摘要:

Chronic ectopic pregnancy is often an enigma and a correct diagnosis is frequently not made until exploratory laparotomy. Hemodynamic stability, chronicity of symptoms, and a high incidence of false-negative pregnancy tests and culdocentesis results are clinical characteristics distinguishing it from the more common acute ectopic pregnancy. Dense adhesions and occasional abscess formation are surgical features that characterize the chronic ectopic pregnancy. Approximately 6% of ectopic pregnancies are chronic.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Urethral prolapse denotes the complete circular eversion of the urethral mucosa through the external meatus. Two different entities exist: premenarcheal and menopausal urethral prolapse. Premenarcheal prolapse is predominantly asymptomatic and is usually brought to medical attention by vaginal bleeding. Trauma and medical conditions predisposing a patient to increased abdominal pressure are associated with prolapse in children. The menopausal group seeks medical attention primarily because of the severity of urinary symptoms, ie, nocturia, urgency, tenesmus, dysuria, and frequency. Therapy for both groups has been traditionally accomplished by surgical manipulation—excision, surgical ligation, cautery, fulguration, and cryosurgery. The authors treated 5 premenarcheal female children with antibiotics, estrogen cream, and sitz baths for 2 weeks. In all the patients prolapse was resolved. The results, with follow-up for 4 to 12 months without recurrence, suggest that urethral prolapse in children can be managed without surgical intervention.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study is based on a review of all moles diagnosed at the Kaplan Hospital in Israel from 1968 to 1977. Histologic reevaluation revealed that of a total of 72 moles, 47 (65%) were complete and 25 (35%) partial. In contrast to complete moles, about one third of the partial moles showed fetal parts. An analysis of the patient records showed smaller uteri, less vaginal bleeding, absence of severe vomiting, lower gonadotropin levels, and normal follow-up in patients with partial moles as compared with those who had complete moles. These results indicate that the partial mole is a distinct clinicopathologic entity that can be suspected by the clinician and confirmed by the pathologist on morphologic grounds, even in the absence of cytogenetic analysis.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Of 127 patients with hydatidiform mole in southern Connecticut, 34 (28%) received chemotherapy for persistently elevated human chorionic gonadotropin (hCG) titers. An hCG regression curve was found to be useful if not mandatory for following patients. Excess uterine size, theca lutein cysts, uterine bleeding, and histologic trophoblastic hyperplasia were relative discriminators of the need for chemotherapy. In the absence of metastases, an hCG titer was the only valid discriminator for initiating chemotherapy, provided the patient could be followed consistently and reliably. The indications for initiating chemotherapy are discussed. Early diagnosis and close follow-up were associated with low morbidity. Five of 6 patients with metastatic disease were referred from outside the center.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Examination of histologic material from 54 patients with endometrial carcinoma, in whom the pretreatment fractional curettage showed adenocarcinoma in the endocervical specimen, demonstrated 4 main patterns. These were designated as tumor separate from endocervical tissue (13 patients), true stage II (23 patients), tumor in stroma (12 patients), and tumor only (6 patients). Patients with tumor separate from endocervical tissue had a better survival rate (expressed as survival to first recurrence) than did patients in the other 3 groups, and this difference was statistically significant. No statistically significant difference between the survival of patients in the true stage II, tumor in stroma, and tumor only groups could be demonstrated. It is therefore suggested that the treatment protocol used for these 3 groups of patients be similar. Among the true stage II group, only 3 patients had superficial endocervical involvement, whereas 15 had stromal involvement without surface tumor. Therefore, spread to the cervix in endometrial carcinoma appears to be more frequent by tissue spaces or lymphatic channels than by contiguous surface extension.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Fifty-five patients with stage I borderline or potentially malignant lesions of the ovary were evaluated. Surgical removal of the disease appears to be as efficacious for adequate therapy as does postoperative pelvic irradiation or adjunctive chemotherapy.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Of 41 women with FIGO stage I endometrial adenocarcinoma who underwent staging paraaortic lymphadenectomy and paraaortic node biopsy, 6 (14.6%) had metastasis to the paraaortic lymph nodes. None of the 11 patients with grade 1 carcinoma had paraaortic node metastasis; 13.6% of grade 2 carcinomas and 37.5% of grade 3 carcinomas were associated with paraaortic node metastasis. None of the 8 patients with tumor limited to the endometrium had paraaortic metastasis, and only 4.5% of the patients with superficial myometrial invasion had metastasis to the paraaortic lymph nodes. However, this increased to 45.5% for tumors deeply invading the myometrium. Of the patients with paraaortic node metastasis, 83.3% had either grade 3 tumors or deep myometrial invasion. Only 1 patient in the study with paraaortic node metastasis did not have either a grade 3 carcinoma or a tumor deeply invading the myometrium. Because of the high incidence of paraaortic node metastasis with grade 3 tumors or deep myometrial invasion, surgical staging by paraaortic lymphadenectomy or lymph node biopsy is recommended at the time of primary surgery for early endometrial adenocarcinoma.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Urethral function following radical hysterectomy was studied by chronologic analysis of the urethral pressure profile. Thirty patients who had radical hysterectomy were divided into 2 groups according to the degree of preservation of the plexus pelvicus at operation. The method of complete preservation is described. Urethral pressure profiles showed a significant. postoperative decrease of mean maximum urethral closure pressure in the group of 20 patients with bilateral nerve transection; this was hot found in the group of 10 patients with complete preservation of the plexus pelvicus. The decrease was ascribed to possible damage of sympathetic nerves originating from the hypogastric nerve. The results indicated that postoperative abnormalities in urination are caused by damage not only to the parasympathetic nerves (the pelvic nerve), but to the sympathetic nerves (the hypogastric nerve) as well.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Ninety-four patients with condylomata acuminata of the lower genital tract and perianal region were treated with the carbon dioxide laser. Most were managed in the outpatient clinic, but 1 to 4 treatments were required depending upon extent of involvement. Of 90 patients, 75 (83.3%) were free of lesions on all follow-up examinations after initial treatment. Of 15 patients with recurrent lesions, 13 underwent a second laser treatment; 7 of these 13 have been subsequently free of condylomata. The overall success rate was 91%. The carbon dioxide laser provides an appealing method of management of condylomata acuminata because of its precision, rapid healing without scarring, and safety when used during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

An operative procedure is described in which the levator ani muscles are used to correct anal incompetence secondary to sphincter damage. The relevant pelvic anatomy and operative procedure are described in detail. Four patients in whom sphincter damage occurred during surgery for posterior vulvar carcinoma underwent the procedure; in 3, good sphincter function was attained. Morbidity was minimal. The transposition of the levator ani muscle to replace partially obliterated anal sphincter muscles is a suitable procedure for patients who have insufficient sphincter tissue for simpler repairs.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID