ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the cost-effectiveness of sacrospinous fixation (SSF) and abdominal sacral colpopexy (ASC) for posthysterectomy vaginal vault prolapse.MethodsCost and effectiveness data for SSF and ASC were accessed from peer-reviewed literature and standard references for charges. Objective assessment of surgical cures at 36–48 postoperative months was used. Taking the perspective of a healthcare planner, the incremental cost-effectiveness ratios were calculated for both procedures.ResultsASC is a more expensive yet more effective procedure than SSF. Compared with no intervention, SSF costs $9290 per cure. The cost per cure of ASC is $2910, compared with SSF.ConclusionsUnder conditions of constrained monetary resources, SSF is a more cost-effective procedure than ASC. However, the decision to proceed abdominally or vaginally is more often dictated by the clinical situation and the need for ancillary repairs.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThis study was designed to assess the effect of unilateral percutaneous sacral nerve stimulation of the S3 root on anorectal function in patients with fecal incontinence.MethodsEight patients with urge incontinence associated with detrusor instability underwent peripheral nerve evaluation. Three patients had no bowel symptoms, two patients had constipation characterized by the occasional need to strain at evacuation, and three patients had urgency at stool and incontinence to liquid stools. One patient used a permanent pulse generator implant for the management of the detrusor instability. Stimulator wires were placed percutaneously and adjacent to the right and left S3 sacral nerve roots, and unilateral stimulation was performed with an external impulse generator. The effect of 5-day subchronic tetanic stimulation on subjective bowel symptoms, anal canal resting pressure (RP), squeeze pressure (SP), electromyography (EMG), and pudendal nerve motor terminal latency (PNTML) was assessed.ResultsSix patients had increased RP of > 25% with stimulation when compared with the prestimulation baseline. Increases in RP were greatest in the three patients with fecal incontinence (67%, 100% and 80%), however no subjective improvement in fecal continence was noted in these patients. No poststimulatory changes in the SP, EMG activity, and PNTML were observed.ConclusionUnilateral S3 sacral nerve root stimulation produced an increased RP, especially in patients with fecal incontinence. Evacuation symptoms, resting anal canal length, SP, EMG and PNTML were not affected. In this study, there were no objective clinical changes in fecal continence. Further studies are required to evaluate whether stimulation of S3 and S4 nerve roots would more effectively affect anorectal function in fecal incontinence.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundPelvic bleeding can be a troublesome clinical problem during surgery. The rich anastomotic blood supply, limited visibility, and restricted surgical access can result in difficulty achieving hemostasis via suture ligation or electrocautery. Alternative methods such as temporary packing, internal iliac artery ligation, and radiographic vascular embolization can be effective, but require a significant change in approach, increased time, and a higher degree of invasiveness. The use of absorbable hemostatic agents in cases of pelvic bleeding is a relatively simple and direct approach, yet this approach has not been frequently reported in the literature.MethodsThe authors describe four cases of difficult pelvic bleeding in which hemostatic packs consisting of three different absorbable hemostatic agents were used successfully. The packs consisted of gelatin sponges soaked in topical bovine thrombin and wrapped in oxidized regenerated cellulose mesh. The packs were applied to the sites of bleeding, and direct pressure or additional packing was used to augment the hemostatic effect. In each case of pelvic bleeding, more conventional management approaches, such as suture ligation and electrocautery, were deemed either too difficult, dangerous, or had been attempted and had failed. In each case of pelvic bleeding, attention was paid to intravascular fluid levels and blood product replacement needs of the patient.ConclusionThe use of absorbable hemostatic packs can be considered for the clinically stable patient experiencing pelvic bleeding when traditional methods of hemostasis cannot or should not be attempted.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundThe aim of this review article is to assess the role of pelvic and paraaortic lymphadenectomy in the management of cervical, endometrial, and ovarian cancer.MethodsReview of the literature on lymphadenectomy in gynecologic oncology was accomplished using MEDLINE entries dated January 1966 to September 1998.ResultsHistorical background, lymphatic tumor spread, clinical nomenclature of pelvic and paraaortic lymphadenectomy, surgical techniques, complications, and benefits for patients with cervical, endometrial, and ovarian cancer are presented.SummaryAlthough pelvic and paraaortic lymphadenectomy has potential risks, in properly selected patients and in the hands of an experienced pelvic surgeon, the procedure has prognostic and possible therapeutic benefits.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveAnalysis of the techniques used for vaginal removal of the adnexa after vaginal hysterectomy.MethodsA prospective evaluation of 100 patients who had undergone vaginal salpingo-oophorectomy after vaginal hysterectomy was performed. The adnexal anatomy, instrumentation, techniques, and technical factors were analyzed.ResultsFour phases of vaginal salpingo-oophorectomy were noted: 1) preparation of the operative field, 2) preparation of the adnexal areas, 3) extirpation of the adnexa, and 4) ligation of the ovarian pedicle. Extirpation of the adnexa was performed using two primary techniques: the mesosalpinx-mesovarium and round ligament. However, several variations of these techniques (i.e., single- and double-pedicle, two-stage, preservation of the uteroovarian pedicle) were necessary for the removal of the adnexa in all patients.ConclusionPreparation of the operative field and the adnexa and variations of the customary techniques used for vaginal salpingo-oophorectomy are necessary for the performance of a successful vaginal salpingo-oophorectomy.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundParaneoplastic neurologic syndromes are neurologic disorders associated with cancer unrelated to metastatic, metabolic, or infectious complications. These symptoms usually precede the diagnosis of cancer.CasesCerebellar dysfunction was diagnosed in two women. Both patients presented with an extremely high titer of anti-Purkinje-cell antibodies (1:983,040 and 1:30,720). Ovarian and fallopian tube cancer was diagnosed. In the first patient, abdominal computed tomography (CT) and pelvic examination revealed a large pelvic mass, and surgical resection revealed stage III adenocarcinoma of the ovary. In the second patient, no tumor could be detected by examination, laboratory evaluation, or radiography. Laparotomy revealed a 1-cm left fallopian tube cancer with a small omental metastasis. Despite aggressive therapy, the patients' neurologic symptoms did not improve.ConclusionPatients with cerebellar dysfunction should be tested for anti-Purkinje-cell antibodies. If antibodies are positive, these patients should undergo careful evaluation for occult gynecologic cancer. Exploratory laparotomy, not laparoscopy, is the way to accurately diagnose, stage, and treat these patients.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Robert Koch (1843–1910) was one of the founding fathers of modem medical bacteriology. His most important work included proving that anthrax, tuberculosis, and cholera are caused by bacteria. For his work, he won the Nobel Prize for physiology or medicine in 1905.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID