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Detectability of intraperitoneal fluid by ultrasonography. An experimental investigation.

The detectability of intraperitoneal fluid was investigated by ultrasonography following injection of physiologic saline in conjunction with hysterosalpingography in 40 patients. It was invariably possible to identify 10 to 15 ml fluid in the pouch of Douglas with the patient in supine position and in Morison's pouch after Trendelenburg and right decubitus position. Ultrasonography is superior to conventional radiography for detection of minor intraperitoneal fluid.

Adult↗

[Vaginal hysterectomy of the non-prolapsed uterus. Rehabilitating a technic].

The main steps to be carried out in the operation of vaginal hysterectomy when the uterus is not prolapsed are overall the same as when vaginal hysterectomy is carried out for prolapse: separation of the bladder from the uterus, opening of the Pouch of Douglas, dividing the utero-sacral ligaments, opening the vesico-uterine pouch, dividing the cardinal ligaments, delivering the fundus of the uterus, freeing the uterine cornua and reperitonealisation. All the same, for each step there are numerous different details to be carried out. Careful attention to all these modifications make it easier to remove a non mobile uterus or one that is markedly enlarged. When the definite advantages of this technique, which is unfortunately insufficiently practised in France, are understood it is the operation of choice rather than the abdominal approach whenever a vaginal approach is possible, which it is in the large majority of cases.

Anesthesia↗

[Vaginal hysterectomy of the non-prolapsed uterus. Toward rehabilitation].

The main steps to be carried out in the operation of vaginal hysterectomy when the uterus is not prolapsed are overall the same as when vaginal hysterectomy is carried out for prolapse: separation of the bladder from the uterus, opening of the Pouch of Douglas, dividing the utero-sacral ligaments, opening the vesico-uterine pouch, dividing the cardinal ligaments, delivering the fundus of the uterus, freeing the uterine cornua and reperitonealisation. All the same, for each step there are numerous different details to be carried out. Careful attention to all these modifications make it easier to remove a non mobile uterus or one that is markedly enlarged. When the definite advantages of this technique, which is unfortunately insufficiently practised in France, are understood it is the operation of choice rather than the abdominal approach whenever a vaginal approach is possible, which it is in the large majority of cases.

Female↗

MRI demonstration of peritoneal implants.

The magnetic resonance imaging (MRI) findings of 12 proven cases of peritoneal implants, mainly carcinomatosis, were reviewed for evidence of peritoneal seedings. The seeded sites include the pouch of Douglas, the ileocecal and retrocecal regions, the right and left paracolic gutters, Morison's pouch, the right subdiaphragmatic parietal peritoneum, the greater and lesser omentum, the gastrocolic, gastrosplenic, and phrenicocolic ligaments, the small bowel mesentery, the sigmoid and transverse mesocolons, and the small and large bowel walls. Sizes varied from less than 1 cm to omental cake and bulky tumors. The findings include linear or tiny nodular infiltrations of the omentum and subperitoneal fat (ligamentous, mesenteric, and mesocolic), focal or segmental wall thickenings, loss of unilateral colonic haustration with sacculation on the contralateral side, and nodular soft tissue masses along different locations of the peritoneal surfaces. Air was introduced via an antegrade or retrograde method to act as a gastrointestinal contrast agent and was found to be useful for delineating the seedings. As is true with computed tomography scan, miliary implants are also not detectable with MRI. The sensitivity and specificity of MRI in detecting peritoneal implants remain to be determined.

Abdominal Neoplasms↗

Fallopian tube patency demonstrated at ultrasonography.

Fallopian tube patency was assessed in 24 infertile patients by hysterosalpingography (HSG) and ultrasonographic examination of the pouch of Douglas following transcervical injection of a sterile isotonic solution of NaCl. The presence of fluid in the pouch, after the injection, was taken to indicate tubal patency. The results of the HSG and the ultrasonographic diagnosis as to the presence of at least unilateral tubal patency were concordant in 21 patients. Pitfalls consisted of fluid accumulation in periadnexal adhesions, edema in the bowel wall, and spill of the injected saline into a large hydrosalpinx. Ultrasonography is advocated as the initial examination in assessing infertility in young women. If tubal patency is demonstrated, the patient should be recommended a six month trial period, to become pregnant, before invasive procedures are initiated.

Adolescent↗