ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundRectourethral fistula repair remains a challenge for reconstructive surgeons. Operative exposure is difficult and successful fistula closure short-lived. The chances of success are even less in the face of prior failed operations or adjuvant therapies. A growing number of latent fistulas were observed to occur after combined radiotherapy and cryosurgery for prostate cancer. In managing these complicated fistulas, consistent success was found using the York Mason approachObjectiveTo demonstrate the technical ease and success of rectourethral fistula repair using the York Mason repair, even in complicated clinical situations.ResultsThree fistula cases that were referred after multiple failed repairs, which were successfully closed using the York Mason approach, are described. Operative repair was performed without complication. Postoperative studies conformed successful fistula closure. At 10 months, the patients remain asymptomatic.ConclusionsThe York Mason approach to rectourethral fistula repair is technically feasible and successful even in the face of multiple failed repairs and chronically injured tissues

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundDiagnostic tools available for nonepithelial vulvar lesion are individual experience, ultrasonography, computed tomography, and magnetic resonance imaging (MRI). Use of MRI in our specialty still is being defined. Two primary advantages of MRI versus ultrasonography and computed tomography are that images can be obtained in any orientation, and soft tissue contrast is superior to other imaging modalities. This makes MRI ideal for diagnostic imaging of the vulva.Case reportsWe present three distinctly different etiologic vulvar mass lesions to highlight the invaluable contribution of MRI to their care.ConclusionsMagnetic resonance imaging is superior to ultrasonography and computed tomography in imaging of nonepithelial vulvar lesions. It provides excellent tissue differentiation with multiplanar orientation and is a helpful adjunct diagnostic tool for uncertain vulvar lesions.

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectivesWe prospectively evaluated the effectiveness and adequacy of endometrial cavity sampling using the Pipelle (Unimar, Wilton,CT)suction curette compared to the hysterectomy specimen.Study DesignAfter methylene blue was instilled in the uterus, Pipelle endometrial sampling was performed immediately before hysterectomy. The excised uterus was examined, and three pathologists read all of the Pipelle sample and hysterectomy slides. Determined adequacy of the Pipelle biopsy sample and diagnoses obtained from the excised uterus and the Pipelle sample were compared; attention was given to interobserver and intraobserver variation.ResultsAdequate Pipelle biopsy specimens were obtained in 17 of 31 (55%) study cases. When the biopsy contained adequate tissue, Pipelle and hysterectomy diagnoses agreed in 76.7% of cases; intraobserver variation was 66.6–100%, and interobserver variation was 74.5–96.7%. Sampling was obtained more consistently from the midportion of the uterus than from the cornua.ConclusionAs a useful diagnostic tool, the Pipelle endometrial suction curette can be used best if its limitations are understood.

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundRestorative proctocolectomy accompanied with ileal pouch anal anastomosis is the ideal surgical solution for the treatment of mucosal ulcerative colitis and familial adenomatous polyposis.Since its first description, the procedure has been adopted by different schools of surgery and modified to obtain optimal functional results and low morbidity and still provide a cure for the disease. These modifications are discussed in this review, limited to the crucial points of controversy.MethodsReview of the current literature was used regarding restorative proctocolectomy accompanied with ileal pouch anal anastomosis.DiscussionTransanal mucosectomy accompanied with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, and finally, indications for pouch surgery in the elderly were individualized as the key points of debate.ConclusionLonger duration of follow-up of patients and increased knowledge and experience with pouch surgery coupled with active prospective evaluation of the procedure are necessary to settle these issues.

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundCertain gynecologic conditions, such as extensive pelvic abscesses, pelvic hemorrhage, intestinal distention, and necrotizing fasciitis, may necessitate reexploration of the abdomen or surgical site. A contemporary closure technique used in trauma surgery can assist pelvic surgeons in the management of wounds that are difficult to close.CaseA temporary abdominal wall closure using a vacuum-packed technique is described in the management of a critically ill patient and outlined in a step-by-step summary.ConclusionThe vacuum-pack closure system used in contaminated wounds in trauma patients may be useful in certain clinical situations in gynecologic surgery that may necessitate reexploration. The vacuum-pack closure offers a unique, temporary technique that is free of associated morbidity and is inexpensive.

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundWandering pelvic spleen is an uncommon radiologic diagnosis in which presentation can be quite dramatic. Previous case reports and literature reviews focused on the use of ultrasound as an initial study for detecting abnormally placed abdominal viscera. The usefulness of helical computed tomography for reaching a definitive, cost-effective diagnosis is vividly illustrated in this case.Case ReportA 53-year-old woman was referred for evaluation of a pelvic mass detected during physical examination. Bimanual examination revealed a firm, somewhat tender, midline pelvic mass in which its long axis was oriented along an anterior-posterior plane. Because of the patient's complicated surgical history, contrast-enhanced helical computed tomography of the abdomen and pelvis were requested, which showed the liver to be markedly enlarged and an obliquely oriented spleen.DiscussionLigamentous laxity or congenital incomplete fusion of the dorsal mesogastrium may allow the spleen to migrate within the peritoneal cavity. This is called a wandering or ectopic spleen. Wandering spleens are quite uncommon.The condition of this patient's pelvic spleen was thought to be related to previous colectomy for ulcerative colitis. Patients with displaced spleens are at significant risk for rupture of the spleen after trauma, leading many to advocate elective splenopexy or surgical resection.SummaryBecause her lifestyle is relatively sedentary, the patient decided not to undergo surgery and was counseled to seek immediate attention after abdominal or pelvic trauma. The patient was referred back to the local health maintenance organization and the local medical doctor for evaluation of hepatomegaly.

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Paracelsus (1493–1541), Swiss physician and alchemist, was one of the most original medical thinkers of the 16th century. He stimulated the development of medical chemistry and, by his attack on the humoral theory of disease, loosened the hold of Galenic medicine.

ISSN:1077-2847    

出版商:OVID    

年代:1998

数据来源: OVID