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At least 343 records · Page 19Linked to original sources
PubMed1983

[Tubal pregnancy: recent aspects of diagnosis and treatment].

The histories of 139 patients who received treatment for tubal pregnancy between January 1975 and December 1981 in our department were reviewed. 12% of the patients had a prior contralateral tubal pregnancy. The commonest clinical finding was metrorrhagia in 84% of the cases. The HCG in the urine was positive in 68% of the cases with the clinical routine methods used up to date. The beta HCG in the blood showed an atypical trophoblastic process in all cases. The tubal pregnancy was diagnosed by ultrasonography in 19% of the cases and suspected in 54% of the cases. Aspiration of the pouch of Douglas verified the diagnosis in 79% of the cases. Laparoscopy confirmed the diagnosis in every case. Laparoscopy was especially required when the symptoms were unclear or when the aspiration of the pouch of Douglas showed negative or dubious results. 85 patients had a salpingectomy, 50 patients had a conservative operation of the tube. Laparoscopy was done in 34 patients who had a conservative tubal operation. In 79% of the patients an intact tubal wall made a conservative operation possible. 51 women desired further child-bearing by written questionnaire. After salpingectomy and normal contralateral fallopian tube at operation, 25 patients showed further desire for child-bearing. 18 cases delivered infants, three cases had abortions, and one case had a recurrent ectopic pregnancy. Following conservative operations 24 patients desired further children. 11 patients had intrauterine pregnancies, one of them an abortion. Five patients had a recurrent ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1993

[What is the predictive value of ultrasound diagnosis in suspected extra-uterine pregnancy in routine clinical practice?].

In this retrospective study the data of 340 patients who underwent invasive diagnostics in suspected ectopic pregnancy from 1985 to 1991 are being analyzed. The aim of this study is to examine the prognostic value of ultrasonic findings after the introduction of transvaginal sonography and highly sensitive urine pregnancy tests in the every day clinical routine. In transvaginal ultrasound significantly more direct signs of an ectopic pregnancy than in the abdominal technique were found showing a markedly higher positive predictive value: 93.5% for an extrauterine double ring, 90.7% for inhomogeneous adnexal masses with the simultaneous finding of echogenic fluid in the pouch of Douglas and 79.3% for isolated inhomogeneous adnexal masses. The predictive values for indirect sonographic hints of suspected extrauterine gravidity were 78.4% for an empty uterine cavity and 87.3% for echogenic fluid in the pouch of Douglas. With growing experience in the vaginal ultrasound technique the positive predictive values of all these signs reached 91% to 98%. Additionally the rate of false-negative urine pregnancy tests in patients with ectopic pregnancy sank with increasing sensitivity from 49% (1000 IU HCG/l) to 3.2% (50 IU/l). Summarizing all these factors the reliability of conservative diagnostic means in suspected ectopic pregnancy raised considerably from 56.4% to 94.3% during the course of our study.

Diagnosis, Differential↗
PubMed1986

A new culdocentesis system.

A new culdocentesis system is presented, based on vacuum fixation of the posterior vaginal wall together with Douglas peritoneum in a small vacuum cup, enabling a controllable central perpendicular puncture with a special catheter-needle unit. The advantages of the new system are the creation of a relatively safe and painless access to the pouch of Douglas, less risk of contamination, the possibility of repetitive examinations, and satisfactory effectiveness in collecting peritoneal fluid. The results of 164 culdocenteses in ambulant infertility patients are reported. Application of the technique is proposed for the investigation of sperm migration in vivo, steroid analysis of peritoneal fluid, and intraperitoneal insemination.

Douglas' Pouch↗
PubMed2001

Does transvaginal hydrolaparoscopy render standard diagnostic laparoscopy obsolete for unexplained infertility investigation?

OBJECTIVE: To evaluate the feasability of transvaginal hydrolaparoscopy in infertile patients undergoing basic infertility investigations, and to determine its usefulness in comparison with standard laparoscopy. MATERIALS AND METHODS: Twenty-three unexplained infertile women were prospectively included. Selected patients had no history of pelvic disease or previous pelvic surgery and had normal findings on gynecological examination and vaginal sonography. The patients received general anesthesia and underwent the transvaginal hydrolaparoscopy immediately prior to a standard laparoscopy by a different operator. The main outcome measures were the rate of successful access to the pouch of Douglas, the duration of the procedure, and the rate of complications. In order to compare the accuracy of the transvaginal hydrolaparoscopy to the standard laparoscopy, findings in terms of tubal pathology, endometriosis, and adhesions were analyzed. RESULTS: The successful rate of access to the pouch of Douglas was 95.7%. The rate of complications was 4.3%. The mean duration of the transvaginal hydrolaparoscopy procedure was 8 min. The concordance between transvaginal hydrolaparoscopy and laparoscopy for pelvic cavity examination was statistically significant (k=0.57, P=0.02). In 40.9% of cases, the transvaginal hydrolaparoscopy procedure has shown a normal pelvic examination confirmed by laparoscopic diagnosis. According to the findings by laparoscopy, transvaginal hydrolaparoscopic diagnosis was correlated well in 81.8% of cases. When transvaginal hydrolaparoscopy showed pathological findings, there were no normal laparoscopies. Pathological laparoscopies were found in 18.2% of the normal transvaginal hydrolaparoscopies. CONCLUSION: The transvaginal hydrolaparoscopy is a reproducible and safe method to investigate the pelvis and its structures. The diagnostic accuracy of the transvaginal hydrolaparoscopy suggests that more than 40% of standard laparoscopies for unexplained infertility could be avoided.

Adult↗
PubMed1997

Pain sensitivity of and pain radiation from the internal female genital organs.

The aim of this study was to determine the sensitivity and the localization of pain from the internal female genital organs. In 28 women undergoing a ring sterilization, the internal genital organs were pinched with a 3 mm forceps and the pain sensitivity and localization were recorded. Pain localization was vague, and pinching of the medial and distal end of the oviduct, or of the anterior, posterior or left or right uterosacral ligament could not be discriminated. The sensitivity of the pouch of Douglas and of the uterosacrals was greater than of the oviduct, uterus or ovaries. Small typical endometriotic lesions were specifically more painful. The pain from the uterus was felt mainly in the hypogastric region. The oviducts and ovaries radiated mainly to the iliac fossa, whereas pain stimulation of the uterosacrals and pouch of Douglas was felt predominantly in the perineal-perivulvar-perianal region. Radiation to the lower back was rare and never occurred in isolation.

Female↗
PubMedDate not supplied

Viability of intraperitoneal free cancer cells in patients with gastric cancer.

The viability and morphologic changes of intraperitoneal free cancer cells in advanced gastric cancer patients were examined by Giemsa and enzymologic staining and by tritiated thymidine uptake. Although many free cancer cells in the pouch of Douglas showed moderate degeneration, viable, morphologically intact cells were noted, leading to the possibility of their implantation and proliferation in the peritoneum. Serosal cancer cells showed a high degree of viability. In patients undergoing gastric cancer surgery, the viability of free cancer cells was markedly decreased by a single intraoperative administration of 10 mg of mitomycin C (MMC) to the pouch of Douglas, suggesting that this may represent an effective means of preventing peritoneal dissemination.

Adult↗
PubMed1991

[Recurrent multicystic peritoneal mesothelioma in endometriosis of the pelvis].

In the case of a 21-year old woman, who complained of chronic pelvic pain and where cystic structures in the adnexal region had been diagnosed ultrasonically and by laparoscopy, a tumour made up of many small cysts was discovered in the pouch of Douglas next to a typical endometrial cyst. Both the endometrial cyst and the cystic tumour were excised by laparotomy. Histology established the tumour as a multicystic peritoneal mesothelioma. Postoperative recurrence was noticed by ultrasound less than one year later. Laparotomy revealed a 5 cm serous cyst of the right ovary and again countless liquid-filled grape-like small cysts in the pouch of Douglas. Histology revealed a multicystic peritoneal mesothelioma identical to the previously excised tumour. Multicystic peritoneal mesothelioma is a rare soft tissue tumour noted for its frequent recurrences. Most authors agree, that it belongs to the morphological spectrum of reactive mesothelial proliferative lesions and not the neoplastic spectrum. It appears mostly in women, often concomitant with endometriosis and pelvic inflammatory disease and frequently in women, who had previous surgical interventions in the abdominal region.

Adult↗
PubMed1991

Medicosurgical approach to diagnosis and treatment of ectopic pregnancy.

Early ectopic pregnancy screening using vaginal ultrasonographic technology together with measurement of beta human chorionic gonadotropin (beta-hCG) and human chorionic somatomammotropin is possible within the first 2 weeks of the missing menses, prior to the appearance of symptoms. This article summarizes the main available treatment modalities, focusing primarily on the pelviscopic surgical tube-conserving approach and on instillation of intrachorionic drugs (methotrexate alone or in combination with ornipressin) and injection of prostaglandin F2 alpha. While the pelviscopic surgical approach can be applied in nearly all cases of ectopic pregnancy, irrespective of pregnancy duration, the pelviscopic medicosurgical approach is only appropriate for the treatment of early ectopic pregnancies until the 8th week of gestation in patients without fluid collection in the pouch of Douglas and beta-hCG values below 2000 mU/mL. The transvaginal intrachorionic drug instillation as a simple medicosurgical approach performed under ultrasonographic guidance without anesthesia remains restricted to the treatment of early viable ectopic pregnancy. A brief account of the expectant treatment of patients with nonviable ectopic pregnancy is given, underlining the prerequisites of decreasing beta-hCG values and the absence of fluid in the pouch of Douglas. Although spontaneous resorptions have been observed in a number of cases of the disease, no clear evidence is available on the reconstitution of tubal function and patency.

Chorionic Gonadotropin↗
PubMed1998

Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive.

OBJECTIVE: To assess the accuracy of initial and repeated serum hCG measurements in the diagnosis of ectopic pregnancy (EP) in patients in whom transvaginal sonography is inconclusive and to evaluate whether patient characteristics influence the accuracy of serum hCG measurements. DESIGN: Prospective study. SETTING: Two large teaching hospitals in Amsterdam, the Netherlands. PATIENT(S): Three hundred fifty-four consecutively seen pregnant patients with suspected EP and inconclusive transvaginal sonographic findings. INTERVENTION(S): Serum hCG measurements. MAIN OUTCOME MEASURE(S): The performance of repeated serum hCG measurements in the diagnosis of EP was evaluated through the analysis of receiver operating characteristic curves. RESULT(S): Initial serum hCG measurements were more diagnostic in conjunction with sonographic evidence of an ectopic mass or fluid in the pouch of Douglas than in the absence of sonographic abnormalities. On repeated measurement, the course of the serum hCG concentration provided more diagnostic information than did the absolute serum hCG concentration 2 and 4 days after the start of the diagnostic process. CONCLUSION(S): The interpretation of serum hCG measurements should depend on additional findings at transvaginal sonography. A cutoff level of 1,500 IU/L is recommended for patients with an ectopic mass or fluid in the pouch of Douglas; in patients without these findings, the cutoff level should be at least 2,000 IU/L. Four days after the start of the diagnostic process, any rise in the serum hCG concentration makes the diagnosis of EP very likely.

Chorionic Gonadotropin↗
PubMed1975

[Vesico-intestinal fistulae].

Vesico-intestinal fistulae were observed in 14 patients within a period of 10 years (vesico-colonic: ten; vesico-rectal: two; vesico-ileal and vesico-rectal-ileal: one each). The causes were diverticulitis in five, carcinoma of the sigmoid in two, radiation damage after prostatic or cervical carcinoma in two, and Crohn's disease, abscess of Douglas's pouch after perforated appendicitis, ileal carcinoma, sarcoma of the pelvis, and ovarian carcinoma, one each. Pneumaturia, faecaluria and dysuria were the most frequent symptoms, treatment-resistant cystitis was present in three. Cystoscopy, intravenous pyelogram, retrograde cystogram, barium meal, barium swallow with follow-through, and rectosigmoidoscopy proved to be the best methods of diagnosis. Four patients had multiple operations, three one operation, with a cure in all. In the neoplastic fistulae the underlying carcinoma could not be radically operated on: colostomy or colostomy with palliative resection was performed. In four of these the fistulae then closed, once it remained open. One woman with a vesicorectal fistula due to ovarian carcinoma died of tumor cachexia 16 days after a colostomy had been made.

Abscess↗
PubMed2005

Surgical indications for combined partial rectosigmoidectomy in ovarian cancer.

AIM: To evaluate surgical indications for combined partial rectosigmoidectomy in ovarian cancer with direct invasion of the rectum and sigmoid colon or dissemination into the pouch of Douglas. METHODS: Subjects comprised 25 patients with ovarian cancer who underwent primary surgery and rectosigmoidectomy between 1990 and 2002 at our hospital. Federation of Obstetrics and Gynecology staging of tumors was II (n = 6), III (n = 17) or IV (n = 2). The histologic type was serous adenocarcinoma (n = 18), clear cell adenocarcinoma (n = 4), and others (n = 3). Bowel resection was performed during primary surgery in 18 patients, and after neoadjuvant chemotherapy (NAC) in seven patients. Cumulative survival rate was compared between NAC and non-NAC groups. Patients were divided into three groups based on extent of surgical resection to compare survival rates: no residual tumor (n = 19); maximum residual tumor diameter <1 cm (n = 5); and maximum residual tumor diameter > or =1 cm (n = 1). RESULTS: Cumulative 5-year survival was 41.3% for all patients. Cumulative 5-year survival in the 18 patients who underwent bowel resection during primary surgery was 62.2%, compared to 13.9% in the seven patients who underwent bowel resection after NAC. Cumulative 5-year survival based on extent of surgical resection was: no residual tumor, 60.8%; residual <1 cm, 0%; and residual > or =1 cm, 0%. Cumulative 5-year survival for patients with complete tumor resection (no residual tumor), excluding clear cell adenocarcinoma, was 79.5%. CONCLUSION: In ovarian cancer with direct invasion of the rectum or sigmoid colon or dissemination into the pouch of Douglas, complete tumor resection with rectosigmoidectomy during primary surgery is associated with good clinical outcomes.

Adult↗