PURPOSE:To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2%). Reoperation rate was 9.6%. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome
trials was conducted to evaluate efficacy and safety of using Absorb BVS system for patients with STEMI. Taking into account the hypothesis of superior effectiveness of Absorb BVS system for patients with STEMI for pharmacoeconomic analysis was chosen "cost-effectiveness" analysis. MS Excel based model was performed to asses 2 strategies: strategy 1-patients with primary percutaneous coronary intervention (PPCI) with Absorb BVS system; strategy 2-patients received thrombolytic therapy in the hospital. The 1 LYG and 1 surviving patient were included into the model as the effectiveness criteria. Direct costs included emergency, inpatient and outpatient treatment, rehabilitation and cost of PPCI with Absorb BVS system. All the direct costs were calculated from the Russian healthcare system perspective. Results: According to published trials the using of Absorb BVS system for patients with STEMI did not lead to different rates of composite patient-oriented and device-oriented adverse events. Strategy 1 has a higher efficiency-the proportion of survivors at 1 year will be the maximum-92.7%, as well as the LYG-5.4.
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