ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundBefore the standardized quantification of pelvic organ prolapse approved by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons in 1996, comparisons of efficacy among various procedures were difficult to assess. Although the three-by-three grid form used for quantitative description of pelvic organ prolapse provides objective measurement, the numbers on the grid do not immediately conjure up the image of the specific prolapse. The authors report a simple office form that incorporates the objective quantification of pelvic organ prolapse and simultaneously illustrates the sagittal profile of the prolapse.MethodSpecific measurements are made using the hymen as the fixed point of reference. The two-dimensional profile is created as the various measurements are plotted on a graph paper. In addition, the paravaginal defect, if present, can be recorded on the rectangle, with each corner of the rectangle representing the corner on the cross-section of the vagina.ConclusionThe authors have used this form to record the pelvic prolapse profile in 109 women since July 1997. The authors find the form easy to complete. The form provides a quick, comprehensive depiction of the prolapse while retaining the original standardized quantification approved by the International Continence Society, the American Urogynecologic Society, and Society of Gynecologic Surgeons. This form is invaluable for follow-up after pelvic prolapse surgery.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective: To develop and evaluate an alternative office injection system for the transurethral injection of collagen that could be performed using a flexible or rigid cystoscope.Methods: Patients who were candidates for periurethral collagen injection were advised that the procedure could be performed in an office setting. A 16-gauge angiocatheter sheath was attached to the cystoscope using sterile adhesive tape or shrink-wrap and inserted into the urethra. At the level of the urethrovesical junction, a 20-gauge needle connected to a syringe of collagen was guided to this area using the angiocatheter. The collagen was injected in the usual fashion.Results: The procedure has been performed in 39 patients for a total of more than 70 cases; 3 of 39 patients (8%) did not become continent despite multiple injection sessions. When analyzed by procedure, the median collagen amount used was one syringe (median, 2.5 mL; mean, 3.1 mL; range 1.3–11.0 mL); when analyzed by patient, less than two syringes of collagen were used (median, 4.5 mL; mean, 5.8 mL; maximum, 20.0 mL; minimum, 2.0 mL) No procedure was discontinued because of patient discomfort or inability to complete the procedure.Conclusion: Using the technique described, the transurethral injection of collagen can be safely injected in the office setting using a minimal amount of collagen (one syringe per procedure, two syringes per patient to achieve dryness.) The technique is easy to master and is accepted by patients who are candidates for the procedure.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective: To investigate long-term urodynamic changes in continent colonic reservoirs.Materials and Methods: Seventeen patients (10 men, 7 women) with a mean age of 56 years underwent continent colonic diversion. All patients underwent enterocystometry and efferent limb outlet pressure profiles at 1 year and 4 years after surgical reconstruction.Results: Volume at maximum enterocystometric capacity remained unchanged or increased in 15 patients (88%). Pressure at maximal enterocystometric capacity remained unchanged or decreased in 15 patients (88%). Bowel segmental contractions remained unchanged or decreased in 12 patients (71%). Maximal outlet pressure decreased in 11 patients (64%) when the reservoir was empty and in 12 patients (71%) when the reservoir was full.Conclusions: Over time, continent colonic reservoirs maintain adequate volume and compliance without the development of segmental bowel contractions. However, there is a concerning decrease in maximal outlet pressure in more than half the patients. This alteration could be responsible for the late development of incontinence in some patients.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objectives: To evaluate the influence of retroperitoneal drainage on intraoperative and postoperative morbidity in patients undergoing radical hysterectomy with pelvic and paraortic lymphadencctomies for early-stage cervical cancer.Materials and Methods: Medical record charts of patients who underwent radical hysterectomy for early cervical cancer from January 1990 to December 1994 were reviewed. Patients were organized into two groups. One group underwent the Miami modifications of the Wertheim-Meigs procedure, which includes reperitonealization and retroperitoneal drain placement. The other group underwent the same procedure without peritoneal closure or drain placement.The groups were compared with respect to operative and postoperative morbidity. The Fisher exact test and chi-square analysis were used to analyze the results.Results: One hundred five patients were included in the “drain” group and 89 were included in the “no drain” group. Both groups had similar demographic features, cancer stage, grade, and histology. There were no significant differences in operative or postoperative complications, including fever or lymphocyst formation.Conclusions: The use of retroperitoneal drains does not decrease morbidity in patients undergoing radical hysterectomy with lymphadenectomy for early cervical cancer.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective: To review the current state of knowledge and propose new areas of investigation using intravascular ultrasound catheters to study disorders affecting the urethra.Materials and Methods: The medical literature from 1966 to present was searched using the MEDLINE database (keywords: ultrasound, urethra) to obtain all pertinent articles. Each article was reviewed along with its reference list to identify any additional articles not found with the author's initial search. Data from the author's experience was included to support previous work already published.Discussion: Miniaturized endoluminal ultrasound probes contain a rotating transducer that produces a 360° cross-sectional image of urethral anatomy. There are distinct morphologic differences in urethral anatomy when comparing patients with stress incontinence to continent controls. Other uses of this technology include the evaluation of suburethral masses, ultrasonographic guidance of concentric needle electromyography, collagen injections, and transperineal prostate biopsy.Conclusion: The role of intraurethral ultrasonography in the evaluation of disorders affecting the urethra has yet to be defined because further investigation is needed.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background: It is uncertain whether the dramatic increase in the number of vaginal hysterectomies performed in the United States between 1988 and 1993 is the result of improved medical and economic outcomes associated with the vaginal approach or is caused by a proliferation of postgraduate courses in vaginal surgery. Many conditions assumed to contraindicate the vaginal approach have not withstood scientific scrutiny. Although better outcomes have been associated with the vaginal approach, unintentional operative cystotomy with the procedure is a concern, especially in patients who underwent previous cesarean section.Discussion: Office and hospital records of 3,447 patients undergoing vaginal hysterectomy were reviewed. The indications for surgery, age, parity, and uterine weight were analyzed and compared with patients who underwent previous cesarean section and those who did not. A total of 2,793 (80%) patients who did not undergo previous cesarean section underwent hysterectomy; 654 (20%) patients underwent previous cesarean section. The overall incidence of operative cystotomy was 21 of 3,447 (0.6%).Summary: The low incidence of the operative cystotomy complication in patients who did and did not undergo previous cesarean section merits consideration by gynecologic surgeons who perform vaginal hysterectomy.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background: Data regarding radiation treatment of patients with pelvic neoplasms who also have inflammatory bowel disease are limited. Therefore, the effect of pelvic radiation therapy on bowel complications in patients with Crohn's disease is not clearly known.Case Report and Discussion: We describe a patient with stage IB2cervical cancer and Crohn's disease whose planned radical hysterectomy was aborted because of grossly positive pelvic lymph nodes. Therapy consisted of external beam radiation and brachytherapy. Seven months after completion of her radiotherapy, she was diagnosed with a pelvic mass that caused a large bowel obstruction. She underwent computed tomography-guided drainage of the pelvic mass followed by exploratory laparotomy and transverse loop colostomy. The pelvic mass was a concealed abscess. The patient continues to be cancer free 18 months after completion of therapy.Conclusion: Surgical management of cervical cancer should be the preferred treatment in women with Crohn's disease.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Research on the glycogenic function of the liver, on the neural control of the circulation, and on blood plasma earned Claude Bernard (1813–1878) international recognition as a distinguished teacher and experimental physiologist.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID