ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo measure and define perioperative fluid disequilibrium (“third spacing”) in patients with ovarian cancer and malignant ascites.MethodsTwenty women undergoing surgical exploration for ovarian masses andasciteswere evaluated prospectively; similar anesthetic techniques were used. All patients remained nor-motensive, and 14 had greater than 1 L malignant ascites and formed the study group. Perioperative fluid dynamics were measured using standard clinical measures and tissue oximetry.ResultsAll patients with malignant ascites experienced moderate (≤ 1.0 mL/kg/hr) or severe (≤ .5 mL/kg/hr) oliguria; most patients required markedly increased rates of crystalloid resuscitation perioperatively. Cumulative fluid imbalance progressed until postoperative Days 3–4. Patients with malignant ascites exhibited pronounced hypoproteinemia and had significantly decreased tissue oxygen tensions.ConclusionsPatients with ovarian cancer and ascites experience clinically measurable perioperative fluid disequilibrium (third spacing) that is associated with tissue hypoxia.

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

IntroductionRectal carcinoid is rare and its management is still controversial. Conventional recommendation for treatment of rectal carcinoids is that a lesion smaller than 2 cm in diameter may be treated adequately by local excision. This view has been challenged in recent literature.PurposeTo evaluate the outcome of treatment methods, specifically with respect to tumor size, muscularis propria invasion and extrarectal spread.MethodsA retrospective chart review of all patients with the diagnosis of rectal carcinoids from 1980 to 1996 was performed.ResultsForty-five patients were identified with histologic diagnosis of rectal carcinoid; 39 patients were included in the study. Associated colorectal neoplasm was found in one third of the patients (13/39). Thirty-seven patients had tumors less than 2 cm in diameter. Thirty-one patients were treated by local procedures and recurrences developed in two. Radical procedure was performed in the remaining six patients. Among these 37 patients, 3 had extrarectal spread, and muscularis propria invasion could be found in 2. Two patients with tumors greater than 2 cm in diameter were treated by radical procedures, and both had muscularis propria invasion.ConclusionTotal colonoscopy is recommended for every patient with rectal carcinoid. Local excision is appropriate treatment in patients with tumors less than 2 cm in diameter if muscularis propria invasion is not found.

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the subjective cure rate and morbidity of the Pereyra urethropexy for genuine stress urinary incontinence and to investigate independent variables' effect on the surgical outcome.MethodsIn a retrospective case series, 103 women were identified who underwent Pereyra urethropexy as a single procedure or in combination with other vaginal procedures between January 1992 and February 1995. Hospital records were reviewed, and a questionnaire was mailed to the patients. The average time from surgery to completion of the survey was 30.4 months. Stepwise logistic regression analysis was used to ascertain relationships between surgical outcome and age, weight, smoking, comorbidity, and estrogen status.ResultsSixty-one percent of the surveyed women reported they are no longer leaking urine (cured), whereas 82% reported that the surgery is providing relief (improved). Women who are pre or postmenopausal and who are taking estrogen have significantly higher rates of cure (P= 0.05) and improvement (P= 0.003). Morbidity rate for the Pereyra and other vaginal procedures was 26%.ConclusionsPereyra urethropexy provides a subjective cure rate that ranges from 61% cured to 82% improved. This is consistent with published objective and subjective data concerning vaginal retropubic procedures for correction of stress urinary incontinence. The Pereyra urethropexy should be considered for correction of genuine stress urinary incontinence in women undergoing vaginal surgery, especially in premenopausal and postmenopausal women taking estrogen replacement therapy.

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify the relative advantages of abdominal, vaginal, and laparoscopic hysterectomy.Data SourcesPublished peer-reviewed English language literature was searched using MEDLINE and HSTAR and bibliographies of published studies found through the computerized literature searches.MethodsAll nonrandomized and randomized controlled trials and a select number of case series were included. Case studies were excluded.ResultsData abstracted from articles included indications for hysterectomy, operating and anesthesia times, blood loss measures, complications, patient convalescence, duration of stay, and hospital charges. These data are presented in tables that allow for comparisons between procedures, and metaanalysis was conducted for operating and anesthesia times, duration of stay, and hospital charges. Five randomized controlled trials were found, but most had significant method-ologjc weaknesses. Substantial overlap in indications for hysterectomy were found among the three procedures. Compared with abdominal hysterectomy, the advantages of laparoscopic hysterectomy are shorter duration of stay, less postoperative pain, and more rapid convalescence, whereas the disadvantages are longer durations of operating and anesthesia times. No advantage was substantiated for either procedure for hospital charges. The findings that compare blood loss measures with complication rates were inconclusive. Compared with laparoscopic hysterectomy, the advantages of vaginal hysterectomy are shorter durations of operating and anesthesia times and lower hospital charges. There was no evident advantage for either procedure in duration of stay. Comparisons were inconclusive for blood loss measures, complication rates, and patient convalescence measures. Comparisons are not as clear, and they appear to have more likenesses than differences in terms of outcomes.ConclusionsGenerally accepted guidelines for surgical approach are needed. The different hysterectomy approaches have relative advantages and disadvantages for some outcome measures, but studies are inconclusive regarding others. More methodologically sound randomized controlled trials are needed to verify and extend this review's findings.

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundVaginal evisceration of the intestine is rare. Sixty-three cases have been reported and more than half had occurred in patients who had previous hysterectomy.CasesTwo subjects with advanced ovarian cancer and massive ascites had asymptomatic vaginal evisceration of bowel 67 and 90 days, respectively, after primary surgery and subsequent early, intensive and highly emetic chemotherapy. Timely treatment by laparotomy allowed prompt recovery without further complications.ConclusionsThe concurrence of recent hysterectomy for advanced ovarian cancer, intense chemotherapy, severe vomiting, and impaired healing because of low serum albumin levels may promote this uncommon complication.

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundThe external iliac artery has a remarkably constant course in the pelvis, and anomalies are rare.CaseDuring the course of lymph node sampling for a mucinous cystadenocarcinoma of the ovary, the left external iliac artery was found to be absent, and this was confirmed by subsequent imaging studies. The common iliac artery continued as an enlarged internal iliac artery, and after giving rise to the visceral branches, became the femoral artery below the inguinal ligament.DiscussionThe embryology and clinical significance of agenesis of the external iliac artery is discussed.ConclusionsGynecologists should be cognizant of such anomalies and identify the external iliac artery before hypogastric artery ligation.

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1997

数据来源: OVID