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At least 487 records · Page 27Linked to original sources
PubMed2002

Incidental ultrasound diagnosis of pseudomyxoma peritonei in an asymptomatic woman.

An incidental finding of pseudomyxoma peritonei is reported in a woman with a 6-month history of postmenopausal bleeding. A transvaginal ultrasound scan revealed a poorly defined echogenic mass in the right iliac fossa above the right ovary and free fluid of mixed echogenicity in the pouch of Douglas. Laparoscopic appendicectomy and aspiration of mucinous fluid was performed without adjuvant chemotherapy. Regular postoperative follow-up scans, which are needed as the disease may have an indolent course, showed no signs of recurrence. The differential diagnosis and management of pseudomyxoma peritonei are discussed.

Diagnosis, Differential↗
PubMed2002

Isolated fluid in the cul-de-sac: how well does it predict ectopic pregnancy?

We examined the risk of ectopic pregnancy among patients with isolated abnormal cul-de-sac fluid at transvaginal ultrasound. We conducted a retrospective cohort study of all ED patients presenting January 1995 to August 1999 with abdominal pain or vaginal bleeding and a positive beta-hCG test. The risk of ectopic pregnancy in patients with a moderate volume of anechoic fluid was compared with those with either a large volume of anechoic fluid or any echogenic fluid. Ectopic pregnancy was diagnosed in 16/38: 42%(95% CI 26%-59%) of patients with isolated cul-de-sac fluid, 5/23: 22% (95% CI 7%-42%) of patients with moderate amount of anechoic fluid, and 11/15: 73% (95% CI 45%-92%) of patients with a large volume of fluid or any echogenic fluid. These differences were significant (P =.005). Patients with isolated abnormal cul-de-sac fluid are at moderate risk for ectopic pregnancy. The risk increases if the fluid is echogenic or the volume is large.

Ascitic Fluid↗
PubMed2002

[Sigmoidoperianal fistula associated with diverticulitis and Cul de Sac situation--diagnostics and therapy].

We report on the case of a 64-year-old female patient who presented herself in our outpatient clinic because of a perianal fistula with recurrent abscesses. We describe the step diagnostics and the surgical treatment of the causal sigmoido-perianal fistula with diverticulitis and Cul de sac situation. Clinical examination, fistulography, colonoscopy and MRT were part of the precise representation and preparation for the high anterior rectosigmoidal resection with simultaneous rectopexy according to Sudeck which were performed without complications. The sigmoidoperianal fistula must be taken into account as a differential diagnosis of a recalcitrant high perianal fistula.

Abscess↗
PubMed2002

Diagnostic laparoscopy, serum CA125, and peritoneal metastasis in gastric cancer.

BACKGROUND AND STUDY AIMS: Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. We report on the utility of laparoscopy and its indications in the detection of peritoneal metastasis in gastric cancer. PATIENTS AND METHODS: A total of 39 patients with gastric cancer underwent laparoscopy and peritoneal cytology investigation in our department, between April 1992 and April 2000. Laparoscopic diagnosis for peritoneal metastasis (LP-P) was determined through macroscopic, pathological and cytological diagnoses. All the patients underwent diagnostic imaging with computed tomography (CT) and ultrasound before laparoscopy. Carcinoembryonic antigen, carbohydrate antigen (CA) 19-9, and CA125 levels in serum and peritoneal fluid were measured using enzyme immunoassay. RESULTS: Laparoscopic diagnosis for peritoneal metastasis gave negative results in 21 patients and positive results in 18. All the patients with negative LP-P findings underwent surgery; 18 of the 21 patients showed no peritoneal metastasis, but three were diagnosed as having peritoneal metastasis, one at the pouch of Douglas and two at the mesentery. The diagnosis of all the patients with positive LP-P findings was finally confirmed as correct. The specificity, sensitivity, and accuracy of laparoscopy for peritoneal metastasis were 100 % (18/18, 95 % CI 0.82 - 1), 86 % (18/21, 95 % CI 0.64 - 0.97), and 92 % (36/39, 95 % CI 0.79 - 0.98), respectively. The specificity, sensitivity, and accuracy of diagnostic imaging for peritoneal metastasis were 100 % (18/18, 95 % CI 0.82 - 1), 38 % (8/21, 95 % CI 0.18 - 0.62), and 67 % (26/39, 95 % CI 0.50 - 0.81), respectively. All of the 11 patients showing high levels of serum CA125 (equal to or more than 35 U/ml) had peritoneal metastasis whereas 17 of the 26 patients with low levels of serum CA125 (less than 35 U/ml) did not ( P < 0.001). CONCLUSIONS: The sensitivity of laparoscopy for peritoneal metastasis was much higher than that of diagnostic imaging. Laparoscopy and serum CA125 level both predicted peritoneal metastasis, but the degree, volume, or distribution of peritoneal metastasis was disclosed only by laparoscopy. Laparoscopy is a useful way of detecting peritoneal metastasis in gastric cancer, and patients with an elevated level of serum CA125 are the best candidates for laparoscopy.

Adult↗
PubMed2004

Incarceration of the retroverted uterus at term gestation.

Incarceration of the retroverted uterus is a rare complication of pregnancy and rarely persists until term. The diagnosis is extremely difficult to make and a cesarean section should be performed in such cases. A 33-year-old Japanese woman was admitted at 40 weeks gestation for evaluation of preeclampsia. Vaginal examination revealed that the uterine cervix could hardly be visualized, although the fetal head was impacted in the pelvis. These findings suggested incarceration of the retroverted uterus. Magnetic resonance imaging (MRI) was performed and clarified the exact anatomical relationship and confirmed the diagnosis. She therefore underwent a cesarean section and a male infant weighing 3552 g was delivered with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. At surgery she was found to have an adhesion between the uterus and the pouch of Douglas. MRI is a useful tool in correctly making the diagnosis of uterine incarceration and facilitates preparation for a cesarean section.

Adult↗
PubMed1995

[Ambulatory contrast hysterosonography as a possibility for assessing tubal patency].

For the diagnostic evaluation of infertility it is crucial to obtain information on potential abnormalities of the uterus or the fallopian tubes. At present, the following diagnostic methods are available: CO2-pertubation, hysteroscopy, hysterosalpingography (HSG) and chromolaparoscopy (CLP). For the latter procedure, general anaesthesia is required. In a clinical trial 103 patients from our infertility clinic were examined for fallopian tube patency using the contrast agent SH U 454 (Echovist). The new technique hystero-contrast sonography (Hy-Co-Sy) was carried out in an outpatient setting without requiring general anaesthesia. Informed consent was obtain from all patients. A Foley catheter was inserted into the uterine cavity, the balloon was inflated and the contrast medium injected. Distribution of the contrast agent as well as the uterine cavity, the fallopian tubes as well as in the pouch of Douglas was then observed by sonography. In addition to Hy-Co-Sy, 58 patients underwent HSG or CLP. Hy-Co-Sy findings could confirmed by HSG and CLP in 90.6% and 91.6%, respectively. Patients were asked to describe their discomfort on a scale of one to hundred. The average time required for the assessment to tubal patency was 9 minutes. Within 12 months of the Hy-Co-Sy study, 23 out of 60 patients (38.3%) became pregnant. Our study shows that Hy-Co-Sy is a valuable and reliable procedure to assess the uterine cavity and the fallopian tubes in patients undergoing treatment for infertility. The procedure can be performed safely in the office without the need for general anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Diffuse petechial peritoneal hemorrhage and ovarian capsule hemorrhage in acute disseminated gonococcal infection].

Acute abdominal pain with fever over 39 degrees led to a diagnostic laparoscopy in a 25-year old woman. Diffuse petechial-like haemorrhages in the visceral peritoneum and superficial haemorrhages in the capsules of both ovaries were found together with an inflamed genitalia. From the pouch of Douglas secretion N. gonorrhoeae could be isolated. So far, this condition is not described in the literature. This probably rare case and its differential diagnosis are discussed.

Acute Disease↗
PubMed1994

[Trans-uterine fallopian tube catheterization--a noninvasive, ambulatory evaluation of fallopian tube patency].

In a prospective clinical study (March 89-June 91), we examined 114 infertile women to evaluate the diagnostic value of trans-uterine tubal cannulation with the injection of sterile fluid and consecutive sonographical control in the assessment of tubal patency. The results of this technique were compared with the findings of laparoscopy and/or hysterosalpingography. With the Jansen-Anderson Catheter (J-A-C) it was possible to reach the isthmic part of the tube without any analgesia or anaesthesia. 10 to 15 ml of sterile culture medium were injected. In case of tubal patency the fluid was detectable in the pouch of Douglas by transvaginal ultrasound. In 108 out of 114 women (94.7%), the cannulation of at least one tube was possible. All 97 patients with patent tubes (laparoscopy) were diagnosed correctly via the J-A-C. The three cases of proximal tubal occlusion were also diagnosed correctly, 8 patients with one or two-sided hydrosalpinx were also recognized. All five patients with bilateral hydrosalpinx were detected. Three women showed a unilateral hydrosalpinx in the laparoscopy. In these cases the diagnosis obtained by the J-A-C was once bilaterally patent and twice bilaterally distally occluded. Trans-uterine cannulation of the tubes with injection of sterile fluid and consecutive transvaginal sonography is an easy and safe method to evaluate the tubal status. It becomes possible thereby to prove tubal patency in a very early stage of diagnostics. Loss of time and futile treatment cycles (stimulations or inseminations in cases of tubal occlusion) can thus be avoided.

Adult↗
PubMed1987

[Diagnostic and therapeutic interventions in extrauterine pregnancy].

Between 1969 and 1985 surgery was performed in 456 cases of extrauterine pregnancy (EUP) at Tübingen University Gynecological Clinic. The average number of such operations performed annually rose from 11 in the first six years to 61 in the last three years. As a result of early detection and treatment of EUP, tubal ruptures and severe intraabdominal hemorrhages have become increasingly rare. In the last six years, blood transfusions were only necessary in 6% of the patients who underwent surgery. In 28% no blood at all was found in the abdomen at surgery. For this reason, puncture of the pouch of Douglas was increasingly--and finally completely--supplanted by laparoscopy. Up to 1977 the affected tube was always removed; subsequently it was ever more frequently preserved. From 1983 to 1985 preservation of the tube was already being requested by 83% of the patients and it was possible to achieve this in 90% of them. In a total of 202 patients in whom the affected tube was preserved the following surgical procedures were employed: salpingotomies in 61%, salpingostomies in 4%, segmental resections with and without anastomoses in 22%, and expression or removal of a tubal abortion in 10%. The principal complications were continued growth of the tubal pregnancy following expression and salpingotomy in one case each, and occurrence of a hematosalpinx with the tentative diagnosis of continued pregnancy. Therefore, it is imperative to check the drop in the beta-HCG level after procedures in which the tube is preserved.

Fallopian Tubes↗
PubMed1980

[Laparoscopy in obese women (author's transl)].

At the department of obstetrics and gynaecology at the University of Graz laparoscopy in the obese women was modified. The pneumoperitoneum is introduced by placing the Verres needle through the pouch of Douglas. An umbilical incision through the fascia is made which admits the index finger of the left hand. Under control by the finger and elevation of the wound with clips the introduction of the trocar becomes safe. The technique is described in detail. The advantages and possible complications of this method are discussed and the first 25 cases reviewed.

Female↗
PubMed1986

[The accuracy of ultrasound in the diagnosis of intra-abdominal abscess formations].

During the last two years 73 patients with a total number of 84 abdominal abscesses have been investigated by ultrasound. Two thirds of the patients (67%) had postoperative abscesses. Spontaneous abscesses occurred in the remaining 33%. Multiple abscesses occurred in the postoperative group only (7 patients). The overall sensitivity in detecting an abscess was 84%. The sensitivity was much better with spontaneous abscesses (92%) than with postoperative abscesses (80%). One third of the patients have also been investigated by computed tomography. The diagnosis was confirmed either by needle aspiration or by operative drainage. Ultrasound was most useful in detecting abscesses in the right and left upper quadrant and in the pelvis, while CT was superior in the mid-abdomen and when dealing with multiple abscesses.

Abdomen↗
PubMed2001

Assessment and grading of pelvic organ prolapse by use of dynamic magnetic resonance imaging.

OBJECTIVE: Our purpose was to assess and compare a new technique of grading pelvic organ prolapse by using dynamic magnetic resonance imaging with the clinical staging proposed by the International Continence Society. STUDY DESIGN: In a cross-sectional study, 20 patients with pelvic organ prolapse underwent dynamic magnetic resonance imaging. Clinical staging (according to the International Continence Society) was compared with staging by magnetic resonance imaging. A new reference line, the midpubic line, was drawn on the magnetic resonance image to correspond to the hymenal ring marker used in the clinical staging. The levator-vaginal angle and the area of the genital hiatus were measured to indicate vaginal supports. Ten nulliparous, symptom-free women were studied as control subjects. RESULTS: The proposed staging by magnetic resonance imaging showed good correlation with the clinical staging (kappa = 0.61). Magnetic resonance imaging improved clinical assessment by its ability to measure the actual pelvic organ descent and to delineate prolapse of the pouch of Douglas accurately. The midpubic line was a useful reference line for grading prolapse on magnetic resonance imaging. The levator-vaginal angle and the area of the genital hiatus are useful in assessing vaginal support at different anatomic levels. CONCLUSIONS: This new method of grading by magnetic resonance imaging uses the same landmarks as the clinical grading, and this uniformity of approach allows an objective assessment of the results of surgical correction of pelvic organ prolapse.

Adult↗