ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Transvaginal paravaginal repair reattaches the pubocervical fascia and vaginal epithelium to the arcus tendineus fasciae pelvis as an adjunctive repair of paravaginal defects in pelvic floor reconstruction.Methods and Materials:Twenty‐five patients underwent transvaginal paravaginal repair as an adjunctive procedure in the repair of severe or recurrent pelvic relaxation.Results:Two patients (8%) had a site‐specific recurrence. Five of six patients had resolution of incontinence with no new incontinence; 6 patients (24%) had central recurrent cystoceles; 3 patients (12%) had apex‐fixation failures. Sexual function was maintained in patients who were sexually active preoperatively.Conclusion:Transvaginal paravaginal repair provides a high site‐specific success in repair of paravaginal defects. Midline anterior compartment failures were common until midline cystocele repairs were added to the procedures. Apex failure contributed to one of the two lateral failures.

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To examine the clinical usefulness or predictive value of measuring endometrial thickness using ultrasonography in patients receiving tamoxifen as adjuvant therapy for breast carcinoma.Methods:A retrospective chart review was conducted at Lehigh Valley Hospital from 1994 to 1997 on patients who 1) received tamoxifen therapy for at least 12 months, and 2) received a screening transvaginal ultrasonogram and subsequent endometrial sampling for histologic evaluation. Critical study variables included patient age, duration of tamoxifen therapy, endometrial thickness, descriptive ultrasonographic findings, and the final histologic diagnoses.Results:Fifty‐four patients were identified by the inclusion criteria. The study population had similar pathological diagnoses when compared with previous studies. The sensitivity and specificity for pathologically significant diagnoses found on screening ultrasonography alone when using an endometrial thickness of 9 mm were 77% and 59% respectively, with a positive predictive value of 37% and a negative predictive value of 89%. Fifteen patients with endometrial thickness between 6 mm and 9 mm received biopsies at an approximate total cost of $7875.Conclusion:Ultrasonographic evaluation of endometrial thickness as a screening examination for clinically significant endometrial pathology has an acceptable predictive value at a threshold of 9 mm. This finding suggests an opportunity for an improved cost‐effective protocol in the treatment of these patients. Additional prospective studies are needed to evaluate the appropriate cost‐effective use of screening ultrasonography.

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To determine the incidence of postoperative uterovaginal prolapse after pubovaginal sling.Methods:The charts of 28 patients (mean age, 54 years) with intact uteri who underwent pubovaginal sling were reviewed. Preoperative evaluation included a history, pelvic exam, and videourodynamics. Six patients had a concomitant cystocele repair. The average period of follow‐up evaluation was 30 months. Postoperative serial pelvic examinations and telephone interviews were obtained, and all patients with symptoms of pelvic relaxation or urinary incontinence were reexamined.Results:Pelvic examinations were performed on 24 of 28 patients. Uterine prolapse was identified in one patient with spinal dysraphism, which was a contributing cause. No patient developed recurrent stress urinary incontinence.Conclusion:In neurologically intact women with a well‐suspended uterus preoperatively, postoperative uterovaginal prolapse is not a significant complication after pubovaginal sling.

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To evaluate types of pelvic masses in women with inflammatory bowel disease (IBD), and to compare preoperative evaluation with histopathological findings during surgery.Materials and Methods:Demographic and clinical data of 150 women admitted to the Cleveland Clinic Foundation (Cleveland, OH) between 1985 and 1996 with diagnoses of IBD (Crohn's disease and ulcerative colitis) and pelvic, ovarian, or adnexal masses, cysts, or tumors were analyzed.Results:The study included 150 women with a mean age of 38 years. Twenty‐three women (15%) had symptomatic pelvic masses, 5 (22%) of which were malignant (2 primary ovarian cancers, 3 metastatic intestinal cancers). One hundred twenty‐seven women (85%) had masses that were discovered during routine examination, radiologic studies, or IBD surgery; most were functional cysts or pseudocysts (94 of 127, 74%), and only 2 were malignant.Conclusion:Women with IBD who develop new symptoms related to a pelvic mass are at high risk for malignancy.

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Despite improvements in the initial management of advanced ovarian cancer, the majority of patients with this disease will be candidates for a second‐line treatment strategy. Chemotherapy options in this setting include reinitiation of the same or similar drugs used during initial therapy, or a number of alternative agents.Discussion:Maximizing the quality of life is a critically important overall goal in the selection of second‐line management approaches in ovarian cancer. When appropriately applied, surgery can play an useful role in this clinical setting. Radiation may have a role as a second‐line strategy in carefully selected patients with localized recurrent or persistent disease in the pelvic region.Summary:Currently, palliation of symptoms and prolongation of the symptom‐free and progression‐free survival are the realistic aims of second‐line therapy of ovarian cancer.

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:In developed countries, the most frequent cause of vesicovaginal fistula is iatrogenic, and occurs during obstetric or gynecologic surgery. In Morocco, a more common etiology is prolonged or difficult labor, and most ofter fistulas are large and involve the urethra and bladder. Pelvic trauma and sexual intercourse have occasionally been cited as a cause of vesicovaginal fistula. Recently, other causes of vesicovaginal fistulas have been reported, such as Behçet's disease.Case:A 24‐year‐old woman was referred to our department for stress urinary incontinence of 2‐week duration.Procedure:Surgical repair via the transvaginal approach was accomplished using general anesthesia. Intraoperative assessment demonstrated a large defect involving the urethra, bladder neck, and lower portion of the trigone. The fistula was repaired in three layers with 3‐0 polyglycolic acid suture. At the end of the procedure, the urethral catheter was removed and a suprapubic catheter was left in the bladder for drainage. Cystostomy was removed after 15 postoperative days, and voiding occurred immediately without urine leakage.

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:The intrauterine contraceptive device (IUCD) has been used for many years. Its efficiency and low cost have made it one of the leading contraceptive methods in developing countries. However, the device is often inserted by midwives with variable skill, and follow‐up evaluations are irregular or absent.Cases:The first case reported is that of a 39‐year‐old woman. In the 6 years after IUCD insertion and before examination in our department, she had experienced two nonmedically assisted childbirths without removal of the IUCD. The second case reported involves a 35‐year‐old woman who delivered a child without the removal of an IUCD, which had been inserted by a midwife in a family planning center 3 years earlier. In both cases, there was no history of follow‐up visits after IUCD insertion. Both patients presented with a urinary bladder stone that had formed on an IUCD.Conclusion:Uterine perforation can occur when the IUCD device is inserted, and can lead to transmigration of the IUCD from the uterine cavity to other pelvic cavities. Seeking minimal invasiveness, we opted for the endoscopic management of these IUCD‐related complications.

ISSN:1077-2847    

出版商:OVID    

年代:2000

数据来源: OVID