ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare the histopathologic quality of surgical specimens produced by two electrosurgical excision instruments when used by obstetrics and gynecology residents under supervision.MethodsA prospective study design was approved by the institutional review board of Temple University Health Science Campus, Philadelphia, PA. All patients who required a Loop Electroexcision Procedure (LEEP) were eligible for the study. A total of 45 patients were enrolled from December 1999 to December 2000. Twenty-two were randomized to the Fischer Excisor and 23 to the Utah Loop. The surgical procedure was performed in a routine fashion by either a fourth-year or second-year gynecology resident under the supervision of a gynecologic oncologist. The specimens were initially evaluated by Temple University Hospital Pathology Department and a histopathologic diagnosis was rendered. Each specimen was evaluated by one of the investigators masked as to which type of instrument was used.The specimens were analyzed for fragmentation, margin quality, epithelial thermal artifact, and depth of thermal damage from the excision margin. A thermal damage score was assigned to each specimen based on the microscopic depth in microns (&mgr;m) of thermal damage from the excision margin and also on the degree of epithelial thermal artifact. The overall histologic quality of the squamous epithelium margins was assessed using the resulting sum of the specimen’s scores for epithelial thermal artifact and depth of damage. Lastly, after each electrosurgical procedure, the gynecology resident that performed the procedure completed a survey to critique the control, maneuverability, and comfort OF the instrument used.ResultsThe specimens obtained using the Fischer Excisor had significantly less thermal damage from the margins than the Utah Loop specimens. The mean thermal damage distance with the Fischer instrument was 481.94 &mgr;m (± 246.29) versus 789.76 &mgr;m (± 713.45) with the Utah Loop (P= 0.0035). The Fischer Excisor produced a median of one tissue fragment per case whereas the Utah Loop produced a median of two (P= 0.4213). The median number of passes needed to complete the procedure with the Fischer Excisor was one, whereas it was twowith the Utah Loop (mean 1.0 vs. 1.74,P= 0.00038). The overall histologic quality score was better for the specimens obtained with the Fischer Excisor than for those obtained with the Utah Loop. The Fischer Excisor displayed statistically significant better evaluations by the residents for its comfort of use, control, and maneuverability than the Utah Loop. The residents had performed an average of seven LEEPs with the Utah Loop and three with the Fischer before the study case (P= 0.0272).ConclusionIn a training program, the Fischer Excisor requires less practice to master and provides specimens with less thermal damage than the Utah Loop.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo describe symptoms and prolapse staging before and after posterior colporrhaphy.MethodsBefore and after posterior colporrhaphy, 108 women completed questionnaires and had staging examinations for prolapse. Comparisons were made with McNemar’s test.ResultsThirty-eight (35%) and 70 (65%) women were assessed at 6 months and 1 year, respectively. Preoperative and postoperative bowel symptoms were as follows: 13% versus 6% had two or fewer bowel movements per week (P= 0.035), 76% versus 45% required straining to defecate (34 resolved, 2 new onset;P< 0.001), 45% versus 8% required manual evacuation (38 resolved, none new onset;P< 0.001), and 10% versus 2% had fecal incontinence more than once a month (9 resolved, 1 new onset;P= 0.011). Ninety-five women (88%) had optimal (stage 0) or satisfactory (stage I) anatomic outcome at the most advanced site of prolapse affecting the posterior vagina (point Bp) with no worsening from pretreatment stage.ConclusionMost women had improvement of posterior vaginal topography and bowel function after posterior colporrhaphy.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo measure the effect of locally injected dilute vasopressin compared to saline on estimated blood loss at vaginal hysterectomy.MethodsTwenty-nine women undergoing vaginal hysterectomy were randomized to receive either locally injected dilute vasopressin (20 U/50 mL normal saline) or normal saline at the initiation of surgery. Some women also underwent concurrent procedures, but only data from the hysterectomy portion was considered in the analysis. Blood loss as estimated by anesthesia personnel at the time of surgery was the major outcome measurement. Independentt-test was used to compare continuous variables, and chi-squared or Fisher’s exact test were used as appropriate for proportions.P< 0.05 was considered to be statistically significant.ResultsThe mean age of the 14 women in the vasopressin group was 41.5 ± 11 years versus 38.6 ± 7 years for the 15 women in the saline group,P= 0.42. There were no differences in race, parity, body weight, or uterine weight between the two groups. The mean operative time in the vasopressin group was 83.5 ± 35 minutes versus 82.1 ± 50 minutes in the saline group,P= 0.93. However, the mean estimated blood loss was significantly less in the vasopressin group compared to the saline group, 179.0 ± 112 mL (range, 50 mL–500 mL) versus 371.3 ± 252 mL (range, 100 mL–900 mL),P= 0.01. Among the 29 women only 1 woman (vasopressin group) experienced a perioperative complication (cystotomy).ConclusionDespite the lack of difference in operative time, women who received locally injected vasopressin averaged less than half the blood loss of women who received saline.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundUsing a major elective abdominopelvic colorectal operation such as low anterior resection of the rectum as an index, this article reviews recent literature on perioperative management.MethodsReview of the current literature regarding perioperative management was performed.DiscussionPreoperative topics discussed are preoperative risk assessment, preoperative tests, preoperative transfusion, and mechanical bowel preparation. True perioperative topics are antibiotic prophylaxis and thromboembolic prophylaxis. Postoperative topics covered are the role of the nasogastric tube and bladder catheter, postoperative nutrition, shortening the postoperative ileus, and length-of-stay management. In each of these areas, some highlights of literature published since 1995 are discussed.ConclusionPerioperative management may be slightly more streamlined in the future, with the exception that patients with significant co-morbidity, early complications, and poor social support will always require more precautions and a longer hospital stay.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundGynecologic laparoscopic surgical procedures are generally considered safe and effective. The reported incidence of perioperative thromboembolism after gynecologic laparoscopy is unknown, and to our knowledge, has never been published.MethodsA review of recent (January 1993 to December 2000) English language literature was performed using MEDLINE to identify the incidence of thromboembolism as a complication of gynecologic laparoscopy.ResultsFourteen studies comprising 179,706 procedures were reviewed for the incidence of postoperative thromboembolism. Eighteen cases (including two deaths) were reported for a reported incidence of 0.0001%.ConclusionThe incidence of thromboembolic events after gynecologic laparoscopy may be underreported and thromboprophylaxis should be considered in most cases. There are no prospective studies evaluating the incidence of venous thromboembolism (VTE) or optimal prophylaxis methods for these procedures.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

IntroductionLymphatic mapping and lymphoscintigraphy are used in breast carcinoma and melanoma to limit the potential degree of lymphatic dissection, resulting in significantly lower postoperative morbidity rates. This approach is also being actively studied in various gynecologic malignancies, most notably those of the vulva and cervix.CaseA 56-year-old woman underwent radical hysterectomy and bilateral pelvic and para-aortic lymphadenectomy for a stage IB1squamous cell carcinoma of the cervix. She was enrolled in a lymphatic mapping trial where both isosulfan blue and technetium99were used. Four “hot” nodes were detected with lymphoscintigraphy, but none were found to be blue. All lymph nodes were histologically negative for carcinoma.ConclusionThe addition of a radiolabeled tracer substance (technetium99-labeled colloid) to the traditional blue dye approach of lymphatic mapping may improve the efficacy of identifying sentinel lymph nodes in women with cervical cancer. It is important to be aware of the time interval between tracer injection and surgical evaluation. Continued investigation is warranted to better define the technique and role of lymphatic mapping in gynecologic oncology.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID