摘要:

Objective:To compare outpatient laparoscopy-assisted vaginal hysterectomy with standard outpatient vaginal hysterectomyMethods:Fifty-six women scheduled for vaginal hysterectomy were randomly assigned to undergo either a laparoscopy- assisted vaginal hysterectomy with endoscopic staples (N=29) or a standard vaginal hysterectomy (N=27). There were no differences between the study groups with regard to age, gravidity, parity, preoperative indications, and previous operationsResults:Twenty-eight of 29 laparoscopy-assisted vaginal hysterectomies and all 27 vaginal hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were completed. The mean operating time was significantly longer for laparoscopy-assisted vaginal hysterectomy (120.1 versus 64.7 minutes). Fifty-three of the 55 patients completing surgery were discharged home by 12 hours from the time of admission. Complications with laparoscopic hysterectomy were related to the technical aspects of laparoscopy. The incidence of febrile morbidity was similar in the groups. Although patients having laparoscopy- assisted hysterectomy required statistically significantly more pain medication and had lower postoperative hematocrit measurements, this did not make a clinical difference in the postoperative courses. The mean hospital charge for laparoscopy-assisted vaginal hysterectomy was $7905 and for vaginal hysterectomy $4891Conclusion:Other than cost, laparoscopy-assisted vaginal hysterectomy and standard vaginal hysterectomy appear comparable in patients who could otherwise undergo a vaginal hysterectomy.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To correlate the listing of multiple preoperative indications for hysterectomy with the risk of nonconfirmation of the preoperative diagnosisMethods:Records of 171 women undergoing consecutive hysterectomies for all indications at a large teaching hospital were reviewed for preoperative indication(s), compliance with published preoperative validation criteria for cases in which tissue pathology was not expected, and histologic verification of the preoperative diagnosis for cases in which tissue pathology was expected. Rates of confirmation (histologic verification plus successful compliance with validation criteria) of the preoperative diagnosis were compared between subgroups of cases in which single indications were listed (N=124) or multiple indications were listed (N=47) preoperativelyResults:The rate of confirmation of single indications (115 of 124 cases, 93%) was significantly higher than the rate of confirmation of even one indication in cases in which multiple indications were listed (28 of 47 cases, 60%, P<.0001; relative risk for non-confirmation of multiple indications=1.55). Multiple indications were more likely to be listed when tissue pathology was not expected, representing 49% of validatable indications as compared with only 18% of histologically verifiable indications (P<.0001). Overall, the rate of compliance with validation criteria (70%) was significantly lower than the rate of histologic verification (90%) (P<.01)Conclusion:These data suggest that listing of multiple preoperative indications for hysterectomy is associated with both decreased appropriateness, as reflected in decreased compliance with generally accepted preoperative validation criteria, and decreased diagnostic accuracy, as reflected in lower rates of histologic verification. (Obstet Gynecol 1992; 80:902-5)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To evaluate the effect of bilateral pudendal blockade on the urethral closure function in the resting state in healthy womenMethods:Synchronous measurements of pressure and cross-sectional area were recorded at the bladder neck, in the high-pressure zone, and in the distal urethra before and after the pudendal blockade in ten womenResults:The blockade reduced the resting pressure significantly (P<.01) all along the urethra. The viscoelastic indices of elastance (reciprocal of compliance) and hysteresis (difference in pressure at a given degree of urethral dilation when this is increased and decreased stepwise) were significantly (P<.05) reducedConclusions:The striated muscles innervated by the pudendal nerve are of paramount importance for the closure function in the resting state all along the urethra. Urethral elastance and hysteresis seem to depend on activity in the surrounding striated muscle fibers. (Obstet Gynecol 1992; 80:906-11)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To evaluate transvaginal sonographic findings in ambulatory patients with suspected pelvic inflammatory disease (PID).Methods:We studied 51 outpatients with a mean age of 26.8 years (range 16-52) who had a history of low abdominal pain, negative pregnancy test, and no gynecologic procedures performed during the last month. Endometrial biopsy was used for the histopathologic diagnosis. The presence of plasma cell endometritis was used as the criterion standard for the diagnosis of PID. Sonography was performed before biopsy in a blinded fashion without knowledge of the clinical findings and laboratory results except for the pregnancy test. Repeat pelvic and ultrasound examinations were performed 4 weeks after antimicrobial therapy.Results:Endometrial biopsy revealed plasma cell endometritis in 13 cases (25%). Thickened fluid-filled tubes were seen in 11 of 13 patients (85%) with plasma cell endometritis and in none of those without. Other sonographic findings associated with plasma cell endometritis were polycysticlike ovaries and free pelvic fluid. A sonogram suggestive of PID, ie, thickened fluid-filled tube with or without free pelvic fluid, had a sensitivity of 85% and a specificity of 100% for the diagnosis of plasma cell endometritis. None of the patients with a normal sonogram or simple cyst had plasma cell endometritis. Repeat examination after 4 weeks showed that the sonographic findings had resolved in 60% of the patients who had had histologic evidence of infection.Conclusion:Transvaginal sonography can facilitate the outpatient management of patients with suspected PID. (Obstet Gynecol 1992;80:912-6)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

One thousand postmenopausal women were examined prospectively with transvaginal ultrasound. Seven hundred forty-three (74%) were asymptomatic and presented for screening. Data were analyzed to determine the accuracy of this new modality. Eighty-three women had surgery, and 29 malignant neoplasms were found. Color flow was identified in 27 of 29 malignant tumors and 35% of benign masses. A cutoff value of 0.41 for the Doppler resistance index in the feeder vessels had the best discriminatory value; sensitivity and specificity were 96 and 95%, respectively, for separating benign from malignant neoplasms. Positive and negative predictive values were 96 and 95%, respectively. Morphology alone had poor sensitivity, but when combined with Doppler indices, the sensitivity improved to 90% and the positive and negative predictive values were 90 and 96%, respectively. The results of this study suggest that in the postmenopausal ovary, transvaginal B-mode imaging, color flow, and Doppler indices satisfy criteria as tests that may be sensitive and specific enough for application in a screening program. (Obstet Gynecol 1992;80:917-21)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To evaluate whether transvaginal Doppler ultrasound is more valid than transvaginal sonography, magnetic resonance imaging (MRI), and CA 125 in differentiating malignant from benign ovarian tumors.Methods:Sixty-three patients with ovarian tumors (36 benign and 27 malignant) were studied with transvaginal Doppler ultrasound before surgery. Blood flow velocity waveforms arising from intratumoral and/or tumor surface arteries were assessed by calculating the resistance index. Transvaginal B-mode sonography and MRI imaging examinations were also conducted. Serum CA 125 levels were measured.Results:There was a significant difference between the resistance index value (0.692 ± 0.188) in benign tumors and the value (0.503 ± 0.107) in malignant tumors (P<.05). When 0.72 (mean of the malignant tumor resistance index values + 2 standard deviations) was considered as the cutoff value of the resistance index, the sensitivity and specificity of the resistance index in detecting malignant ovarian tumors were 92.6 and 52.8%, respectively. These values did not differ significantly from those with transvaginal sonography diagnosis (sensitivity 85.2%, specificity 69.4%). The resistance index sensitivity was significantly higher than those with MRI diagnosis (66.7%) and CA 125 levels (59.3%) (P<.05); however, the resistance index specificity was significantly lower than those with MRI diagnosis (97.1%) and CA 125 levels (91.7%) (P<.05).Conclusion:Our results suggest that transvaginal Doppler ultrasound does not provide more useful diagnostic information than transvaginal sonography, MRI, and CA 125 for the differentiation of malignant from benign ovarian tumors. (Obstet Gynecol 1992;80:922-6)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To compare prognostic information from the new surgical staging system of the International Federation of Gynecology and Obstetrics (FIGO) with the old clinical staging system for vulvar cancer.Methods:One hundred six women with previously untreated squamous cell carcinoma of the vulva who underwent radical vulvectomies and inguinal lymph node dissections at the University of Oklahoma from 1971-1990 were considered eligible for this study. A retrospective chart review was conducted to assign surgical stage. The clinical and pathologic factors analyzed for survival included the clinical and surgical stage of disease, nodal status, tumor size, and lesion location.Results:Overall 5-year survival was 64%. Forty-three patients had inguinal and femoral node metastasis with a 5-year survival of 38%, versus 87% for patients without nodal metastasis (P<.00001). An increased number of positive groin lymph nodes was associated with a poorer prognosis. Thirty-one patients had rumors of 2 cm or less in maximum diameter with no recurrences, versus 52% 5-year survival in the remaining patients (P<.001). Perineal involvement was identified in 24 patients, but did not significantly influence survival.Conclusion:Overall, the new classification system revised by FIGO for vulvar cancer staging places patients into more accurate risk categories. (Obstet Gynecol 1992;80:927-30)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To determine the proper management of patients found to have invasive cancer of the cervix on pathologic examination of a uterus removed for benign indications.Methods:We report 18 patients undergoing hysterectomy who were found to have cervical cancer with invasion deeper than 3 mm and/or lymph-vascular space involvement. None had gross residual tumor following simple hysterectomy. All patients underwent a second operation. Seventeen women underwent a radical parametrectomy, upper vaginectomy, and pelvic lymphadenectomy; one had pelvic and periaortic lymphadenectomy alone because of bilateral grossly positive obturator nodes.Results:Median follow-up was 72 months. One of the 15 women without residual disease or nodal involvement at second operation had pelvic recurrence 66 months after therapy. Three patients with disease identified at radical surgery underwent tailored postoperative pelvic radiation, and two of these had pelvic recurrence. The overall actuarial 5-year survival for the 18 patients was 89%. Operative morbidity was comparable to that of patients undergoing primary radical hysterectomy.Conclusion:This study confirms that patients with unexpected invasive cervical cancer found at total hysterectomy can undergo radical re-operation with low morbidity and excellent cure rates. (Obstet Gynecol 1992;80:931-4)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To assess the diagnostic accuracy of cervical conization in women with adenocarcinoma in situ and to determine whether a select group of women could be managed by conization alone without hysterectomy.Methods:We retrospectively reviewed 40 cases of cervical adenocarcinoma in situ diagnosed on cervical conization.Results:Cervical conization revealed adenocarcinoma in situ alone in 15 women. Twenty-five women had adenocarcinoma in situ coexisting with squamous dysplasia (23) or microinvasive squamous cell carcinoma (two). Twenty-two women underwent hysterectomy after cone biopsy. Adenocarcinoma in situ was detected in the hysterectomy specimen in one of 12 women with uninvolved cone margins, versus seven of ten women with involved margins (P=.006); two of these seven women also had foci of invasive adenocarcinoma in the hysterectomy specimen. Conization was the only treatment for 18 selected women with adenocarcinoma in situ and uninvolved margins; all were relapsefree after a median interval of 3 years (range 1.5-5).Conclusions:Women with cervical adenocarcinoma in situ diagnosed by conization who have positive margins are at high risk of residual adenocarcinoma in situ and moderate risk of occult invasive adenocarcinoma; expectant management is not warranted. However, a cone biopsy with uninvolved margins can reliably guide subsequent therapy. Selected young women who desire preservation of fertility and have uninvolved margins probably can be managed by conization alone, but further study is required to establish the safety of this approach. (Obstet Gynecol 1992,80:935-9)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:To determine whether there is a significant difference in treatment outcome and acute and chronic complications in obese compared with non-obese women having radical hysterectomy for early-stage cervical cancer.Methods:From 1970-1985, 320 women underwent a class III radical hysterectomy and pelvic lymphadenectomy for stage IB-HA invasive cervical cancer at Duke University Medical Center. Forty-three of these women weighed at least 80 kg and had a body weight greater than 25% above their ideal predicted weight. These women were compared to 277 patients with normal weight for height.Results:The median age, incidence of diabetes mellitus and hypertension, number of nodes removed at lymphadenectomy, disease-free survival, length of hospital stay, and serious surgical or medical complications were the same in the two groups. However, obese patients had a significantly higher estimated blood loss, greater incidence of transfusion, and longer operative times.Conclusions:Survival is not compromised and the incidence of serious complications is not increased in obese patients treated with radical hysterectomy, but the operative technique is more difficult, the procedure lasts longer, and the surgery is associated with greater blood loss. (Obstet Gynecol 1992;80:940-3)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID