ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundOgilvie syndrome is an uncommon, potentially fatal postoperative complication manifested by abdominal distension, cecal dilatation without mechanical obstruction, and, in some cases, bowel ischemia and perforation.CasesCase 1: An 81-year-old woman underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. She was discharged and returned home on postoperative day 3 but sought treatment on postoperative day 5 for abdominal distension. Abdominal radiographs revealed a cecum dilated to 11 cm in diameter. The dilatation resolved with conservative management. Case 2: An 87-year-old woman underwent the same procedure. On postoperative day 3 she complained of abdominal distension, and her cecum measured 14 cm in diameter. Colonoscopic decompression failed, as did Cystografin enema. She successfully underwent a right hemicolectomy with primary ileotransverse anastomosis.ConclusionThe abdominal distension of Ogilvie syndrome must be differentiated from simple adynamic ileus. Early intervention may prevent mortality.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesA modification of the colposacropexy and hysterosacropexy procedures to minimize the risks of presacral hemorrhage and deviation of the vagina to a vertical axis.MethodsEighteen women with posthysterectomy vault prolapse and one woman with uterovaginal prolapse underwent abdominal colposacropexy and hysterosacropexy with polypropylene mesh or collagen implant and titanium bone anchors introduced in sacral segments 3 and 4. The postoperative vaginal axis was ascertained with MRI.ResultsSurgery resulted in a marked improvement in the level of cuff elevation, and awareness of genital prolapse disappeared in all women. There were no intraoperative or postoperative complications, and the median blood loss was 75 mL. The median length of follow-up was 27 months. None of the patients reported de novo incontinence, defecation problems, or sexual dysfunction. MRI demonstrated a vaginal axis toward the hollow of the sacrum in all women. There were no cases of osteitis of sacral segments 3 and 4. Vaginal vault prolapse recurred in two women after 8 months due to breakage of the sutures between the mesh/implant and the titanium bone anchors. Follow-up at respectively 48 and 17 months after repeat colposacropexy was uneventful.ConclusionsIn this preliminary study colposacral suspension using titanium bone anchors gives excellent anatomical results with low intraoperative and postoperative complication rates.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveSurgical repairs of a paravaginal defect using both transvaginal and retropubic approaches have been described. The authors compare suture position of the two approaches in a cadaveric model.MethodsTwo adult female cadavers with evidence of bilateral paravaginal defects on physical examination were selected. Paravaginal defect repairs, both transvaginal and retropubic, were completed by one surgeon on each cadaver. The surgeon was blinded to suture position of each technique.ResultsBoth transvaginal and retropubic paravaginal repairs were able to reduce the paravaginal defect. The retropubic approach allows more uniform suture approximation with incorporation of the ischial periosteum and iliococcygeus fascia. The transvaginal approach allows excellent suture position in the midtendinous arc, but it does not achieve the proximal to distal width of suture placement that is achieved through the retropubic approach. There was no incorporation or violation of the internal iliac vessels, pudendal vessels, or obturator nerve with either approach.ConclusionParavaginal repair may be performed both transvaginally and retropubically. The retropubic approach allows more proximal placement of sutures and has better incorporation of tissues in the ischial periosteum and iliococcygeus fascia than the transvaginal approach.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThe authors describe the technique of closure of a 7-cm vesicovaginal fistula involving the trigone and bladder neck with a suprapubic approach and a myocutaneous gracilis flap.Materials and MethodsA patient underwent the procedure in a primary attempt to close the fistula. She required two additional procedures for correction of small cribriform fistulas, which then resulted in complete closure of the original injury.ConclusionAn abdominal approach using a myocutaneous gracilis flap for the repair of a vesicovaginal fistula is a particularly useful technique for restoring a large area of tissue loss and maintaining bladder and vaginal capacity.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Pelvic floor dysfunction (PFD) is a disorder predominantly affecting females. It is common and undermines the quality of lives of at least one third of women. There is little agreement on the reasons for such a high prevalence of pelvic floor disorders, the relative importance of specific risk factors that predispose to their development, or the poor outcome sequelae of treatment or subsequent prevention. Mechanical, neural, and endocrine disturbances all play a role in the development of PFD with the principal causative factors associated with childbirth and obstetric injury, previous gynecological or anorectal surgery, aging, menopause, obesity, and conditions that produce chronic pelvic floor straining. Subsequent deterioration in long-term pelvic floor support and function of the pelvic viscera is the result of either direct muscular damage (for example to the anal sphincter complex) and/or cumulative pressure that leads to weakness and injury to the pelvic muscles, ligaments, and the pudendal nerve supplying them. There is a wide range of functional problems seen with pelvic floor disorders. They are anatomically grouped together and are often assessed and managed within individual specialties rather than within a comprehensive multidisciplinary setting. It is has been found that an established team approach with fully integrated services can be more effective and offers many advantages including dynamic links between disciplines, appropriate and timely investigations and referrals, and better coordination of patient-centered care. Many disciplines may be involved in the care of women with pelvic floor dysfunction, yet evidence-based treatment strategies are still lacking and there is little consensus on a standardized treatment approach in this area. Integrating services can be problematic, especially when a degree of flexibility and understanding is required to initiate change and adopt new practices. Inherent in achieving and promoting better services for women with PFD are new approaches to care that focus on the development of combined outpatient and joint surgical procedures and introduction of evidence-based combination therapies. The aim of this paper is to discuss current practice for each of the main pelvic floor disorders and consider how assessment, management, and treatment outcomes of combined symptomatology may be improved.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo describe the medical student clerkship experience and relative value of that experience with regard to female pelvic floor dysfunction (PFD).MethodsIn June 2001, 141 new PGY-1 house staff completed a 12-item questionnaire that included medical school attended, amount of time spent on obstetrics and gynecology clerkships, name and time spent on a fourth-year OB/GYN elective (if pertinent), name of designated residency, as well as questions describing their didactic and clinical experience with female PFD topics (urinary incontinence, pelvic organ prolapse, fecal incontinence, pelvic pain, and sexual dysfunction). In addition, participants were asked to indicate the relative value they placed on their PFD instruction during third and fourth year of medical school.ResultsRespondents represented 85 US medical schools and 11 chosen residencies. Time spent on third-year OB/GYN clerkships ranged from 3 weeks to 3 months (median: 6 weeks), and time spent specifically on gynecology for third-year clerks ranged from 2 weeks to 2 months (median: 3 weeks). While rotating on OB/GYN clerkships, 34.0% to 70.2% of house staff recalled receiving a didactic lecture on a PFD topic, while 51.8% to 92.9% remembered seeing at least one patient with a PFD condition. This varied greatly according to the specific type of PFD condition. In general, new OB/GYN, family practice, and general medicine residents reported a higher degree of relative value for education on pelvic floor disorders.ConclusionPGY-1 house staff report varied medical school didactic experiences and exposure to patients with female pelvic floor dysfunction. Given the likelihood of increasing prevalence of female PFD conditions in the population, the authors advocate a critical reassessment of both the content and the systematic evaluation of current medical school curricula to address this need.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID