers results which are not available for other methods of cancer therapy. Thus, photodynamic therapy allows to avoid gross scars (that is very important, for example, in gynecology for treatment of patients of reproductive age with cervical and vulvar cancer, delivers good cosmetic effect for skin tumors, allows minimal trauma for intact tissue surrounding tumor. Photodynamic therapy is also used in other fields of medicine, such as otorhinolaryngology, dermatology, ophthalmology, orthopaedics, for treatment of papilloma virus infection and purulent wounds as antibacterial therapy.

Film Music: The Material, Literature and Present State of Research.

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Marks, Martin

1982-01-01

A comprehensive look at the neglected art of film music. Examines the nature of the medium, the literature (how others have wrestled with film music's recalcitrant materials), and the present state of research into film music. Includes a bibliography. (PD)

Lateral subtalar dislocation : Case report and review of the literature

NARCIS (Netherlands)

Veltman, Ewout S; Steller, Ernst Ja; Wittich, Philippe; Keizer, Jort

2016-01-01

A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis

Law and Literature: a theoretical perspective

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Lorenzo Zolezzi Ibárcena

2013-12-01

Full Text Available While most of the Law and Literature books and articles stress from the beginning the distinction between Law in Literature and Law as Literature, my approach is from the standpoint of Law teaching. A course on Law and Literature will help the students not only to write better, but it may convey the students facts that surround the work of the formal legal systemas the human condition or the legal culture, as well as a legal perspective thatis, so to speak, engraved in the human mind. The so-called didactic school is treated and criticized. The distinction between Law in Literature and Law as Literature cuts across the whole work.

Critical appraisal of published literature

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Umesh, Goneppanavar; Karippacheril, John George; Magazine, Rahul

2016-01-01

With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader's work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice. PMID:27729695

Critical appraisal of published literature

Directory of Open Access Journals (Sweden)

Goneppanavar Umesh

2016-01-01

Full Text Available With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader′s work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.

Literature promotion in Public Libraries

DEFF Research Database (Denmark)

Kann-Christensen, Nanna; Balling, Gitte

2011-01-01

This article discusses a model that can be used in order to analyse notions on literature promotion in public libraries. The model integrates different issues which interact with how literature promotion is understood and thought of in public libraries. Besides cultural policy we regard the logics...... of new public management (NPM) and professional logics in the field of public libraries. Cultural policy along with the identification of underlying logics present among politicians, government officials, managers and librarians/promoters of literature, play an important part in creating an understanding...... of literature promotion in Danish libraries. Thus the basic premise for the development of the model is that cultural policy (Policy) has an important influence on notions on literature promotion and other activities in public libraries, but that cultural policy must be seen in some kind of interaction...

Effective pedagogies for teaching math to nursing students: a literature review.

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Hunter Revell, Susan M; McCurry, Mary K

2013-11-01

Improving mathematical competency and problem-solving skills in undergraduate nursing students has been an enduring challenge for nurse educators. A number of teaching strategies have been used to address this problem with varying degrees of success. This paper discusses a literature review which examined undergraduate nursing student challenges to learning math, methods used to teach math and problem-solving skills, and the use of innovative pedagogies for teaching. The literature was searched using the Cumulative Index of Nursing and Allied Health Literature and Education Resource Information Center databases. Key search terms included: math*, nurs*, nursing student, calculation, technology, medication administration, challenges, problem-solving, personal response system, clickers, computer and multi-media. Studies included in the review were published in English from 1990 to 2011. Results support four major themes which include: student challenges to learning, traditional pedagogies, curriculum strategies, and technology and integrative methods as pedagogy. The review concludes that there is a need for more innovative pedagogical strategies for teaching math to student nurses. Nurse educators in particular play a central role in helping students learn the conceptual basis, as well as practical hands-on methods, to problem solving and math competency. It is recommended that an integrated approach inclusive of technology will benefit students through better performance, increased understanding, and improved student satisfaction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Clinical leadership and nursing explored: A literature search.

Science.gov (United States)

Stanley, David; Stanley, Karen

2017-10-27

To explore what we know of the concept of clinical leadership and what the term means. Clues to the definition of clinical leadership, the attributes of effective and less effective clinical leaders, models of clinical leadership and the barriers that hinder clinical leadership development were explored. While nursing leadership and healthcare leadership are terms that have been evident in nursing and health industry literature for many decades, clinical leadership is a relatively new term and is may still be misunderstood. A search was undertaken of formal and informal literature using a library database and a range of search engines for the words "clinical leadership" and "clinical leadership in nursing." In each case, the full search parameters were employed with searches between 1974-2016. Full-text articles were requested, and English was the preferred language. In total, 3,259 publications were located through seven database search tools, although these included a large number of duplications. Following further informal searches and removing irrelevant material, 27 research or literature review focused papers were retained that included 17 qualitative studies, one quantitative study, one mixed method study, one Delphi study and two that compared other research studies. As well, five literature reviews were retained in the synthesis. The data synthesis resulted five categories: definitions of clinical leadership, characteristics most likely or least associated with clinical leadership, models applied to clinical leadership and limits to clinical leadership development. Clinical leaders are recognised for having their values and beliefs parallel their actions and interventions. They are found across the spectrum of health organisations, often at the highest level for clinical interaction, but not commonly at the highest management level in a ward or unit team and they are seen in all clinical environments. Clinical Leadership and an understanding on how

A retrospective of the GREGOR solar telescope in scientific literature

Science.gov (United States)

Denker, C.; von der Lühe, O.; Feller, A.; Arlt, K.; Balthasar, H.; Bauer, S.-M.; Bello González, N.; Berkefeld, Th.; Caligari, P.; Collados, M.; Fischer, A.; Granzer, T.; Hahn, T.; Halbgewachs, C.; Heidecke, F.; Hofmann, A.; Kentischer, T.; Klva{ňa, M.; Kneer, F.; Lagg, A.; Nicklas, H.; Popow, E.; Puschmann, K. G.; Rendtel, J.; Schmidt, D.; Schmidt, W.; Sobotka, M.; Solanki, S. K.; Soltau, D.; Staude, J.; Strassmeier, K. G.; Volkmer, R.; Waldmann, T.; Wiehr, E.; Wittmann, A. D.; Woche, M.

2012-11-01

In this review, we look back upon the literature, which had the GREGOR solar telescope project as its subject including science cases, telescope subsystems, and post-focus instruments. The articles date back to the year 2000, when the initial concepts for a new solar telescope on Tenerife were first presented at scientific meetings. This comprehensive bibliography contains literature until the year 2012, i.e., the final stages of commissioning and science verification. Taking stock of the various publications in peer-reviewed journals and conference proceedings also provides the ``historical'' context for the reference articles in this special issue of Astronomische Nachrichten/Astronomical Notes.

Towards pervasive computing in health care - a literature review.

Science.gov (United States)

Orwat, Carsten; Graefe, Andreas; Faulwasser, Timm

2008-06-19

The evolving concepts of pervasive computing, ubiquitous computing and ambient intelligence are increasingly influencing health care and medicine. Summarizing published research, this literature review provides an overview of recent developments and implementations of pervasive computing systems in health care. It also highlights some of the experiences reported in deployment processes. There is no clear definition of pervasive computing in the current literature. Thus specific inclusion criteria for selecting articles about relevant systems were developed. Searches were conducted in four scientific databases alongside manual journal searches for the period of 2002 to 2006. Articles included present prototypes, case studies and pilot studies, clinical trials and systems that are already in routine use. The searches identified 69 articles describing 67 different systems. In a quantitative analysis, these systems were categorized into project status, health care settings, user groups, improvement aims, and systems features (i.e., component types, data gathering, data transmission, systems functions). The focus is on the types of systems implemented, their frequency of occurrence and their characteristics. Qualitative analyses were performed of deployment issues, such as organizational and personnel issues, privacy and security issues, and financial issues. This paper provides a comprehensive access to the literature of the emerging field by addressing specific topics of application settings, systems features, and deployment experiences. Both an overview and an analysis of the literature on a broad and heterogeneous range of systems are provided. Most systems are described in their prototype stages. Deployment issues, such as implications on organization or personnel, privacy concerns, or financial issues are mentioned rarely, though their solution is regarded as decisive in transferring promising systems to a stage of regular operation. There is a need for further

Orthodontic treatment in periodontitis‐susceptible subjects: a systematic literature review

Science.gov (United States)

Lindsten, Rune; Slotte, Christer; Bjerklin, Krister

2016-01-01

Abstract The aim is to evaluate the literature for clinical scientific data on possible effects of orthodontic treatment on periodontal status in periodontitis‐susceptible subjects. A systematic literature review was performed on studies in English using PubMed, MEDLINE, and Cochrane Library central databases (1965‐2014). By manually searching reference lists of selected studies, we identified additional articles; then we searched these publications: Journal of Periodontology, Periodontology 2000, Journal of Clinical Periodontology, American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, International Journal of Periodontics & Restorative Dentistry, and European Journal of Orthodontics. Search terms included randomized clinical trials, controlled clinical trials, prospective and retrospective clinical studies, case series >5 patients, periodontitis, orthodontics, alveolar bone loss, tooth migration, tooth movement, orthodontic extrusion, and orthodontic intrusion. Only studies on orthodontic treatment in periodontally compromised dentitions were included. One randomized controlled clinical trial, one controlled clinical trial, and 12 clinical studies were included. No evidence currently exists from controlled studies and randomized controlled clinical trials, which shows that orthodontic treatment improves or aggravates the status of periodontally compromised dentitions. PMID:29744163

Heat Transfer and Pressure Drop with Rough Surfaces, a Literature Survey

Energy Technology Data Exchange (ETDEWEB)

Bhattacharyya, A

1964-05-15

This literature survey deals with changes in heat transfer coefficient and friction factor with varying nature and degree of roughness. Experimental data cover mainly the turbulent flow region for both air and water as flow mediums. Semiempirical analysis about changes in heat transfer coefficient due to roughness has been included. An example of how to use these data to design a heat exchanger surface is also cited. The extreme case of large fins has not been considered. Available literature between 1933 - 1963 has been covered.

New Interpretations of Native American Literature: A Survival Technique.

Science.gov (United States)

Buller, Galen

1980-01-01

Uses examples from the work of several Native American authors, including N. Scott Momaday and Leslie Silko, to discuss five unique elements in American Indian literature: reverence for words, dependence on a sense of place, sense of ritual, affirmation of the need for community, and a significantly different world view. (SB)

A Literature Review of Academic Library Web Page Studies

Science.gov (United States)

Blummer, Barbara

2007-01-01

In the early 1990s, numerous academic libraries adopted the web as a communication tool with users. The literature on academic library websites includes research on both design and navigation. Early studies typically focused on design characteristics, since websites initially merely provided information on the services and collections available in…

Borehole sealing literature review of performance requirements and materials

International Nuclear Information System (INIS)

Piccinin, D.; Hooton, R.D.

1985-02-01

To ensure the safe disposal of nuclear wastes, all potential pathways for radionuclide release to the biosphere must be effectively sealed. This report presents a summary of the literature up to August 1982 and outlines the placement, mechanical property and durability-stability requirements for borehole sealing. An outline of the materials that have been considered for possible use in borehole sealing is also included. Cement grouts are recommended for further study since it is indicated in the literature that cement grouts offer the best opportunity of effectively sealing boreholes employing present technology. However, new and less well known materials should also be researched to ensure that the best possible borehole plugging system is developed. 78 refs

Multicultural Literature as a Classroom Tool

Science.gov (United States)

Osorio, Sandra L.

2018-01-01

Multicultural literature can be found all across classrooms in the United States. I argue it is more important what you do with the literature than just having it in the classroom. Multicultural literature should be seen as a tool. In this article, I will share how I used multicultural literature as a tool to (a) promote or develop an appreciation…

Brasilian Literature: dependence and liberation

Directory of Open Access Journals (Sweden)

Célio Antonio Sardagna

2015-07-01

Full Text Available This research discusses aspects related to Brazilian Literature, in its trajetory between a production that followed the models dictated by Europe and its quest for independence to the extent that the authors sought autonomy, appropriating the national reality as inspiration. In this way, we try to understand this search for autonomy by the concept of in-between, developed by Silviano Santiago, in the seventies. For a long time, Brazilian Literature - as well as other Latin American literature themselves - were considered inferior, because of this marginalized, whereas European literature was considered superior. The independence shout of Brazilian Literature in relation to Europe took place with the advent of Modernism, which saw in reality and Brazilian language the source of artistic and literary expression. Since then, conceiving the national element as a source, the Brazilian literary expression takes its place, tracing its destination.

Impact of comorbidity and healthcare utilization on colorectal cancer stage at diagnosis: literature review

Science.gov (United States)

Corkum, Mark; Urquhart, Robin; Burge, Fred; Porter, Geoffrey; Johnston, Grace

2013-01-01

Purpose Individuals diagnosed with cancer close to death have low access to enrollment in palliative care programs. The purpose of this literature review was to assess the usefulness of pre-diagnostic comorbidity and healthcare utilization as indicators of late-stage colorectal cancer (CRC) diagnosis, to help with early identification of individuals who may benefit from palliative care. Methods A literature search was conducted in relevant databases using title/abstract terms which included “cancer,” “stage,” “diagnosis,” “determinants,” “predictors,” and “associated.” Included studies examined whether comorbidity and/or healthcare utilization had an impact on the stage at which CRC was diagnosed. A standardized data abstraction form was used to assess the eligibility of each study. Thirteen articles were included in the literature review. These studies were assessed and synthesized using qualitative methodology. Results We found much heterogeneity among study variables. The findings of this literature review point to the presence of comorbidity and non-emergent healthcare utilization as having no association with late-stage diagnosis. Conversely, emergency room presentation (ERP) was associated with late-stage diagnosis. Conclusions The results of this literature review did not find strong evidence to suggest that comorbidity and healthcare utilization are potential indicators of late-stage diagnosis. However, ERP may be useful as a flag for consideration of prompt referral to palliative care. Additional research is required to identify potential indicators of late-stage diagnosis that may be available in administrative databases, particularly in the area of healthcare utilization. PMID:22101505

Spontaneous regression of metastases from melanoma: review of the literature

DEFF Research Database (Denmark)

Kalialis, Louise Vennegaard; Drzewiecki, Krzysztof T; Klyver, Helle

2009-01-01

Regression of metastatic melanoma is a rare event, and review of the literature reveals a total of 76 reported cases since 1866. The proposed mechanisms include immunologic, endocrine, inflammatory and metastatic tumour nutritional factors. We conclude from this review that although the precise...

Attracting and maintaining the Y Generation in nursing: a literature review.

Science.gov (United States)

Hutchinson, Dianne; Brown, Janie; Longworth, Karen

2012-05-01

This paper explores the literature related to attracting the Y Generation (Y Gen: people born between 1980 and 2000) to the nursing profession and retaining them in our current workforce. A comprehensive review of the literature supported the need for further research. Three searches were conducted and all relevant literature was reviewed by each researcher. Literature included in the review was chosen based on specific search-term inclusion. Structured searches were conducted with no limitations on publication type, date or language. Search engines used included: Australian Family and Society, CINAHL, Expanded Academic, Google Scholar, Medline, ProQuest and PubMed. A critical review of the literature, particularly empirical work on the subject has informed decision making regarding the research questions that remain to be explored. The literature revealed that the Y Gen is currently contributing to the nursing workforce demographics. Much discussion exists surrounding the integration of the Y Gen into the workplace along with the other three generations of nurses. There is also an abundance of descriptions of the Y Gen characteristics and values. There is, however, limited reference relating to what attracted this generation to nursing or what might retain them in the nursing workforce. The Y Gen is the largest generation to enter our workforce since the Baby Boomers. Health services need to recognize the needs of the Y Gen nurses and develop strategies to move the profession forward by preparing the current workforce and environment for a generation that is already here. The focus should be on their strengths with development made to structure a workforce that will support the Y Gen in their professional nursing role. Understanding what attracts the Y Gen to nursing, what managers can do to retain the Y Gen in nursing and how the nursing profession can support the Y Gen to assume a role in nursing and nursing governance will ensure that the retiring generation

Non-deployment factors affecting psychological wellbeing in military personnel: literature review.

Science.gov (United States)

Brooks, Samantha K; Greenberg, Neil

2018-02-01

Most military mental health research focuses on the impact of deployment-related stress; less is known about how everyday work-related factors affect wellbeing. This systematic narrative literature review aimed to identify non-deployment-related factors contributing to the wellbeing of military personnel. Electronic literature databases were searched and the findings of relevant studies were used to explore non-deployment-related risk and resilience factors. Fifty publications met the inclusion criteria. Determinants of non-deployment stress were identified as: relationships with others (including leadership/supervisory support; social support/cohesion; harassment/discrimination) and role-related stressors (role conflict; commitment and effort-reward imbalance; work overload/job demands; family-related issues/work-life balance; and other factors including control/autonomy, physical work environment and financial strain). Factors positively impacting wellbeing (such as exercise) were also identified. The literature suggests that non-deployment stressors present a significant occupational health hazard in routine military environments and interpersonal relationships at work are of fundamental importance. Findings suggest that in order to protect the wellbeing of personnel and improve performance, military organisations should prioritise strengthening relationships between employees and their supervisors/colleagues. Recommendations for addressing these stressors in British military personnel were developed.

GreyGuide - Guide to Good Practice in Grey Literature: A Community Driven Open Resource Project

OpenAIRE

Biagioni, Stefania (ISTI-CNR); Carlesi, Carlo (ISTI-CNR); Schopfel, Joachim (University of Lille); Farace, Dominic J. (GreyNet); Frantzen, Jerry (GreyNet); GreyNet, Grey Literature Network Service

2014-01-01

The goal of this project is to develop an open source repository of good practices in the field of grey literature. That which originated in monographic form will now open and expand to include content from the global grey literature community. Such practices will range from the production and processing of grey literature through to its distribution, uses, and preservation. The repository will contain guidelines such as those in handling theses and dissertations, how to write research report...

Literature information in PubChem: associations between PubChem records and scientific articles.

Science.gov (United States)

Kim, Sunghwan; Thiessen, Paul A; Cheng, Tiejun; Yu, Bo; Shoemaker, Benjamin A; Wang, Jiyao; Bolton, Evan E; Wang, Yanli; Bryant, Stephen H

2016-01-01

PubChem is an open archive consisting of a set of three primary public databases (BioAssay, Compound, and Substance). It contains information on a broad range of chemical entities, including small molecules, lipids, carbohydrates, and (chemically modified) amino acid and nucleic acid sequences (including siRNA and miRNA). Currently (as of Nov. 2015), PubChem contains more than 150 million depositor-provided chemical substance descriptions, 60 million unique chemical structures, and 225 million biological activity test results provided from over 1 million biological assay records. Many PubChem records (substances, compounds, and assays) include depositor-provided cross-references to scientific articles in PubMed. Some PubChem contributors provide bioactivity data extracted from scientific articles. Literature-derived bioactivity data complement high-throughput screening (HTS) data from the concluded NIH Molecular Libraries Program and other HTS projects. Some journals provide PubChem with information on chemicals that appear in their newly published articles, enabling concurrent publication of scientific articles in journals and associated data in public databases. In addition, PubChem links records to PubMed articles indexed with the Medical Subject Heading (MeSH) controlled vocabulary thesaurus. Literature information, both provided by depositors and derived from MeSH annotations, can be accessed using PubChem's web interfaces, enabling users to explore information available in literature related to PubChem records beyond typical web search results. Graphical abstractLiterature information for PubChem records is derived from various sources.

Quality Assurance in Higher Education: A Review of Literature

Science.gov (United States)

Ryan, Tricia

2015-01-01

This paper examines the literature surrounding quality assurance in global higher education. It provides an overview of accreditation as a mechanism to ensure quality in higher education, examines models of QA, and explores the concept of quality (including definitions of quality and quality assurance). In addition, this paper provides a review of…

Current status and a short history of grey literature. Focusing on the international conference on grey literature

International Nuclear Information System (INIS)

Ikeda, Kiyoshi

2010-01-01

'Grey literature' is a loosely defined term whose application is rather complex, but it is also an important source of information for academic researchers. Today, the spread of the Internet has led to changes not only in the circulation but also in the role and definition of 'grey literature'. This article therefore presents a short history of the definition of 'grey literature', with central focus on topics discussed by the International Conference on Grey Literature. After this, the current status and future prospects of 'grey literature' in the digital society are described. Finally, the article introduces the JAEA Library's activities on 'grey literature', particularly the acquisition of proceedings and the editing and dissemination of the JAEA Reports (technical reports of JAEA). (author)

The 'New' World Literature: A Review Essay

Directory of Open Access Journals (Sweden)

Russell McDougall

2014-05-01

Full Text Available Works discussed: Theo D'haen, The Routledge Concise History of World Literature (Routledge, 2011; Theo D'haen, David Damrosch & Djelal Kadir, eds. The Routledge Companion to World Literature (Routledge, 2011; Theo D'haen, Cesar Dominguez & Mads Rosendahl Thomsen eds., World Literature: A Reader (Routledge, 2012; Elke Sturm-Trigonakis, Comparative Cultural Studies and the New Weltliteratur (Purdue University Press, 2013; Emily Apter, Against World Literature: On the Politics of Untranslatability (Verso, 2013; Robert Dixon and Bridget Rooney, Scenes of Reading. Is Australian Literature a World Literature? (Australian Scholarly Publishing, 2013; David Damrosch. ed. World Literature in Theory (Wiley-Blackwell, 2014

DSHEA's third-party literature exemption; mail order sales, direct marketing, and Internet use.

Science.gov (United States)

Raubicheck, C J

1999-01-01

This article examines ways in which marketers of dietary supplements can make use of the "third-party literature" section of the Dietary Supplement Health and Education Act of 1994 (DSHEA). This provision permits persons or entities, other than manufacturers or distributors, to distribute to consumers certain publications in connection with the sale of particular supplements. These publications may include statements about the therapeutic benefits of such products without subjecting the products to regulation by the Food and Drug Administration (FDA) as unapproved new drugs. Specifically, this article addresses the following: Can a dietary supplement manufacturer or distributor send third-party literature about a dietary supplement to a customer in a mail order sales transaction? Can third-party literature be disseminated by mail with dietary supplement catalogues only? Can third-party literature be disseminated by sales representatives engaged in direct marketing of dietary supplements? Can third-party literature appear on the Internet? The answer appears to be affirmative in each of these situations.

Gastric cancer screening, literature review

International Nuclear Information System (INIS)

Porras Alfaro, Erika

2014-01-01

A comprehensive literature review was made of the methods of screening (pepsinogen test, gastrin-17, anti HP, SGD and Endoscopy). The review and descriptive study of the scientific literature related to the subject was conducted in the scientific databases: Pud Med, MD Consult and Medscape, from August 2013 to March 2014. 65 articles were found related to the topic. The review has included 47 items, assigned according to the criteria of inclusion and exclusion. Available methods were defined of high cost, difficult to spread, little sensitive, little specific and invasive. Endoscopy has had limitations of cost, quality, morbidity, mortality and availability. Pepsinogen tests and helicobacter pylori have helped identify the population at risk for later sift with endoscopy; but it is a very sensitive method. Endoscopy is recommended every two years in the population at risk (patients between 50 and 70 years with a family history of gastric cancer, chronic atrophic gastritis, Helicobacter pylori infection, intestinal metaplasia and dysplasia, patients with symptomatology of dyspepsia and with positive pepsinogen test) is a higher method than SGD in cost, sensitivity and specificity similar to invasive level. The training of the endoscopists should be strengthened in early gastric cancer detection since the detection depends on the quality of endoscopy [es

Quantum chemistry literature data base

International Nuclear Information System (INIS)

Ohno, Kimio; Morokuma, Keiji

1982-01-01

Ab initio computations of atomic and molecular electronic structure now appear in so many journals that it is very difficult for interested scientistics to locate proper and comprehensive references. This book is designed to help them and contains more than 2500 references to the literature published in the years 1978-1980. These have been gathered from nineteen well-known international core journals by quantum chemists themselves and the result is a thorough bibliography. Each entry is a full reference consisting of the following items: (1) authors, (2) journal name, volume, page and year, (3) compounds, (4) methods of calculation, (5) basis sets, (6) calculated properties, and (7) comments. For easy access to the references, the reader can consult the compound and author indexes. A short article on the reliability of ab initio calculations is included as an appendix; this gives a rough idea about the accuracy of the calculated results reported. As the book has been complied using the resources of a computer data base of quantum chemistry literature, it is particularly up to date and the authors will be able to provide supplements regularly. This bibliography will be an asset to large departments of chemistry and all university libraries. (orig.)

Gender discrimination and nursing: α literature review.

Science.gov (United States)

Kouta, Christiana; Kaite, Charis P

2011-01-01

This article aims to examine gender stereotypes in relation to men in nursing, discuss gender discrimination cases in nursing, and explore methods used for promoting equal educational opportunities during nursing studies. The literature review was based on related databases, such as CINAHL, Science Direct, MEDLINE, and EBSCO. Legal case studies are included in order to provide a more practical example of those barriers existing for men pursuing nursing, as well as statistical data concerning gender discrimination and male attrition to nursing schools in relation to those barriers. These strengthen the validity of the manuscript. Literature review showed that gender discrimination is still prevalent within nursing profession. Nursing faculty should prepare male nursing students to interact effectively with female clients as well. Role modeling the therapeutic relationship with clients is one strategy that may help male students. In general, the faculty should provide equal learning opportunities to nursing students. Copyright © 2011 Elsevier Inc. All rights reserved.

Special Collections of Children's Literature: A Justification for Their Support.

Science.gov (United States)

Whitney, Ellen

1986-01-01

Describes the various purposes of special collections of children's literature including their value to historians, sociologists, psychologists, artists and authors, their reference purposes, and their value in preserving regional artistic and literary heritages. A bibliography of journal articles, pamphlets, and brochures listed by state is…

A guide to experimental elementary particle physics literature, 1985--1989

International Nuclear Information System (INIS)

Alekhin, S.I.; Bazeeva, V.V.; Ezhela, V.V.; Filimonov, B.B.; Lugovsky, S.B.; Nikolaev, A.S.; Petrova, N.L.; Slabospitsky, S.R.; Striganov, S.I.; Stroganov, Y.G.; Shelkovenko, A.N.; Yuschenko, O.P.

1990-11-01

We present an indexed guide to experimental high energy physics literature for the years 1985--1989. No actual data are given, but approximately 3500 papers are indexed by Beam/Target/Momentum, Reaction/Momentum (including the final stare), Final State Particle, and Accelerator/Experiment/ Detector

Partnerships panel: natural, resource partnerships: literature synthesis and research agenda

Science.gov (United States)

Steve Selin; Nancy Myers

1995-01-01

This paper presents a summary of an annotated bibliography on natural resource partnerships. Resource areas and management functions addressed in the partnership literature are examined. Partnership research is summarized and broken into categories including: Partnership outcomes, assessing the potential for partnerships, characteristics of successful partnerships,...

Automatic target validation based on neuroscientific literature mining for tractography

Directory of Open Access Journals (Sweden)

Xavier eVasques

2015-05-01

Full Text Available Target identification for tractography studies requires solid anatomical knowledge validated by an extensive literature review across species for each seed structure to be studied. Manual literature review to identify targets for a given seed region is tedious and potentially subjective. Therefore, complementary approaches would be useful. We propose to use text-mining models to automatically suggest potential targets from the neuroscientific literature, full-text articles and abstracts, so that they can be used for anatomical connection studies and more specifically for tractography. We applied text-mining models to three structures: two well studied structures, since validated deep brain stimulation targets, the internal globus pallidus and the subthalamic nucleus and, the nucleus accumbens, an exploratory target for treating psychiatric disorders. We performed a systematic review of the literature to document the projections of the three selected structures and compared it with the targets proposed by text-mining models, both in rat and primate (including human. We ran probabilistic tractography on the nucleus accumbens and compared the output with the results of the text-mining models and literature review. Overall, text-mining the literature could find three times as many targets as two man-weeks of curation could. The overall efficiency of the text-mining against literature review in our study was 98% recall (at 36% precision, meaning that over all the targets for the three selected seeds, only one target has been missed by text-mining. We demonstrate that connectivity for a structure of interest can be extracted from a very large amount of publications and abstracts. We believe this tool will be useful in helping the neuroscience community to facilitate connectivity studies of particular brain regions. The text mining tools used for the study are part of the HBP Neuroinformatics Platform, publicly available at http://connectivity-brainer.rhcloud.com/.

An Initial Look at the Quality of Life of Malaysian Families That Include Children with Disabilities

Science.gov (United States)

Clark, M.; Brown, R.; Karrapaya, R.

2012-01-01

Background: While there is a growing body of literature in the quality of life of families that include children with disabilities, the majority of research has been conducted in western countries. The present study provides an initial exploration of the quality of life of Malaysian families that include children with developmental/intellectual…

17 CFR 270.34b-1 - Sales literature deemed to be misleading.

Science.gov (United States)

2010-04-01

... includes the information specified in paragraphs (a) and (b) of this section. Note to introductory text of..., illustrations, and descriptions contained in investment company sales literature are misleading, see § 230.156... adjusted to reflect the effect of taxes (not including a quotation of tax equivalent yield or other similar...

Effectiveness of palliative care including physiotherapy in hiv patients a review of the literature

Directory of Open Access Journals (Sweden)

J. Uwimana

2007-01-01

(UNAIDS 2004.  The HIV/AIDS epidemic is devastating the African continent.In Africa poorly resourced health care infrastructure further impairs the quality of life in HIV sufferers. Palliative care is an approach that aims to improve the quality of life of people living with threatening diseases such as cancer and HIV/AIDS. This review aimed to determine the efficacy of palliative care. Complementary therapies such as Cognitive Behavioural Therapy, peer/counselling group therapy, massage  therapy, and exercise therapy constitute palliative care. Seventeen articles published in peer reviewed journals during the period 1990-2005 were reviewed. The findings of our review demonstrate that there are indications that palliative care can be effective in improving the quality of life in patients with life threatening diseases such HIV/AIDS. Research in this field is complicated by the heterogeneity of study samples, difficulty in patient recruitment, and death before the end of the intervention period. Future research in this area should aim to include larger study samples, using valid tools to assess quality of life and to employ qualitative methods in studies to assess the effectiveness of palliative care.

Why teach literature and medicine? Answers from three decades.

Science.gov (United States)

Jones, Anne Hudson

2013-12-01

In this essay, I look back at some of the earliest attempts by the first generation of literature-and-medicine scholars to answer the question: Why teach literature and medicine? Reviewing the development of the field in its early years, I examine statements by practitioners to see whether their answers have held up over time and to consider how the rationales they articulated have expanded or changed in the following years and why. Greater emphasis on literary criticism, narrative ethics, narrative theory, and reflective writing has influenced current work in the field in ways that could not have been foreseen in the 1970s. The extraordinary growth of interest and work in the field nationally and, especially since 1996, internationally has included practitioners in many additional areas such as disability studies, film studies, therapeutic writing, and trauma studies. Along with the emergence of narrative medicine, this diverse community of scholars and practitioners-affiliated more through their use of narrative methodologies than the teaching of literature-makes the perennial challenge of evaluation and assessment even more complicated.

Locked doors in acute inpatient psychiatry: a literature review.

Science.gov (United States)

van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K

2009-04-01

Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry.

Challenges of Access to Literature and Attitude among Postgraduate ...

African Journals Online (AJOL)

The uptake of modern technology in learning and teaching including e-learning and Open Educational Resources are still out of reach by many learners and lecturers alike. Distance learners are also faced with time constraints as they work, and many of them are very far from any access to literature. This study aimed at ...

Home care in Europe: a systematic literature review

Science.gov (United States)

2011-01-01

Background Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. Results Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the

Testicular microlithiasis and testicular cancer: review of the literature.

Science.gov (United States)

Pedersen, Malene Roland; Rafaelsen, Søren Rafael; Møller, Henrik; Vedsted, Peter; Osther, Palle Jörn

2016-07-01

To perform a systematic literature review to assess whether the occurrence of testicular microlithiasis (TML) in conjunction with other risk factors is associated with testicular cancer. A systematic literature search was performed of original articles in English published 1998 to 2015. Relevant studies were selected by reading the title and abstract by two of the authors. Studies were included if TML was diagnosed by ultrasonography and a risk condition was reported. Studies were only eligible if the particular risk condition was reported in more than one article. In total, 282 abstracts in were identified. Based on title and abstract the eligibility was assessed and 31 studies were included. Five conditions in relation to TML and testicular cancer emerged: Down syndrome, McCune-Albright syndrome, cryptorchidism, infertility and familial disposition of testicular cancer. Data support the conclusion that TML is not an independent risk factor for testicular cancer but associated with testicular cancer through other conditions. In male infertility, TML appears to be related to an increased risk of testicular cancer possibly as part of a testicular dysgenesis syndrome.

A literature review of safety culture.

Energy Technology Data Exchange (ETDEWEB)

Cole, Kerstan Suzanne; Stevens-Adams, Susan Marie; Wenner, Caren A.

2013-03-01

Workplace safety has been historically neglected by organizations in order to enhance profitability. Over the past 30 years, safety concerns and attention to safety have increased due to a series of disastrous events occurring across many different industries (e.g., Chernobyl, Upper Big-Branch Mine, Davis-Besse etc.). Many organizations have focused on promoting a healthy safety culture as a way to understand past incidents, and to prevent future disasters. There is an extensive academic literature devoted to safety culture, and the Department of Energy has also published a significant number of documents related to safety culture. The purpose of the current endeavor was to conduct a review of the safety culture literature in order to understand definitions, methodologies, models, and successful interventions for improving safety culture. After reviewing the literature, we observed four emerging themes. First, it was apparent that although safety culture is a valuable construct, it has some inherent weaknesses. For example, there is no common definition of safety culture and no standard way for assessing the construct. Second, it is apparent that researchers know how to measure particular components of safety culture, with specific focus on individual and organizational factors. Such existing methodologies can be leveraged for future assessments. Third, based on the published literature, the relationship between safety culture and performance is tenuous at best. There are few empirical studies that examine the relationship between safety culture and safety performance metrics. Further, most of these studies do not include a description of the implementation of interventions to improve safety culture, or do not measure the effect of these interventions on safety culture or performance. Fourth, safety culture is best viewed as a dynamic, multi-faceted overall system composed of individual, engineered and organizational models. By addressing all three components of

Pruritus in Female Patients

Directory of Open Access Journals (Sweden)

Julien Lambert

2014-01-01

Full Text Available Pruritus is a frequent symptom in many dermatological diseases. In this review we want to focus on not only itch problems specific to women, namely, pruritic vulvodermatoses, but also the specific pruritic dermatoses of pregnancy. The specific characteristics of the vulva and the hormonal changes during the different age periods make these dermatoses very particular. It seems that vulvar diseases are still underdiagnosed and undertreated. Pruritic vulvar diseases have a huge impact on quality of life. The most common pruritic diseases will be discussed, such as atopic and contact dermatitis, psoriasis, lichen sclerosis, lichen planus, and infectious vulvaginitis. We focus on the diagnostic issue of these diseases and will consider the general principles of therapy.