摘要:

ObjectiveTo assess the results of sacrospinous ligament fixation with transvaginal needle suspension for the correction of advanced pelvic organ prolapse and stress incontinence.MethodsNinety-six women who had pelvic organ prolapse to or beyond the hymen with or without stress incontinence were surgically managed over 3.5 years. Objective follow-up was available on 75 women. The subject group comprised 54 of these women who had stress incontinence and underwent sacrospinous ligament fixation with transvaginal needle suspension. The remaining 21 women who did not have stress incontinence underwent sacrospinous ligament fixation and served as controls. Appropriate vaginal repairs were performed as needed in both groups.ResultsThe mean duration of follow-up was 24 months (range 7–72) for the subjects compared with 24.3 months (range 3–53) for the controls. Eighteen subjects (33%) developed recurrent prolapse to or beyond the hymen. Additionally, five (9%) subjects developed recurrent stress incontinence and nine (17%) complained of urge incontinence. Four (19%) controls developed recurrent prolapse, two of whom also have urge incontinence. There was no statistical difference in the mean duration of follow-up or the incidence of recurrent prolapse between subjects and controls.ConclusionDespite the absence of statistical significance, we believe that the 33% recurrent prolapse rate associated with sacrospinous ligament fixation and transvaginal needle suspension is clinically important.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the effects of oral and transdermal estrogen replacement therapy (ERT) on ambulatory 24-hour blood pressure (BP) recordings.MethodsIn a nonrandomized, prospective study, 90 normotensive, oophorectomized women, ages 30–59 years, underwent ambulatory 24-hour BP measurements at study entry and after 3 and 6 months of either oral (n= 50) or transdermal (n= 40) ERT.ResultsIn the women receiving transdermal estrogen, we observed a change in mean nighttime systolic BP of −4.2 mmHg (95% confidence interval [CI] −7.7, −0.7;P= .039) after 6 months' treatment. There was a change in mean daytime diastolic BP after 3 months (−3.3 mmHg; 95% CI −5.5, −0.9;P= .016) and 6 months (−4 mmHg; 95% CI −6.8, −1.2;P= .014), and in mean nighttime diastolic BP after 3 months (−3.8 mmHg; 95% CI −6.6, −0.9;P= .027) and 6 months (−4.4 mmHg; 95% CI −7.1, −1.7;P= .005). No significant BP changes were observed in the women taking oral estrogen. Although the statistical power to detect a change of 4 mmHg at the 5% significance level was 90% for diastolic BP, it was weaker for systolic BP (63%) in this group. However, in more than one-third of the women receiving either treatment, a statistically significant increase in BP was observed.ConclusionsTransdermal ERT was associated with a reduction in mean ambulatory BP, whereas oral treatment did not after BP. Although the overall effect of estrogen was to lower BP, individual responses were variable, and BP increased in more than one-third of the women on either treatment. Therefore, long-term monitoring of ambulatory measurements may be required.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo elucidate the mechanism of cardiovascular protection of hormone replacement therapy (HRT) by comparing the effect of oral and transdermal HRTs on the production of antiaggregatory, vasodilatory prostacyclin, and its endogenous antagonist, thromboxane A2.MethodsOral estradiol (2.0 mg/d) plus norethisterone acetate (1.0 mg/d) (n= 13) or transdermal estradiol (50 μg/d) plus medroxyprogesterone acetate (10 mg/d) as 12-day courses at 4-week intervals (n= 13) were given to postmenopausal women. Urinary excretion of the metabolites of prostacyclin, ie, 6-ketoprostaglandinF1αand 2,3-dinor-6-ketoprostaglandinF1α, as well as those of thromboxane A2, ie, thromboxane B2and 2,3-dinor-thromboxane B2, were measured by radioimmunoassays, after purification by extraction and high performance liquid chromatography, before and during the sixth and the 12th treatment cycles.ResultsOral HRT stimulated excretion of thromboxane B2from 3.4 ± 0.7 ng/mmol creatinine to 4.5 ± 1.5 (mean ± standard deviation,P< .05) and that of 2,3-dinorthromboxane B2from 16.6 ± 8.0 ng/mmol creatinine to 26.2 ± 10.7 (P< .01), and thus led to the dominance of thromboxane A2. No changes in prostanoids occurred during transdermal HRT.ConclusionsThe effects of various HRTs on prostanoids may significantly differ.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the nationwide incidence of laparoscopic complications, as the number of demanding gynecologic laparoscopic procedures increases worldwide.MethodsThe National Patient Insurance Association was founded in 1987 in Finland. All major complications are reported to the Association because it handles financial compensation for patients' injuries without proof of malpractice. We analyzed 256 complications following laparoscopic procedures occurring in 1990–1994. There were 160 minor complications, which were defined as mild infections, mild hemorrhages, and failed sterilization. In all, 96 major complications occurred, including intestinal, urinary tract, and vascular injuries. The number of gynecologic laparoscopies (70,607 procedures) was obtained from the Finnish Hospital Discharge Register.ResultsThe total complication rate was 3.6/1000 procedures, and the rate of major complications was 1.4/1000 procedures. In diagnostic laparoscopies, the annual major complication rate was constantly below 0.6/1000, and in sterilization, it was below 0.8/1000. In operative laparoscopies, major complications increased from 0/1000 in 1990 to 10.5/1000 in 1993 and leveled to 10.1/1000 in 1994. In all, intestinal injuries occurred in 0.6/1000, ureteral injuries in 0.3/1000, bladder injuries in 0.3/1000, and vascular injuries in 0.1/1000 laparoscopic procedures.ConclusionsDiagnostic and sterilization laparoscopies appear to be safe, but more complex laparoscopies are associated with an unacceptably high number of serious complications requiring continuous follow-up and expertise.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the feasibility of the detection of ureteral jets into the bladder in obstetric-gynecologic patients using transvaginal color Doppler ultrasound.MethodsFifty-two women were recruited and categorized into four groups: 1) 20 normal nonsurgical, 2) 17 postcesarean delivery, 3) 12 post-total abdominal hysterectomy, and 4) three with only one functional kidney or ureter. In the first three groups, transvaginal color Doppler sonography was used to evaluate the time to detection of the first jet and the number of jets in 5 minutes bilaterally. In the last group, the presence or absence of the jet was documented only on the functional side. Statistical analysis was performed using Studentttest and analysis of variance followed by Tukey honestly significant difference.ResultsUrine jets could be detected bilaterally in all women except for those with only one functional kidney (accuracy 100%). Time to detection of the first jet did not differ significantly in the nonsurgical, cesarean, or hysterectomy patients on either the right side (P= .07) or the left side (P= .43). The total number of jets was similar in the nonsurgical and cesarean patients, but was significantly lower in the hysterectomy group (right sideP= .006; left sideP= .004). In the women with one functional kidney, the normal side was identified in all cases.ConclusionTransvaginal color Doppler sonography is a simple, accurate technique that can be used to evaluate ureteral jets into the bladder in women. The length of time to detection of the first jet is not affected by the postoperative status. Fewer jets should be expected in women who have undergone hysterectomies. This method should be used when ureteral integrity is in question, especially after surgery.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate whether the incidence of persistent ectopic pregnancy after linear salpingostomy can be reduced by prophylactic administration of a single dose of methotrexate postoperatively.MethodsWomen who underwent linear salpingostomy for treatment of unruptured ectopic pregnancy and who agreed to participate in the study (n= 129) were randomly assigned to the prophylaxis or control group. Women with anemia, renal insufficiency, or liver disease were excluded. In the prophylaxis group, patients received a single dose of methotrexate, 1 mg/kg intramuscularly, within 24 hours postoperatively. No treatment was used in the control group. Both groups were followed with serial serum β-hCG titers; titers were measured on the seventh postoperative day, then every 72 hours until levels were lower than 15 mIU/mL. A blood count and chemistry panel were also obtained on postoperative day 7, and any side effects related to methotrexate were noted. Persistent ectopic pregnancy was defined as a rise in the serum β-hCG level or a decline of less than 20% between two consecutive measurements taken 3 days apart.ResultsA total of 116 women completed the postoperative follow-up: 54 in the prophylaxis group and 62 in the control group. Ten women had persistent ectopic pregnancy, one in the prophylaxis group (1.9%) and nine among the controls (14.5%); this difference was statistically significant (P< .05). The relative risk of developing persistent ectopic pregnancy after prophylactic methotrexate was 0.13 (95% confidence interval 0.02, 0.97). Three women (5.5%) reported mild side effects after methotrexate, but these resolved spontaneously.ConclusionThe incidence of persistent ectopic pregnancy was significantly reduced after a single prophylactic dose of systemic methotrexate administered postoperatively. This regimen is safe and can be used to decrease the extent of postoperative monitoring after conservative treatment of unruptured ectopic pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine our experience with performing pelvic examination and obtaining cervical cytology in women with mental retardation.MethodsFrom November 1985 to October 1992, 658 women were seen in our clinic for women with mental disabilities. A standardized clinic visit form was completed for each woman. Of these records, 574 were available for analysis. All charts were reviewed for data on the level of retardation, incidence of sedation, success in performing pelvic examination and Papanicolaou smear, technique used for cervical smear, and pathology results of the cervical cytology.ResultsOf the 574 women, 289 (50%) had severe, 69 (12%) moderate, and 31 (5%) mild retardation. In 185 (32%), the exact level of retardation was not established. During the study period, 1235 pelvic examinations were analyzed. Within this group, 845 examinations could be completed initially, 177 required the use of sedation (14%), and 213 (17%) examinations could not be completed. Of the 845 examinations, 706 cervical smears were available for analysis. Of these, only 243 (34%) contained endocervical cells. Two abnormal cytology results were found (0.3%). Of the 177 examinations done with sedation, 44 women (25%) still could not be examined. Cytology specimen results were obtained in 124 of the examinations, and 40 (32%) of these specimens contained endocervical cells. No cytologic abnormalities were present. In a cervical smear technique comparison, endocervical cells were present in 58% of 161 standard speculum examinations and in 18% of 93 cotton-swab tests (P< .001).ConclusionCytology specimens can be obtained without sedation in most mentally retarded women. Only one-third of Papanicolaou smears contained endocervical cells from examinations with sedation as well as those without. The cotton-swab technique has a significantly lower endocervical cell collection rate than the standard speculum technique. The incidence of abnormalities on cytologic examination appears to be low compared with other populations of women. Whether this is due to suboptimal smears, lower prevalence of human papillomavirus, or a combination of both remains to be resolved.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In minilaparotomy-assisted vaginal hysterectomy, the operation begins vaginally by opening the peritoneal folds and ligating the uterine vessels and uterosacral ligaments. Minilaparotomy is then performed for myomectomy, cutting the fallopian tubes and the utero-ovarian ligaments and detaching any adhesions on the anterior peritoneal angle. In 26 women who underwent this procedure, the feasibility rate was 100% and no intraoperative complications or postoperative morbidity was observed (except in one case of ovarian bleeding), indicating that vaginal hysterectomy assisted by minilaparotomy is a feasible approach for hysterectomy in the setting of large myomas, myomas with adhesions caused by endometriosis or previous pelvic surgery, and adenomyosis.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A disposable suturing instrument is used in our surgical method for sacrospinous vault suspension to facilitate suture placement and retrieval. The pararectal space is dissected and the suturing device is placed just medial to the lateral third of the sacrospinous ligament-coccygeus muscle complex. Depression of the device's firing button advances a standard needle in a controlled circular path through the sacrospinous ligament-coccygeus muscle complex. The needle is retrieved with a straight-needle holder at a consistent location, 3 mm from the shaft of the instrument. A second suture is placed 0.5–1 cm medial to the first suture. If the holding strength for either suture is considered inadequate, the device is reloaded with the same suture and subsequent bites are taken. The procedure is completed using standard methods. In ten women treated for vaginal vault eversion, lateral dissection was completed in less than 10 minutes, and passage of two sutures through the sacrospinous ligament was accomplished in less than 2 minutes. There were no complications. One patient described mild buttock pain that resolved in 1 week. At 4–6 months' follow-up, vaginal examination with maximal straining demonstrated direct apposition of the vaginal wall to the sacrospinous ligament.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Supracervical or subtotal hysterectomy is a procedure that largely was discarded in the middle part of this century. This decision was made because of the reduction in morbidity and mortality associated with total hysterectomy, the only known and available method for the prevention of cervical cancer. This rationale, appropriate earlier in the century, has become somewhat undermined with the advent of Papanicolaou smear screening, colposcopic diagnosis, and simple outpatient therapy for preinvasive cervical neoplasia. Furthermore, some have argued that supracervical hysterectomy better preserves bladder and sexual function, and may be associated with reduced surgical and postoperative morbidity. Recently, laparoscopic supracervical hysterectomy has been introduced as another operative alternative with putative advantages over the procedure performed via laparotomy. However, for routine cases, the available literature does not confirm that one procedure is superior, regardless of the route of access. In selected cases, where benign conditions significantly distort the cervical anatomy complicating the dissection, supracervical hysterectomy would seem a prudent choice. It is clear that appropriately designed comparative studies are in order, to better determine the place for supracervical hysterectomy in the contemporary management of women with benign uterine disease.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID