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Results for “DOUGLAS' POUCH”

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At least 217 records · Page 12Linked to original sources

PubMed2002

Ovarian hyperstimulation-like syndrome after administration of triptorelin to a woman with endometriosis.

Ovarian hyperstimulation after a single dose of gonadotropin-releasing hormone (GnRH) analog is a rare phenomenon. A case of ovarian hyperstimulation-like syndrome after sole administration of triptorelin (Decapeptyl 3.75 mg) is reported in a woman who had undergone surgery for an endometriotic cyst. After administration of the drug, abdominal pressure increased with nausea and diffuse pelvic pain. Ultrasound examination showed bilateral enlargement of the ovaries (right 74 x 62 mm, left 62 x 53 mm), more than 10 follicles ranging in diameter from 15-25 mm, proliferative endometrium 7 mm thick and fluid in the Douglas pouch up to 25 x 23 mm thick. Estradiol plasma level was in the normal range. The syndrome spontaneously resolved in the course of treatment and a spontaneous pregnancy occurred when the triptorelin effect disappeared.

Adult↗

PubMed2003

[Pelviperitonitis and intestinal occlusion: two unusual cold-knife conisation complications].

Complications associated with cold-knife conization are mainly hemorrhage, genital and urinary infections. We presented two cases of accidental posterior colpotomy with Douglas pouch wound initially unnoticed at the time of the cold-knife conization, and secondary complicated by a pelviperitonitis for the first case and by an incarceration of the bowel loop in the vaginal wound for the second case.

Adult↗

PubMedDate not supplied

Peritoneal cytology in patients with gastric cancer exposed to the serosa--a proposed new classification based on the local and distant cytology.

BACKGROUND/AIMS: The clinical impact of the cytology of intraperitoneal samples taken from the local and distant sites was examined in patients with gastric carcinoma. METHODOLOGY: Intraoperative peritoneal cytology was evaluated in 149 patients with gastric cancer invading the serosa but no metastasis to the peritoneum (macroscopic P0), the liver (H0), or distant organs (M0). Lavage samples were collected from the Douglas pouch and the left subphrenium (distant sites). Both lavage and smear samples were taken from the serosal surface invaded by the tumor (local). RESULTS: Positive peritoneal cytology was found in 33 of 149 patients (22.1%). All patients were categorized into three groups: Group I had negative cytology (n = 116, 77.9%), Group II had positive local cytology (n = 14, 9.4%), and Group III had positive distant cytology irrespective local status (n = 19, 12.8%). By multivariate analysis, peritoneal cytology was the only significant independent factor affecting survival. Median survival was significantly shorter in Group III (400 +/- 177 days) than in Group I (2228 +/- 599 days). The peritoneal recurrence-free interval was significantly shorter in Group II than in Group I. CONCLUSIONS: The extent of peritoneal seeding was variable and appeared to have a significant impact on prognosis. Peritoneal cytology should be evaluated not only at a distant site, but also locally to identify the subset of patients with limited peritoneal dissemination.

Female↗

PubMed1992

[Ultrasonographic criteria of diagnosing tubal pregnancy].

The results were subjected to analysis of USG examination of 11 patients with tubal pregnancy, verifying the found echographic anomalies with the intraoperative assessment done shortly after the USG examination. Of greatest usefulness for the preoperative diagnosis of tubal pregnancy is, according to the authors' opinion, coexistence of the following sonographic signs: enlargement of the uterus without echographic sing of pregnancy in the uterine cavity;-a mass of irregular outline, cystic-solid appearance, and axial dimension of above 50 mm, situated near the uterus;-fluid in the Douglas pouch. The experience of the authors shows that ultrasonography is a valuable supplementation of clinical examination and laboratory analysis in the diagnosis of tubal pregnancy, on condition of using objective criteria for sonogram interpretation.

Adult↗

PubMed1992

[The indications for second-look laparotomy in ovarian cancer patients].

Data on 304 patients with ovarian malignancies (mostly epithelial-72.0%) who had undergone second-look surgery were analysed to develop indications and assess the clinical value of the procedure. Second-look operations were performed 10-22 months after primary surgery in the following clinical settings: (1) clinical remission if wash-offs from the Douglas' pouch peritoneum revealed tumor cells or a high blood-CA-125 level was established (8 patients with stage I-II cancer), (2) remission after 6-10 courses of combination chemotherapy (13 patients with stage III-IV tumor), (3) remission following non-radical primary surgery (117 cases), (4) patients with suspected relapse (144), and (5) cases who were not suspicious for relapse but required laparotomy for concomitant surgical pathology such as, for instance, ventral hernia (22). Intra- and postoperative complications were encountered in 29 out of 304 (9.5%) patients and operative lethality rate was 0.9%. It was shown that improvement in noninvasive methods of monitoring allows to limit indications for second-look surgery in stage III cancer.

Adenocarcinoma↗

PubMed1992

[Immunochemotherapy of carcinomatous peritonitis and pleuritis--report of 2 cases].

Intraperitoneal and pleural immunotherapy has been used as an effective therapy for malignancy. Recently we treated two patients with peritonitis and pleuritis due to cancer by intraperitoneal and pleural administration of IFN-gamma, OK-432 and antitumor agents. One patient with gastric cancer (stage IIIb) was treated with intraperitoneal administration of IFN-gamma and OK-432 in combination with intraarterial infusion of MMC, ADM, 5-FU and CDDP. Two months later, ascites and pleural fluid diminished. Another patient with ovarian carcinoma (stage IV), was administered IFN-gamma, OK-432 and CDDP into ascites with general medication of CDDP and Epi-ADM. Two months later, her ascites and tumor size decreased. This patient was treated with palaplatin every two months for the ten months and hysterosalpingecctomy and tumorectomy of Douglas pouch were performed at the sixteenth month. The histopathological examination of resection from this patient showed complete necrotic tissue of tumor. Endogenous cytokine therapy with intraperitoneal and pleural administration of IFN-gamma for priming and OK-432 for eliciting in combination with antitumor agents may be effective treatment for malignant peritonitis and pleuritis.

Adenocarcinoma, Mucinous↗

PubMed1992

[Organ preserving endosurgery in pyosalpingitis].

Pyosalpinges are a difficult therapeutic problem in a complicated pelvic inflammatory disease. To avoid a diffuse peritonitis, often a laparotomy with salpingectomy is performed. 20 women of reproductive age with a uni- or bilateral pyosalpinx were incorporated in a prospective study to investigate the possibilities of a combined endosurgical/antibiotical treatment. After endoscopic confirmation, the patients were taken into study. During diagnostic laparoscopy, a salpingotomy with rinsing of the tubes and a drainage of the Douglas pouch took place. After one week of antibiotic treatment, a second-look laparoscopy was performed in all patients; no recurrence was documented. The combination of endosurgery and chemotherapy showed to be a safe and efficient therapy of tubal abscesses in women of reproductive age.

Adult↗

PubMed1992

[Effectiveness of intraoperative cytological examination of peritoneal washings for patients with pancreatic cancer].

To confirm the effectiveness of cytological examination of peritoneal washings for detecting invisible micro-peritoneal dissemination in patients with pancreatic cancer, results were analyzed with the survival and the background factors of the patients. Cytological examination of peritoneal washings or ascitic fluid at recto-vesical pouch or pouch of Douglas was performed in 37 patients with primary pancreatic cancer. Positive results for cancer cells were obtained in five of 9 patients (55.6%) who received cytological examination of ascitic fluid and in seven of 28 patients (25.0%) who received that of peritoneal washings. Four of 6 patients (66.7%) with visible peritoneal dissemination showed positive results. These 6 patients died of peritoneal dissemination with about 10 months. Eight of 31 patients (25.8%) without visible peritoneal dissemination showed positive results of the cytological examination. Two of the 8 patients received resection of the tumor. Other 6 patients without resection developed clinically evident peritoneal carcinomatosis. A high positive rate (66.7%) of cytological examination of the patients with visible peritoneal dissemination and a high incidence of appearance of peritoneal carcinomatosis in patients with positive cytological results but without visible peritoneal dissemination (75.0%; positive vs 26.1%; negative) indicate a high reliability of the cytological examination to detect invisible micro-peritoneal dissemination.

Ascitic Fluid↗

PubMed2003

Computed tomography findings of primary serous papillary carcinoma of the peritoneum in women.

With the aim to describe preoperative computed tomography (CT) findings, the clinical, histopathological, and CT findings of the 12 consecutive patients with a confirmed diagnosis of primary peritoneal serous papillary carcinoma (PPSPC) were retrospectively evaluated. Of the 12 patients with a mean age of 57.5 +/- 10.3 years, ten (83.3%) were postmenopausal. Serum Ca-125 levels were elevated in all patients. Ten (83.3%) had Stage III and two (16.7%) patients had Stage IV disease and none of the excised ovaries had deep parenchymal involvement. The most common CT findings were the omental (n = 11), mesenterial (n = 11) and parietal peritoneal involvements (n = 10), and variable amount of ascites (n = 10). Pelvic peritoneal involvement in four (33.3%) patients was so extensive that it resembled a mass in the Douglas pouch. Thickening of the wall of gastrointestinal viscera (n = 9), lymphadenopathy (n = 5) and pleural effusion (n = 5) were the other CT findings and calcification was seen in only three (25.0%) patients. Although, none of them was characteristic, CT features of diffuse peritoneal, omental and mesenterial involvement especially in middle-aged or elderly postmenopausal women with normal-size ovaries in the absence of an identifiable primary site in conjunction with elevated level of serum CA-125 should suggest the possibility of PPSPC.

Cystadenocarcinoma, Papillary↗

PubMedDate not supplied

[Laparoscopic cholecystectomy: incidents and complications. Analysis of 8002 consecutive cholecystectomies performed at the Surgical Clinic III Cluj-Napoca].

Incidents and postoperative complications of laparoscopic cholecystectomy (LC) are analyzed based on a series of 8002 patients who underwent the procedure during a period of seven years. Conversion rate was 2.02% (161 cases) and 6 (0.07%) death were encountered. Intraoperative hemorrhage (2.43%) could be controlled by intraoperative haemostasis in all but 8 patients (bleeding from the hepatic bed and from the cystic artery) which required conversion. Lesions of the bile ducts occurred in 16 patients (0.2%), 13 of them being identified during the operation and solved by conversion or laparoscopic choledochorraphy (for a tangential lesion). Postoperative complications required re-intervention in 45 patients: 11 for bile leak, 19 for choleperitoneum, 6 for hemorrhage, 4 for subhepatic abscesses and 5 for remnant CBD lithiasis. There was 1 puncture of the Douglas pouch in a case of choleperitoneum, 7 laparoscopic re-interventions and 25 open surgery re-interventions. EST solved postoperative bile leaks (from the gallbladder bed) successfully in 7 cases and remnant CBD lithiasis (5 cases). So, 44% of the cases were treated by minimally invasive means (laparoscopic re-interventions or endoscopic procedures). The majority of the incidents and postoperative complications were linked to the presence of an acute cholecystitis and were partially due to some technical limits of the laparoscopic technique of the gallbladder bed peritonisation. The minimally invasive treatment of postoperative complications, was very efficient and offered optimum healing conditions.

Adult↗

PubMed2004

Paclitaxel/carboplatin versus cyclophosphamide/carboplatin in peritoneal carcinomatosis of the ovary.

The preceding platinum-based combination chemotherapy could possibly reduce tumor masses, allowing for adequate surgical debulking in advanced ovarian cancer. In this study, a total of 18 patients with peritoneal carcinomatosis of the ovary were evaluated between 1996 and 2003. All patients underwent open biopsy for the histopathologic confirmation of ovarian tumor. Forty-one percent of the patients (8/18) were administered six cycles of carboplatin/cyclophosphamide (CP) and the rest were administered six cycles of paclitaxel/carboplatin (TP) as a neoadjuvant chemotherapy (10/18). After six cycles of chemotherapy metastases to the peritoneum, Douglas' pouch, diaphragm, and liver serosa were higher in the CP group than the TP group (p < 0.05). All patients also had a better performance status (WHO performance status 0 or 1), but no statistical difference was observed between either group (p > 0.05). Optimal debulking surgery rates were significantly higher in the TP group (p < 0.05). In conclusion, we suggest paclitaxel/carboplatin in peritoneal carcinomatosis of the ovary as a neoadjuvant chemotherapy. However, large prospective, randomized studies should be performed in patients with peritoneal carcinomatosis of the ovary.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

A successfully treated case of severe necrotizing fasciitis caused by acute appendicitis: a case report.

We successfully saved a patient with appendicitis followed by necrotizing fascitis. A 77-year-old man with a history of ambulatory treatment for depression underwent an emergency operation because of severe abdominal pain. Laparotomy demonstrated that necrotizing appendicitis was massively extending over the abdominal cavity, involving the right paracolic sulcus and Douglas pouch and posterior surface of the right kidney. Irrespective of the emergency surgery, redness and swelling in the right chest and abdomen, which was noted at the time of admission, was not decreased. Successively, a retension incision was performed under the diagnosis of necrotizing fasciitis. Necrotizing fasciitis is an extremely rare complication of appendicitis, and there were only 10 cases documented. Once necrotizing fasciitis occurs, the mortality rate is high, so that correct diagnosis and prompt debridement are mandatory. Particularly for elderly patients with appendicitis, rapid and accurate diagnosis and treatment are required.

Acute Disease↗

PubMedDate not supplied

Laparoscopic placement of Oreopoulos-Zellerman catheters in CAPD patients.

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease. Various techniques have been described for the insertion of peritoneal dialysis catheters. Lately, with the evolution of laparoscopic surgery, different laparoscopic techniques have also been presented, suggesting the technique is preferable to the open and percutaneous methods. OBJECTIVE: To introduce and evaluate a new laparoscopic technique for insertion of Oreopoulos-Zellerman catheters in CAPD patients. SETTING: The study was carried out in the First Department of Propaedeutic Surgery, Athens University Medical School, Hippokration Hospital. PATIENTS AND METHODS: Between November 2000 and March 2002, the technique was applied in 20 consecutive patients (mean age 62 years, range 54 - 70 years) with end-stage renal disease. During this technique, a 10-mm trocar is placed just below the umbilicus for the optics and a 5-mm trocar is placed in the right lower quadrant. With the help of a 10-mm trocar, a tunnel is formed in the standard paramedian position on the left side, 2 - 3 cm below the plane of the umbilicus, for the insertion of the peritoneal catheter. A laparoscopic needle (GraNee needle; R-Med, Oregon, Ohio, USA) is used for the closure of the 10-mm trocar-induced peritoneal and fascia defect using a purse-string suture. The catheter is advanced into the abdomen under direct vision and guided toward the Douglas pouch. The subcutaneous tunnel and the patency test of the catheter are performed as the last main steps in our procedure. One surgeon undertook all procedures. RESULTS: All procedures were completed laparoscopically. The mean operative time was 30 minutes (range 25 - 40 minutes). There was no intraoperative complication or surgical mortality. One patient developed leakage at the catheter exit site 3 days after surgery; it was corrected under local anesthesia. During a mean follow-up time of 17 months (range 12 - 28 months), 1 patient required catheter removal due to fungal peritonitis. CONCLUSION: Laparoscopic insertion of the Oreopoulos-Zellerman catheter is a simple, quick, and safe method. We believe future experience will encourage the laparoscopic technique as the method of choice.

Aged↗

PubMed1992

Culdocentesis in diagnosis of disturbed ectopic pregnancy still a useful procedure in developing countries.

Over a period of 5 years culdocentesis was carried out in 156 cases of suspected ectopic pregnancy using needle aspiration through the pouch of Douglas. The result was positive in 134 cases, with 131 being true positive and 3 false positive. In 22 cases the result was negative, 6 of which were false negative. It is concluded that culdocentesis is an effective method of diagnosing disturbed ectopic pregnancy.

Biopsy, Needle↗

PubMed2005

[Incidence of endometriosis in infertile women: clinical and laparoscopic characteristics].

BACKGROUND: The incidence and symptomatology of endometriosis vary according to the different populations. OBJECTIVES: To determine the incidence of endometriosis as well as the clinical and laparoscopic characteristics in infertile women with endometriosis. PATIENTS AND METHODS: This study included 68 infertile patients with endometriosis diagnosed by laparoscopy; in all of them we analyzed the demographic and clinical characteristics. RESULTS: In 68 out of 197 medical files that were analyzed, endometriosis was reported (34.5%). The average age was 30.3 +/- 3.9 years. Forty patients had primary infertility (58.8%) and 28 (41.29%) secondary infertility. In 34 patients endometriosis (50%) was mild, moderate in 16 (23.5%) and severe in 18 (26.5%). Only one endometriosic foci was found in 25% of the patients and multiple foci in 75% of them. The most common sites in which it was found were the uterosacral ligaments, Douglas pouch and the ovaries. In patients with primary infertility it predominated the medium-high socioeconomic level and in those with secondary infertility the low one. In severe endometriosis the predominant symptom was the moderate or severe dysmenorrhea, while in mild and moderate endometriosis was mild dysmenorrhea (p < 0.007). Six out of 16 patients with severe endometriosis had endometrioma. CONCLUSIONS: The endometriosis incidence in infertile women was similar to that reported in literature, as well as age of presentation. It was also observed a direct relationship between endometriosis severity and dysmenorrhea intensity.

Adult↗

PubMed2005

[Clinical significance of washing cytology in patients with advanced gastric cancer].

Since 1988, we have performed intraoperative peritoneal washing cytology (CY) of the Douglas pouch in 1,255 patients (pts) with gastric cancer to diagnose latent peritoneal dissemination. Patients were classified as follows: 914 pts in P0, CY0; 100 pts in P0, CY1; 90 pts in P1; 53 pts in P2; and 98 pts in P3. Usually Papanicolaou's staining method was used and immunocytochemical staining of CEA and MOC-31 was carried out to make a definitive diagnosis. Prognostic factors were determined in 638 pts without liver metastasis by multivariate analysis. Curability, depth of tumor invasion, lymph node metastases, histological type and CY were independent prognostic factors. The survival of P0, CY1 pts who had undergone curative surgery was better than those with non-curative surgery. In conclusion, CY can serve as an independent predictor of prognosis, so immunocytochemical staining is important. P0, CY1 pts without residual cancer should be treated with multimodal therapy.

Adult↗

PubMed2006

[A case of advanced gastric cancer with peritoneal dissemination responding remarkably to TS-1/CDDP combination chemotherapy].

A 57-year-old woman visited a physician with complaints of anorexia and pollakiuria. Because a pelvic tumor and ascites were detected, she was referred to our department. Douglas pouch puncture revealed adenocarcinoma cells. Further examination showed an advanced gastric cancer with peritoneal dissemination. The cancer was judged to be unresectable. Chemotherapy with a combination of TS-1 and CDDP was performed before the operation. After 2 courses of the chemotherapy, her complaints disappeared, although abdominal CT confirmed remaining peritoneal dissemination. After 7 courses of chemotherapy, abdominal CT showed that the peritoneal dissemination had disappeared. Total gastrectomy and lymph node dissection were performed. Histological findings of the stomach revealed complete disappearance of cancer cells in the stomach and the regional lymph nodes. We confirmed that the TS-1/CDDP therapy resulted in a complete response to advanced gastric cancer and peritoneal dissemination. We recommend that chemotherapy be continued until the peritoneal dissemination disappears.

Adenocarcinoma↗

PubMed1991

[Clinical evaluation of intra-peritoneal hyperthermic perfusion under hypothermic general anesthesia for advanced gastric cancer].

Right after surgery, intra-peritoneal hyperthermic perfusion (IPHP) was performed under hypothermic general anesthesia for 41 gastric cancer patients with peritoneal dissemination or serosal invasion. The control group consisted of 40 patients given surgery alone. With respect to the direct antitumor efficacy of IPHP, there were no cancer cells in the peritoneal lavage from Douglas' pouch and, ascitic effusion disappeared in all patients with peritoneal dissemination. The 1- and 3-year survival rates for the IPHP group were 68% and 39%, whereas those of the control group were 30% and 0%, respectively. The survival rates for the IPHP group were better than those for the control group, with a statistically significant difference of p = 8.1 x 10(-7). As to prevention of recurrence, the incidence of peritoneal dissemination for the IPHP group was lower at p = 0.002 than the control group.

Anesthesia, General↗