ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveCan the patient’s intraoperative and postoperative safety be improved using operative laparoscopy with sole incision of the abscess cavity and lavage (organ-preserving treatment) compared with laparoscopic salpingectomy or salpingo-oophorectomy (ablative treatment)?MethodsFrom 1994 to 1999 the authors performed a retrospective chart review of 68 patients with tubo-ovarian abscess (TOA) undergoing laparoscopic treatment in combination with broad-spectrum antibiotics. Patients not wishing to remain fertile underwent salpingectomy or salpingo-oophorectomy whereas patients wishing to remain fertile were treated by means of an organ-preserving procedure.ResultsThirty of 68 women with TOA were treated laparoscopically preserving the internal genital organs. Thirty-eight patients received ablative treatment. In the organ-preserving group there were no operative complications or serious systemic sequelae apart from two postoperative re-admissions for pelvic pain. With ablative treatment, however, the authors found a significantly higher incidence of intraoperative and postoperative complications.ConclusionWhen laparoscopic treatment of TOA is performed, organ-preserving treatment should be preferred in order to reduce the risk of complications. This choice should be made irrespective of the patient’s age or desire to remain fertile.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine the characteristic features of complete rectal prolapse in patients with schistosomiasis and to evaluate the anatomical and functional results of limited rectal dissection and reconstruction of the pelvic floor, with or without sigmoid resection.MethodsThirty-two patients with complete rectal prolapse were divided into two groups according to the presence (group 1, n = 22) or absence (group 2, n = 10) of schistosomiasis. Rectal involvement was confirmed by rectal snip biopsy. Patients were subjected to clinical assessment, proctoscopy (or flexible sigmoidoscopy), barium enema or colonoscopy, and abdominal ultrasonography. Anal canal manometry and proctometrography were performed preoperatively and at 6 months postoperatively. Hydroxyprolene content in the anterior rectus sheath was measured by high-performance liquid chromatography in both groups and in control subjects (schistosomal and nonschistosomal) without complete rectal prolapse .ResultsIn the schistosomal group, there were 18 men (81.1%) with a mean age of 27.05 years. In the nonschistosomal group, there were 8 women (80%) with a mean age of 64.6 years. Characteristically, schistosomal patients had splenomegaly (100%), hepatomegaly (72.7%), anemia (mean Hgb % = 67), hypoalbuminemia (mean = 3.1 g/dL), and collagen deficiency. There was no significant difference between groups in the resting anal pressure (RAP), maximum squeeze pressure (MSP), or volume at which rectal sensation was first perceived. Patients with schistosomiasis had a shorter functional anal canal length (FACL) at rest and on squeeze (P< 0.05). Postoperatively, there was a significant increase in RAP and reduction in the volume required for first rectal awareness in both groups (P< 0.05). Anatomical reduction was achieved in all patients. There was no postoperative constipation. Incontinence improved in 75% of cases (6/8), and ejaculatory power was maintained in all male patients.ConclusionComplete rectal prolapse in patients with schistosomiasis represents a particular clinicopathologic entity. It occurs most commonly in young men who are usually anemic and hypoproteinemic and who have collagen deficiency and a shorter FACL than nonschistosomal patients. One-sided rectal dissection and pelvic floor reconstruction with sigmoidectomy in patients with redundant sigmoid proved to be a safe procedure, efficient in achieving anatomical correction, with improvement of incontinence in the majority, preservation of ejaculatory power in all young men, and no postoperative constipation.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine if a correlation exists between the fluid-filled, lateral vesicocervical peritoneal depressions (“puddle signs”) and paravaginal defects.MethodsThe authors’ prospective randomized case analysis spanned January 1998 to August 1998, involving multiparas undergoing laparoscopic tubal sterilization at the University Hospital’s Benign Gynecology Service. Certain of those exhibiting the largest “puddle signs” agreed to undergo postoperative MRI to identify any paravaginal defects that might be associated with these “puddle signs.”ResultsIn each of the 10 laparoscopic cases undergoing MRI, ipsilateral paravaginal defects were imaged that corresponded to the sites of the laparoscopic “puddle signs.”ConclusionLaparoscopically, the lateral vesicocervical peritoneal depressions seem to result from the empty bladder dome peritoneum collapsing into the pathology of the paravaginal breaks. The normal peritoneal fluid, or blood-tinged fluid instilled, fills the peritoneal depression over the defect, and reflects the “virtual” image of the paravaginal defects hidden beneath.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo investigate clinical outcome of the pubovaginal sling (PVS) procedure using autologous fascia versus cadaveric dermal patch.MethodsThis was a retrospective cohort study where hospitalization data of 36 consecutive women who underwent PVS for stress incontinence diagnosed by video-urodynamics were reviewed. A single surgeon performed surgeries over a 10-month period. The first 17 women underwent autologous fascia PVS, whereas the subsequent 19 women underwent PVS using a cadaveric dermal patch. Length of surgery, hospitalization, outcome, and cost were compared for the two groups.ResultsFifteen of 17 women with autologous and 17/19 with cadaveric dermal patch slings had significant improvement or cure of SUI. One patient per group developed de novo detrusor instability. With the cost of surgery US$39/min, the average room charge of US$400/d, and the average cost of the dermal graft US$275 at our institution, a cost savings of nearly US$750 per patient is expected when using the cadaveric dermal patch. Additional savings are possible when considering reduced nursing needs and narcotic usage, which were not measured in this study.ConclusionThe use of cadaveric dermal patch slings resulted in significantly reduced operating time and length of stay when compared to the standard autologous fascia sling. A potential cost savings is generated by use of the allograft sling without increased morbidity or decreased clinical success.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine whether postoperative ketorolac use is associated with decreased length of stay in patients with gynecologic malignancies.MethodsA retrospective review of 150 patients undergoing hysterectomy for cervical or uterine cancer between 1996 and 1998 was conducted. Information was collected on length of stay and postoperative course. Ketorolac users and non-users were compared using the two-samplet-test and Fisher’s exact test. Regression analysis was performed to control for year of surgery, age, stage of disease, and operative procedure.ResultsPatients who received ketorolac (n = 87) compared to those who did not (n = 63) had shorter length of stay (4.0vs.5.4 daysP< 0.001). The difference remained statistically significant after regression analysis was performed to control for confounding variables. The ketorolac group used less morphine (76.2 mgvs.105.8 mg,P= 0.003), tolerated feeding earlier (P< 0.001), and experienced less ileus (6.9%vs.19%,P= 0.039) and fever (5.7%vs.19%,P= 0.017). Mean pain scores, postoperative infection rates, and readmission rates were not different between the two groups.ConclusionIn patients undergoing surgery for gynecologic malignancies, the use of ketorolac for postoperative pain control was associated with decreased length of stay. Less morphine use and decreased incidence of postoperative complications may have resulted in earlier discharge.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundVarying goals of treatment have led to different strategies for urinary diversion.MethodIn this review, the authors review the background of different strategies and principles of urinary diversion that have developed in North America and Europe. Errors and negative developments are analyzed, as are the influences of the different surgical schools on the application and propagation of different surgical techniques. The significance of relevant publications is discussed.DiscussionIncontinent urinary diversion in adults and orthotopic bladder substitutions with ileal segments will stand. More sophisticated techniques using the transverse or the ileocecal segment are reserved for patients after irradiation or respectively in children and the detubularized rectal reservoirs for the so-called third world. Quality of life studies in the civilized countries showed no difference in the adult patients between continent and incontinent urinary diversion. Conversion from incontinent to continent, however, improved the quality of life.ConclusionMyriad factors have influenced the evolution of urinary diversion techniques. The urologist’s role in modern oncology must be re-evaluated to prevent part of urinary diversion being lost to the general surgeons.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundColorectal cancer is a genetic disease caused by inactivation or abnormally enhanced function of specific genes that control cell division, cell growth, cell–cell interaction, and cell death. Cell lines with defective genes acquire survival advantages over their normal neighbors. Ultimately some of these cell lines will gain enough of a survival advantage to make them capable of independent growth as malignant cells. The DNA in these neoplasms shows evidence of the genetic defects: mutations, loss of heterozygosity, hypermethylation, or microsatellite instability.Whereas all colorectal neoplasms are genetic, only a few are inherited. The patient with an inherited mutation is primed for early-onset, multifocal disease. The main inherited syndromes that affect the colon and rectum are hereditary nonpolyposis colorectal cancer (HNPCC), familial adenomatous polyposis (FAP), familial juvenile polyposis (FJP), and Peutz-Jehger’s Syndrome (PJS). The significance of inherited colorectal cancer lies not just in the clinical treatment of families affected by these syndromes but also in what can be learned from the syndromes and applied to colorectal cancer in general.DiscussionTesting for germline mutations plays an important role in the treatment of patients with a dominantly inherited syndrome of colorectal cancer. The tests to be used depend on the syndrome and the genes to be tested. In general the mutation is sought in an affected relative first and then in other at-risk family members. In patients without an obvious inherited syndrome, tumors may be tested for microsatellite instability or evidence of mismatch repair deficiency. Immunohistochemistry for expression of mismatch repair proteins may reveal which gene is mutated.Extraction of tumor DNA from stool is a promising new technique that may make fecal occult blood testing obsolete. If the cost is acceptable and test performance is confirmed by large-scale studies, stool DNA analysis may allow accurate triage of patients for colonoscopy, and may even separate patients with mismatch repair–deficient tumors from those with tumors caused by chromosomal instability.Genetic profiling of tumors may provide prognostic information over and above that given by traditional histopathology. Occult nodal metastases may be detected by various genetic techniques and may also be used to refine prognosis and to triage patients for adjuvant therapy.Genetic profiles of tumors may suggest resistance or susceptibility to various types of chemotherapeutic agents. Adjusting protocols to fit genetic information about the tumor may optimize chemotherapy. Chemoprevention of tumors may also be prescribed appropriately for the particular syndrome or tumor type concerned. Gene therapy offers the prospect of treating inactivated genes by reinserting wild-type alleles into tumors.ConclusionDifferences in tumor biology related to the genetic pathways of tumor origin are being identified. Such genotype/phenotype relationships may be useful in differentiating mismatch repair–deficient from mismatch repair–competent tumors, in defining inherited syndromes of these tumor types, and in refining prognosis. Techniques that allow tumor DNA to be recovered from stool may usher in a new era of noninvasive screening, whereas genetic profiles of tumors may allow chemotherapy and chemopreventative drugs to be tailored specifically for each cancer. Further work in discovering as yet unrecognized genes, in refining gene therapy, and in developing cheaper and easier techniques for DNA analysis make for an exciting future.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundPrimary malignant melanoma of the female urethra is a rare pathology. Treatment options are still debated.CaseThe authors describe a patient with a primary malignant melanoma of the urethra 5.4 cm in diameter presenting as postmenopausal vaginal bleeding and treated with anterior pelvic exenteration. No adjuvant therapy was administered. The patient died of pneumonia shortly after discharge.DiscussionHistogenesis, diagnosis, therapy, and prognosis of malignant melanoma are discussed briefly.ConclusionSuccessful treatment of malignant melanomas of the urethra has been reported. These tumors should be treated aggressively. The role of adjuvant &agr;-interferon and chemotherapy is currently under investigation. Involvement of lymph nodes and depth of invasion are important prognostic factors.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundAngiomyofibroblastoma (AMFB) is a recently described and rare soft tissue tumor that has been documented in multiple sites within the female pelvis. In females, it primarily affects the vulva and vagina.CaseA 47-year-old woman gravida 2, para 2, presented with right buttock enlargement and asymmetry. She was referred for presumed lipoma. During the buttock dissection a large fleshy tissue mass was encountered, and the operation was terminated. Additional radiologic study was obtained which revealed a large paravaginal/pararectal mass. Subsequent exploratory laparotomy with retropubic dissection revealed a 25 × 9 × 1.5-cm fleshy, soft-tissue mass. Pathologic examination confirmed an AMFB.ConclusionAMFB can occur anywhere in the pelvis, including the retropubic space. It should be considered in the differential diagnosis of a solid pelvic mass and distinguished from the more aggressive angiomyxoma by histology and immunohistochemical techniques.

ISSN:1077-2847    

出版商:OVID    

年代:2002

数据来源: OVID