ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Six patients treated with leuprolide acetate for rapid uterine growth caused by presumptive uterine fibroids were found to have malignancy during subsequent laparotomy. Two patients had endometrial stromal sarcoma; three had leiomyosarcoma; and one had a cervical lymphoma. Five of the six patients had significant reduction in fibroid size before laparotomy and most had improvement in bleeding. Five of the six had an endometrial sampling done before treatment and most had an office-based sonography only. Three patients had an intraoperative frozen section. Appropriate pretreatment evaluation of patients with rapid uterine growth before leuprolide acetate therapy must include an endometrial biopsy and accurate uterine sonography.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveThe objectives of this study were to compare laparoscopic assisted vaginal hysterectomies performed in a residency training program, where training is relatively structured and consistent, with laparoscopic assisted vaginal hysterectomies performed in a private institution, where training is largely accomplished through continuing education courses; to compare complications and their rate of occurrence at the two institutions; and to examine data to identify the existence of a “learning curve.”Study DesignA retrospective chart review of 128 patients on whom laparoscopic assisted vaginal hysterectomies were performed between July 1991, and June 1995, was undertaken at two institutions to examine complications and their rate of occurrence. Data, which included patient age, parity, preoperative diagnosis, disease, estimated blood loss, operative time and complications, and surgical technique, were reviewed on all laparoscopic assisted vaginal hysterectomies performed at a university-based training program and a large private community hospital.ResultsPatient demographics at the two institutions were similar. There were 50 minor complications that occurred at institution A and 66 that occurred at institution B. There was little difference in the incidence of the complications, with the exception of postoperative febrile morbidity and urinary tract infections, which occurred at a higher rate. A higher incidence of complications, particularly major complications, occurred at institution B, particularly in patients who underwent a stage 4 or 5 laporascopic assisted vaginal hysterectomy as noted by John's and Diamond's classification.ConclusionsThe training and credentialing of physicians in private practice, where a majority of laporascopic assisted vaginal hysterectomies are performed, has raised concern. Insufficient numbers of are laparoscopic assisted vaginal hysterectomies are performed by most surgeons for them to become proficient and perform the surgery safely. There was also an apparent decrease in complications in patients who underwent laparoscopic assisted vaginal hysterectomies in which the laparoscopic portion was halted at the level of the bladder flap.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectivesThis article determines whether an oophorectomy, when performed during vaginal hysterectomy, increases perioperative morbidity compared with a vaginal hysterectomy without oophorectomy.MethodsThe records of 1026 patients who had undergone vaginal hysterectomy, with or without vaginal oophorectomy, were reviewed.ResultsA total of 490 women underwent attempted vaginal oophorectomy. The removal of one or both ovaries was accomplished in 440 patients (90%). The removal of both ovaries was possible in 410 patients (84%). The vaginal removal of only one ovary when the removal of two ovaries was attempted was accomplished in 30 patients (6%). The mean additional time necessary for vaginal ovarian removal was 11.4 minutes. Although there was an increase in the mean change in hemoglobin (preoperative minus postoperative) associated with attempted vaginal oophorectomy (2.2 versus 1.9,P= 0.004), no statistically significant association was identified when change in hemoglobin was stratified for concurrent procedures or when successful and unsuccessful oophorectomy attempts were compared(P >0.05). No complications were related to attempted or successful vaginal oophorectomy. The inability to remove any ovary through the vagina occurred in 50 patients (10%). The most common reasons for the failure of vaginal oophorectomy included high position of the ovaries (76%), adhesions (11%), and ovarian disease (4%). Vaginal ovarian removal was less likely to be successful in older women who had higher degrees of pelvic relaxation and who were obese. Conclusions: In 90% of women on whom vaginal hysterectomy and oophorectomy were attempted, one or both ovaries could be removed vaginally without an increase in perioperative morbidity when compared with patients who underwent vaginal hysterectomy only.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundInjury to the urinary tract during pelvic surgery can have devastating consequences. Intraoperative recognition of these injuries by endoscopy can lead to immediate correction and a significant decrease in morbidity.AimThis study evaluated the value of intraoperative endoscopy in the identification of urinary tract injuries during surgeries for prolapse and incontinence.MethodA retrospective chart review was performed on 240 patients who underwent urogynecologic surgery that included routine bladder endoscopy. After approval was obtained from our Institutional Review Board, an analysis of the patient's history, operative report, and postoperative care was completed.ResultsTwo hundred forty consecutive urogynecologic surgeries that included routine bladder endoscopies were performed. Seven occult urinary tract injuries were recognized by endoscopic evaluation. Additionally, six patients with other clinically significant findings were noted. Urinary tract injuries uncovered were limited to the bladder. These included five patients who had suture material and one patient who had a Gortex (W. L. Gore and Associates, Flagstaff, AZ) graft in the bladder. In addition, one patient had a tuck in the bladder from an unsatisfactory stitch placement. There were no ureteral or urethral injuries found in this study. The overall urinary tract injury rate for this population was 2.9%. However, if other clinically significant findings are included, the overall recognition rate using routine bladder endoscopy was 5.4%.ConclusionsThis study suggests that routine intraoperative bladder endoscopy during urogynecologic procedures is valuable in the recognition of urinary tract injuries.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundOvarian pregnancy is a rare form of ectopic pregnancy increasing in incidence. It is difficult to diagnose clinically and even intraoperatively. Although much effort has focused on appropriate diagnosis and management, it is difficult or nearly impossible because some pitfalls associated with this condition are inherent and are prone to be overlooked.CaseThis case was initially diagnosed as a tubal pregnancy with abortion that occurred during previous laparoscopic surgery, but proved to be ovarian pregnancy 3 weeks later complicated with massive hemoperitoneum.ConclusionsThe following steps are recommended: 1) the removal of any suspected ovarian mass, or at least a biopsy from the free edge of the ovarian cyst wall; 2) a longer follow-up period in the postoperative monitoring of /31-hCG level; 3) the complete removal of all the specimens during operation be mandatory, especially if the specimen is fragmented; 4) the careful use of chromotubation for the exclusive diagnosis of ectopic pregnancy.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundUterine septal defects have been linked to infertility and recurrent pregnancy loss. Hysteroscopic metroplasty is the procedure of choice for removal of such Mullerian anomalies. The long-term complications of operative hysteroscopy become more apparent as the number of such procedures increases.CaseA 26-year-old woman with a history of hysteroscopic resection of a uterine septum presented at term in active labor. Two hysteroscopic metroplasty procedures had been performed to remove the septum and uterine perforation occurred during the second procedure. In the subsequent pregnancy, uterine rupture occurred intrapartum, which lead to emergent Cesarean delivery and significant maternal morbidity.ConclusionUterine rupture may occur during labor, in pregnancies that follow hysteroscopic metroplasty.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundThe association of congenital anomalies of the female genital tract and carcinoma have been reported in the literature for the past century. Most cases reported involved uterus didelphys and associated carcinomas.CaseThe article describes well-differentiated adenocarcinoma and atypical endometrial hyperplasia associated with noncommunicating rudimentary uterine horns.ConclusionThe coexistence of Mullerian anomalies and carcinomas is relatively uncommon, and their existence in noncommunicating rudimentary uterine horns is rare. The following report describes a patient with carcinoma of the endometrium associated with complex atypical endometrial hyperplasia in noncommunicating rudimentary uterine horns.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectivesThis article represents the first report, to our knowledge, of a primary retroperitoneal neurofibroma that mimics a perineal hernia. In addition to the case report, a review of pelvic floor hernias and retroperitoneal hernias is presentedMethods and MaterialsThe information for the case report was obtained from hospital records and the office records of two of the authors (Thad R. Denehy, MD and James L. Breen, MD).DiscussionRetroperitoneal tumors and pelvic floor hernias are rare clinical entities. Care should be undertaken not to prematurely diagnose either of these conditions; this will lead to unnecessary delay in intervention, inadequate preoperative evaluation and suboptimal outcome.ConclusionThis article emphasizes the importance of operative management in the treatment of retroperitoneal tumors. A careful preoperative workup, and an experienced surgeon are imperative. It is crucial that the management of each case is tailored to the resources available.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Clara Barton (1821–1912), American Civil War nurse, is credited with founding the American Red Cross (1881). This originally was part of the larger organization, the International Red Cross, which was founded in 1864. In addition to her work in the Civil War, Barton helped organize relief for people after natural disasters occurring both in the United States and around the world.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID