摘要:

Pulsion enterocele has a well-deserved reputation as a difficult surgical problem; the multiplicity of suggested solution attests to this. Until the functional anatomy of the pelvic floor is better understood, particularly the specific anatomic defects involved, planning of a rational surgical attack will remain elusive. Both the pelvic cellular tissues and the levator ani complex are involved in the genesis of the condition, and both require correction during any surgical procedure. The supporting effect of the levator complex and the positioning effect of the cellular tissues must be restored.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Surgical correction of large pulsion enterocele is a contentious subject and until a technique is founded upon proper anatomic facts, the arguments will continue. Pulsion enterocele follows changes in the pelvic cellular tissues and levator ani complex; both defects must be corrected. Synchronous abdominoperineal repair attends to both defects with accuracy, and in a healthy woman who wishes to regain normal vaginal function, it should be the procedure of choice. During the past 11 years, 66 patients, many of whom had been unsucessfully treated by other techniques, have been managed with this procedure. Accurate follow-up has been possible in 60 patients, and of these women, 56 have been cured.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Colposcopically visible alterations of the vaginal mucosa associated with the use of tampons have been identified. These include mucosal drying, epithelial layering, and microulcerations. The pathophysiology of these transient changes appears to involve fluid transfer with subsequent impairment of intercellular bridges and loss of cell coherence. Tampon products containing superabsorbents are significantly more likely to produce microulceratons than are conventional tampons when worn at times other than during active menstruation. Chronic production of these alterations could lead to clinically obvious lesions of the vagina, and should now be considered in the differential diagnosis of vaginal ulcers.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Random blood samples were obtained from 114 women with history of diethylstilbestrol (DES) exposure in utero and were analyzed for follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrone (E1), estradiol (E2), androstenedione (A), testosterone (T), and progesterone (P) by respective radiommunoassays. Colposcopic examinations of the lower genital tract and biopsies of suspicious areas of vaginal mucosa were performed in every patient. The mean age of these patients was 21.6 ± 0.3 years (mean ± SE) and mean age of menarche was 12.6 ± 1.0 years. The incidence of irregular menses was 16.7%. A positive colposcopic finding was observed in 73.7% of all patients, 69.5% of patients with regular menses, and 94.7% of patients with irregular menses. Histologically confirmed vaginal adenosis was found in 43% of all patients, 46.3% of patients with regular menses, and 42.1% of patients with irregular menses. No significant differences were observed between DES-exposed versus unexposed females with regular menses in all hormones except testosterone. An elevated testosterone level was noted in postovulatory and perimenstrual phases of DES-exposed females. Elevated testosterone was also observed in DES-exposed females with irregular menses. Cross-analysis of hormone levels among the patients with lower genital tract pathology failed to show any statistical differences.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To determine the role of Bacteroides fragilis in the development of infectious complications following hysterectomy, serum antibody to the capsular polysaccharide was measured with a radioactive antigen-binding assay in 53 women before and several days after surgery. Patients with postoperative abscess formation had a significantly greater mean increase in antibody concentration (4.91 μ/ml) than those without complications (0.62 μg/ml), those with wound infection (1.90 μg/ml), those with pelvic cellulitis (0.63 μ/ml), and those with febrile morbidity (0.95 μg/ml). There were no significant differences among the latter 4 groups. The authors conclude that B fragilis may play an important role in abscess formation following hysterectomy, but is infrequently involved in other infecious complications of this procedure.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A study was undertaken to evaluate the postoperative morbidity of classical cesarean section (CCS). Eighty-nine such procedures, performed between 1970 and 1977, were reviewed. All cases in which prophylactic antibiotics were used were excluded from the study. Forty-seven patients (53%) developed standared morbidity, and 46 patients (52%) had a clinical diagnosis of infection. Of these, 30 patients (34%) had endoparametritis, 5 patients (6%) had abdominal wound infection, and 11 patients (12%) had urinary tract or pulmonary infection. Two patients (2%) had pelvic thrombophlebitis, but no patient was found to have an abscess or pelvic hematoma. In comparison with matched patients who had a low cervical transverse cesarean section (LCTCS) performed during the same time, patients with a CCS had a comparable incidence of standard morbidity and operative site infection. These infections responded promptly to vigorous antibiotic therapy with no apparent increased risk of major postoperative complications in the population studied.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Swan-Ganz catheters were used in the care of 3 toxemic parturients who developed pulmonary edema. Initial pulmonary capillary wedge pressures (PCWP) ranged from 22 to 33 torr, indicating decompensated left ventricular failure. Simultaneous central venous pressures were essentially normal. Isolated left ventricular dysfunction was primarily the result of increased afterload and responded to afterload reduction with arteriolar vasodilators. Continued measurement of PCWP permitted the titration of afterload reduction to the levels associated with normal ventricular filling pressures and volume. Since the relationship between right and left ventricular pressures may be distrurbed in cardiogenic pulmonary edema, the Swan-Ganz catheter is the preferred method of hemodynamic monitoring in toxemic patients who develop cardiopulmonary dysfunction.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Electronic fetal monitoring (EFM) and cesarean sections (CS) have been studied in 14,484 patients delivered between 1970 and 1975. The primary CS rate for those monitored was 107/1000, and for the unmonitored was 57/1000. Multivariate analysis of these data shows that most of the increase in CS rate associated with monitoring is attributable to inherent differences between monitored and unmonitored patients. Furthermore, the association between monitoring and CSs was not homogeneous among sub-groups. Cesarean sections were relatively less frequent in monitored nulliparas with malpresentation and more frequent in otherwise normal monitored multiparas. These opposing effects tended to balance each other. During the study period the primary CS rate rose from 4.3 to 11.2%. This increase was strong in unmonitored patients and was primarily due to operations undertaken for fetopelvic dis-proportion. We cannot therefore attribute much of the increasing CS rate at our hospital to fetal monitoring.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A retrospective analysis was made of 186 consecutive primary cesarean sections performed on patients at high risk for infection to determine whether extraperitoneal cesarean section would have decreased the incidence of infections and other complications. Women who theoretically would have benefited most from extraperitoneal cesarean section were not candidates for the procedure because of technical reasons, while those who would have been candidates for the procedure did very well despite the fact that the procedure was not done. Except for women with severe toxemia, prophylactic antibiotics markedly reduced febrile morbidity. A number of significant unsuspected pathologic conditions also would not have been diagnosed if the extraperitoneal cesarean section technique had been used. It is concluded that prophylactic antibiotics and intraperitoneal cesarean sections are the preferred techniques even for those women with apparent amnionitis.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A study of maternal glucose tolerance conducted during 137 pregnancies in which the infant weighed 4540 g or more at birth revealed an increased incidence of hyperglycemia (20.4%, P < 0.01). Only when a birth weight of more than the 99th percentile was considered was a significant association with maternal hyperglycemia evident. However, 105 of the 137 patients (77%) had normal glucose tolerance, which indicated that hyperglycemia is not necessarily the cause of fetal overgrowth. When a woman delivers an infant with a birth weight of 4540 g or more, it cannot be assumed that she was a gestational diabetic.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID