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PubMed1983

Hematosalpinx in tubal pregnancy: sonographic-pathologic correlation.

Review of sonograms in 84 patients with documented tubal pregnancies yielded 15 cases with discrete, diffusely echogenic, adnexal masses (18%). All these cases were proven at surgery to represent hematosalpinx containing clotted blood. The characteristic sonographic findings in these cases enabled an accurate preoperative diagnosis in 12 consecutive patients. Hematosalpinx containing clotted blood was seen as a diffusely echogenic adnexal mass accompanied in most cases by areas of high-intensity echoes. Pelvic hemoperitoneum (five cases) was diffusely echogenic due to clotted blood, and its recognition enabled evaluation of the upper abdomen for extension of hemorrhage. The echogenicity of the adnexal mass and pelvic hematoma was similar to that of the uterus, resulting in obscuration of its contour. The following sonographic features are characteristic of tubal pregnancy in the proper clinical setting: (1) absence of intrauterine gestation; (2) diffusely echogenic adnexal mass with areas of high-intensity echoes; and (3) diffusely echogenic hematoma in the pouch of Douglas.

Adnexa Uteri↗
PubMed2006

[Detection of free cancer cells in peritoneal cavity in patients surgically treated for gastric adenocarcinoma].

BACKGROUND/AIM: Peritoneal metastasis is a leading cause of therapeutic failure after an operative treatment of patients with gastric adenocarcinoma. Free cancer cells might induce or indicate an early peritoneal seeding with a subsequent peritoneal metastasis. The aim of this study was to determine the frequency of the presence of free cancer cells in the peritoneal cavity in the patients surgically treated for gastric adenocarcinoma, and its relation to certain clinical, operative and pathohistological paramethers. METHODS: Inside a period from April 2000, and April 2004, the total of 100 patients underwent intraoperative peritoneal lavage for cytological examination. Immediately after the laparotomy, 200 ml physiologic saline, heated to 37 degrees C, was introduced into the abdominal cavity, mannualy dispersed and collected from the region around the gastric tumor and the pouch of Douglas. The nucleated cell layer was smeared on four glass slides for every patient and dyed with May-Grünwald-Giemsa stain. The cytological findings were defined as positive or negative according to the presence of cancer cells. The frequency of positive cytological findings was compared to the location and the diameter of the cancer, pathohistological type of carcinoma, pathohistological stage of the disease, lymph node and the liver and/or peritoneal metastases and the type of surgical procedure. RESULTS: Free cancer cells were found in 24 (24%) of the patients, while in 76 (76%) of them cytological findings were negative. A statistically highly significant difference (p < or = 0.001) in the frequency of positive cytological finding was found between the groups of patients with and without cancer invasion of serosa, with cancer diameters > 5 cm and < or = 5 cm, in the stage of disease I, II and III, IV, with macroscopically present and without metastases, with re section and D2 lymphadenectomy and palliative procedure. Free cancer cells were statistically more frequently (p < or = 0.05) detected in the patients with lymph nodes metastases comparing to the patients with out lymph nodes involvement. The results of the univariate analysis showed that the cancer diameter > 5 cm, tumor invasion of serosa, pathohistological stage of the disease III and IV and macroscopically visible metastases were the most important risk factors for the free cancer cells detection. CONCLUSION: Peritoneal lavage cytology was shown to be a useful tool for the detection of the group of patients with greatest risk of peritoneal dissemination. The frequency of positive cytological findings was highly associated with the diameter of the tumor and the cancer invasion of serosa. Cytological examination of peritoneal lavage fluid improved the accuracy of staging and selection of patients who might have benefit from neoadjuvant chemotherapy.

Adenocarcinoma↗
PubMed1978

Doxycycline (Vibramycin) in pelvic inflammatory disease.

Using standardized laparoscopy technique, fluid was aspirated from the pouch of Douglas, from the Fallopian tubes and from ovarian cysts in 85 cases with clinical diagnosis of pelvic inflammatory disease (PID). The concentration of doxycycline in the aspirates was measured after oral ingestion of 200 mg of doxycycline (Vibramycin). A therapeutic level was achieved in the tubes and in ovarian cysts within a few hours, and on continuation of the treatment these values followed the plasma concentration closely, still being within the therapeutic range 24 hours after the final dose. The clinical effect was excellent, 94% (60/64) of the cases with verified PID being cured by doxycycline.

Adolescent↗
PubMed1979

Amoxycillin absorption and penetration in pelvic inflammatory disease.

Five patients with pelvic inflammatory disease (PID) had thin polyethylene catheters introduced percutaneously through the abdominal wall into the pouch of Douglas for sampling of peritoneal fluid. At hourly intervals specimens were aspirated, simultaneously with the sampling of finger tip capillary blood. In both the concentration of amoxycillin was determined by the micromethod of Jalling et al. (1972). One hour after the oral ingestion of 0.5 grams of amoxycillin, a therapeutic level was recorded in blood plasma, the peak level being achieved in 2 hours. The concentration of amoxycillin in the peritoneal fluid showed some delay, mainly in the cases with a thick purulent exsudate, but the peak levels were similar to those in blood plasma. After a single dose of 0.5 gram of amoxycillin, a therapeutic level was maintained in blood and in peritoneal fluid for 7-8 hours. The drug was well tolerated and showed an excellent clinical effect.

Absorption↗
PubMed1982

Antibiotic levels in plasma and peritoneal fluid after amoxycillin, ampicillin, and bacampicillin treatment for pelvic inflammatory disease.

Fifteen patients with pelvic inflammatory disease had a thin polyethylene catheter inserted through the abdominal wall into the pouch of Douglas for sampling of peritoneal fluid. At hourly intervals peritoneal fluid and capillary blood were collected. Five patients each received a single oral dose of either 0.5 g of ampicillin or amoxycillin, or 0.8 g of bacampicillin (approximately equimolar doses). This highest median peak plasma level was observed after bacampicillin. Bacampicillin also showed less variation in individual plasma concentration. The area below the plasma curve was similar for amoxycillin and bacampicillin, whereas that of ampicillin was significantly smaller (p less than 0.01). The rate of penetration into peritoneal fluid was slower for amoxycillin than for bacampicillin, even though the area below the peritoneal fluid curve was similar for the two drugs. Therapeutic levels were maintained for 5--8 hours, longer after amoxycillin than after bacampicillin.

Administration, Oral↗
PubMedDate not supplied

Long-term survival after immunochemotherapy for juvenile colon cancer with peritoneal dissemination: a case report.

A 20 year-old man was hospitalized with an abdominal mass and abdominal distension. Investigations resulted in a diagnosis of ileus caused by advanced colon cancer with peritoneal dissemination to the pouch of Douglas. Palliative surgery was performed to relieve bowel obstruction and debulk the tumor. Histopathological examination showed that the tumor was a mucinous adenocarcinoma invading the serosa without lymph node metastasis. Ascites collected during the operation was diagnosed as class V. Administration of PSK (3.0 g/day) and UFT (600 mg/day) as adjuvant immunochemotherapy was started postoperatively to achieve tumor dormancy. He has been followed as an outpatient for 2.5 years with no ascites or abdominal symptoms.

Adenocarcinoma↗
PubMed1976

[Douglas' abscess with ureteric obstruction (author's transl)].

In a 19 year old man with a single kidney the development of a large Douglas' abscess was followed by anuria; The various causes are discussed. It is resonable to assume, that the obstruction resulted from longitudinal tension of the ureter over the iliace vessels (iliac sign).

Abscess↗
PubMedDate not supplied

[Unusual course of an advanced extra-uterine pregnancy].

We report about the course of an advanced ectopic pregnancy in case of uterine leiomyomata, which was diagnosed after surgery. A vaginal bleeding appeared in the first trimester. Vaginal ultrascan was missing in those early time of pregnancy. Finally prenatal diagnosis in a center of perinatal medicine led to a suspicious fetal morphology and gave the indication for medical abortion. The induction of abortion with Gemeprost remained without success. Meanwhile abdominal pain increased and a laparoscopic exploration was carried out and showed a big vital ectopic pregnancy. This indicated laparotomy. This case showed the difficulties in diagnosis of ectopic pregnancy in the second trimester and discusses possibilities of the therapeutic procedures.

Adult↗
PubMed1999

[Laparoscopic therapy of chronic constipation].

Chronic constipation is a common complaint. Clinical presentation varies with each individual. This study reports the results of laparoscopic therapy in 92 patients with chronic constipation. In two patients conversion was necessary. The majority of patients were female (n = 84, 93.3%). Mean age was 60.3 years (+/- 15.7). In three patients with slow-transit constipation a laparoscopic assisted subtotal colectomy was performed. In patients with outlet obstruction a laparoscopic assisted sigmoid resection was carried out, whereas in 79 a rectopexy with reconstruction of the pouch of douglas was added. In 6 of 8 patients with concomitting diverticulitis an anterior resection was necessary. Mean stay on ICU was 0.5 days. OR time ranged from 100 up to 490 minutes. In 21 patients (23.4%) postoperative complications were observed; however only in 7.8% (n = 7) this lead to additional surgical intervention. The postoperative follow-up is 24 months (6-52 mon). In 76.3% of patients with outlet obstruction and rectal prolapse chronic constipation postoperatively improved or patients felt "symptomfree". In patients with outlet obstruction but without rectal prolapse constipation postoperatively was better in 75.8%. After subtotal colectomy 2 of 3 patients (66%) felt cured after surgery. Careful patients selection by thorough preoperative physiologic testing is mandatory for successful outcome in surgery of chronic constipation. Based on this by laparoscopic surgery same functional results as with conventional open technique could be achieved.

Adult↗
PubMedDate not supplied

The self-locating catheter: clinical evaluation and comparison with the Tenckhoff catheter.

BACKGROUND: Peritoneal catheter displacement appears to be related to various causes including omental attachment, bowel contractions, peritoneal adhesions, and the catheter floating in the dialysis fluid. In order to prevent this complication, which can impair peritoneal dialysis efficacy, Di Paolo et al. designed a "self-locating catheter" (SLC) that is similar to the Tenckhoff catheter (TC) and includes a small tungsten cylinder (weight 12 g) at the distal end (Di Paolo N, et al. The self positioning catheter. Proceedings of the VII Italian Congress on Peritoneal Dialysis. Milan: Wichtig Editore, 1993:539-42). The weight of the tip prevents the catheter from floating and migrating by gravitation toward the Douglas cavity. OBJECTIVE: Starting in 1996, we implanted SLC in 15 continuous ambulatory peritoneal dialysis patients. The aim of our study was to compare the ratio of migration and other catheter-related complications between patients with SLC (196 patient-months) and 13 patients with conventional straight TC (295 patient-months). RESULTS: Peritonitis ratio, catheter complication rate, dialysate inflow and outflow, and weekly creatinine clearance were similar in the two groups of patients. The incidence of catheter displacement was significantly higher (p = 0.0349) in theTC group than in the SLC group (4 vs 0). CONCLUSION: In our experience, the SLC seems to be useful in preventing catheter migration by continuous gravitation of its extremity toward the pelvic cavity.

Aged↗
PubMed2000

[Retrovesical and retroperitoneal extrarenal hydatid cyst: descriptive study of 9 cases].

OBJECTIVE: To determine the clinical, radiological and surgical features of retrovesical, retroperitoneal hydatid cyst and to discuss the aetiology and pathogenesis. MATERIAL AND METHODS: Nine cases of hydatid cyst operated in the urology department of Charles Nicolle hospital in Tunis between 1982 and 1998 were reviewed: five retroperitoneal sites and 4 retrovesical sites. RESULTS: Retrovesical and retroperitoneal sites represent about 10% of all operations for hydatid cyst in our department. The mean age of our patients was 49.8 years. The clinical presentation was dominated by voiding disorders in the cases of retrovesical hydatid cyst (4 cases) and the appearance of a lumbar or abdominal mass with or without associated abdominal pain in the cases of retroperitoneal hydatid cyst (5 cases). The positive diagnosis was based on abdominopelvic ultrasonography, completed by computed tomography in 3 patients. All patients were treated by wide cyst resection with a favourable course and no recurrence. CONCLUSION: Retrovesical and retroperitoneal hydatid cysts are rare, but not exceptional in a country with a high endemic rate, such as Tunisia. The diagnosis can be confirmed by radiological investigations. Implantation of the hydatid larva is essentially haematogenous. However, secondary implantation in the pouch of Douglas of protoscolex derived from rupture of an intraperitoneal cyst can also be responsible for some retrovesical sites.

Adult↗
PubMed2001

Laparoscopic repair of rectal prolapse: surgical technique.

Technical features of laparoscopic rectopexy include complete rectal mobilization without division of the lateral stalks to avoid parasympathetic denervation and postoperative problems with defecation. Suture rectopexy is equally effective as posterior mesh rectopexy in preventing recurrences and eliminates the use of foreign material which is sometimes associated with intense fibrosis, sepsis and increased constipation. According to two randomised studies constipation seems to be less after resection rectopexy than suture or posterior mesh rectopexy alone perhaps by eliminating possible kinking at the rectosigmoid region by falling of the redundant sigmoid colon in the pouch of Douglas. Randomized studies are, however, needed to validate the need for colonic resection and to determine its optimal extent in patients who suffer from rectal prolapse, constipation and slow transit.

Humans↗
PubMed2001

Increased nitric oxide in peritoneal fluid from women with idiopathic infertility and endometriosis.

OBJECTIVE: To verify whether nitric oxide in peritoneal fluid is associated with endometriosis and infertility. STUDY DESIGN: Twenty-five women with idiopathic infertility and 38 with endometriosis were recruited, and 18 cases of uterine myomata and 2 cases of ovarian cyst served as controls. Peritoneal fluid samples were aspirated from the pouch of Douglas during laparoscopy or laparotomy. Metabolites of nitric oxide (nitrite and nitrate) in peritoneal fluid were determined by a method using nitrate reductase and the Griess reaction. RESULTS: Peritoneal concentrations of nitrate/nitrite in both infertile women (42.02 +/- 12.98 mmol/L) and patients with endometriosis (41.75 +/- 16.42 mmol/L) were significantly higher than that in controls (33.96 +/- 13.07, P < .05 for both). No significant difference in peritoneal nitrate/nitrite level was found between infertile women and patients with endometriosis (P > .5). Peritoneal levels of nitrate/nitrite were comparable among patients with endometriosis at different stages (P > .5). Patients with endometriosis had more peritoneal fluid than controls and idiopathic infertile women, while controls and idiopathic infertile women had comparable amounts of peritoneal fluid. CONCLUSION: An increased peritoneal level of nitric oxide is a common alteration in endometriosis, endometriosis-associated infertility and idiopathic infertility and may be associated with the pathogenesis of these diseases.

Adult↗