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At least 613 records · Page 34Linked to original sources
PubMed2004

[Laparoscopic suture uterosacral ligament hysteropexy for uterine prolapse].

OBJECTIVE: To investigate possibility and effect of laparoscopic suture uterosacral ligament hysteropexy or colpopexy for women with uterine prolapse. METHODS: Thirty-two women with symptomatic uterine prolapse underwent laparoscopic suture uterosacral ligament hysteropexy. At the laparoscopic suture hysteropexy or colpopexy, the pouch of Douglas was closed and the uterosacral ligaments were plicated and reattached to the cervix. All patients were multipara and menopausal with prolapse of anterior wall of vagina. Additionally, 4 patients were with prolapse of posterior wall of vagina, 15 with stress urinary incontinence, and 4 with myomas. RESULTS: All procedures were successfully completed laparoscopically. The mean operating time for the laparoscopic suture hysteropexy or colpopexy alone was (32 +/- 11) min (range 20 approximately 80 min), and the mean blood loss was less than 50 ml. After a mean follow-up of (12 +/- 6) months (range 4 approximately 28 months), 23 women had no symptoms of uterine prolapse and seven had no objective evidence of uterine prolapse. Two women presented recurrence of uterine prolapse 3 months after operation. CONCLUSIONS: The laparoscopy suture hysteropexy or colpopexy is effective and safe in the management of symptomatic uterine prolapse. It may be an appropriate procedure for women with uterine prolapse hoping for uterine preservation.

Aged↗
PubMed2005

[Application of fertiloscopy in infertile women].

OBJECTIVE: To investigate the advantages of fertiloscopy in the examination and therapy of infertile women. METHODS: One hundred and fifteen infertile patients underwent fertiloscopy including transvaginal hydrolaparoscopy (THL), conventional dye-test, hysteroscopy, and dye-test using catheterization of the tubal ostium by hysteroscopy from May 2003 to Mar 2005. Access to the pouch of Douglas was achieved in 110 patients (95.7%). The primary infertile patients (primary group) and secondary infertile patients (secondary group) included respectively 49 and 61 cases. The patients of tubal occlusion in two groups were respectively 21 and 22 cases preoperatively. The fallopian tube patency, pelvic adhesions, complete evaluation (all pelvic organs seen) or not, and intra- and postoperative complications were observed. RESULTS: There was no significant difference in the percentage of uni- and bilateral tubal patency cases between two groups postoperatively (69.4%, 34/49 vs 68.9%, 42/61) (P > 0.05). Of the cases that were bilateral tubal occlusion in both groups preoperatively, the uni- and bilateral tubal patency cases accounted for respectively 47.6% (10/21) and 50.0% (11/22) (P > 0.05) postoperatively. There was no significant difference in the percentage of pelvic adhesions cases between two groups (42.9%, 21/49 vs 60.7%, 37/61; P > 0.05). The overall complete evaluation rate of pelvic organs was 69.1% (76/110), the rates of both groups were respectively 77.6% (38/49) and 62.3% (38/61, P > 0.05). The rate of additional transabdominal operative laparoscopy was 18.2% (20/110) after fertiloscopy, of which, the rate of primary group was only 8.2% (4/49), much less than that of secondary group (26.2%, 16/61; P < 0.05). Seventeen women underwent transabdominal operative minilaparoscopy after fertiloscopy. No complications including pelvic organ injury, rectum perforation, intra- and postoperative bleeding, and postoperative pelvic inflammation occurred. CONCLUSIONS: THL is simple, convenient, and complication-free for the infertile women. Fertiloscopy could be used as a first-line and one-stop procedure in the pelvic assessment of infertile women without clinical or ultrasound evidence of pelvic disease instead of transabdominal laparoscopy. Transabdominal laparoscopy should be only used as a complementary procedure after fertiloscopy.

Adult↗
PubMed1991

Laparoscopic repositioning of malfunctioning peritoneal dialysis catheters.

Continuous ambulatory peritoneal dialysis is commonly used for the maintenance of patients with chronic renal failure. A common complication associated with this treatment is outflow obstruction of the catheter. Noninvasive approaches to outflow obstruction such as enemas, infusions of saline, and body position changes are rarely successful in the management of these complications (1). Herein we report a review of our experience with the use of laparoscopy for the evaluation and management of peritoneal dialysis catheters with outflow obstruction.

Adult↗
PubMed1991

False-positive cultures of the cul-de-sac associated with culdocentesis in patients undergoing elective laparoscopy.

We studied 21 women undergoing elective laparoscopy to determine whether positive bacterial cultures obtained by culdocentesis were contaminants from the vaginal mucosa. Cultures for aerobic and anaerobic microorganisms were prepared from swabs of the posterior vaginal fornix, laparoscopic cul-de-sac aspirates, culdocentesis aspirates, and repeat laparoscopic aspirates of the cul-de-sac. Cultures were positive from the vaginal fornix in all cases. All cultures from the cul-de-sac before culdocentesis were negative. Five of seven cultures (71.4%) from culdocentesis specimens and seven of nine cultures (77.8%) from repeat laparoscopic cul-de-sac aspirates were positive in women without povidone-iodine vaginal preparation. Five of 12 cultures (41.7%) from culdocentesis specimens and three of 12 cultures (25%) from repeat laparoscopic cul-de-sac aspirates were positive in the women with vaginal preparation. Both aerobic and anaerobic bacteria were recovered. We conclude that false-positive culdocentesis cultures occur and that bacterial contamination of the cul-de-sac following culdocentesis may lead to false-positive cultures of specimens obtained during subsequent laparoscopy.

Adult↗
PubMed1991

[Continuous hyperthermic peritoneal perfusion (CHPP) therapy in advanced gastric cancer].

In CHPP therapy for advanced gastric cancer, a perfusate containing 20 mg CDDP and 8 mg MMC in 1,000 ml physiologic saline warmed at 47 degrees C was infused at a constant rate of 200 ml/min into the pouch of Douglas. The intraperitoneal temperature at the supra-pancreatic region was around 39.0 degrees C. To obtain a more stable and higher intraperitoneal temperature, the infusing rate was increased to 400 ml/min. This yielded a 3 degrees C higher temperature (42 degrees C) at the same measuring site. However, the temperature recorded at various intraperitoneal sites did not always reach such an effective range. The maximal plasma concentrations of MMC determined during CHPP at the 200 and 400 ml/min infusion were 0.09 +/- 0.03 and 0.11 +/- 0.03 microgram/ml, and those of CDDP 1.6 +/- 0.4 and 1.7 +/- 0.3 microgram/ml, respectively, all of which were not significantly different. When an intraperitoneal dosage of 20 mg MMC was given to 3 patients, the portal venous blood, at 10 min after the administration, produced a 1.7 times higher concentration of the agent than did the peripheral venous blood. This discrepancy between the two concentrations was much smaller than found by other investigators in animal experiments.

Adult↗
PubMedDate not supplied

Simultaneous intra- and extrauterine pregnancy after multiple ovulation induction.

Superovulation was induced by combined treatment with a GnRH analog, hMG and hCG in a 31 years old nulligravida with a diagnosis of unexplained infertility. She developed a mild hyperstimulation syndrome for which she received conservative treatment in hospital, and she was discharged only after we demonstrated a gestation sac in utero with evident fetal heart beat and beta hCG assays were positive. One week later the patient was readmitted urgently with acute abdominal pain. Laparoscopy revealed a left tubal pregnancy with corpus luteum on the right ovary and free blood in the pouch of Douglas. Salpingotomy was therefore performed with dilatation and curettage of the uterine cavity. Histological examination confirmed the presence of contemporary intra- and extrauterine pregnancy. Based on this first communication, a high index of clinical suspicion for an extrauterine pregnancy is warranted in all patients undergoing superovulation even after a pregnancy in utero has been demonstrated.

Adult↗
PubMedDate not supplied

Relationship between the cytologic characteristics of intraperitoneal free cancer cells and the prognosis in patients with gastric cancer.

The presence of free cancer cells in the peritoneal cavity of 387 patients with gastric cancer was analyzed using specimens obtained by intraoperative lavage of the pouch of Douglas. If cancer cells were found in the specimen, the case was classified with respect to the number and arrangement (clustered or isolated) of the cancer cells found. Study of the relationship between the histologic type of cancer and the presence of free cancer cells showed that poorly differentiated adenocarcinomas and signet ring-cell carcinomas were associated with a higher incidence of free cancer cells than were other types of cancer. The relationships between the characteristics of the free cancer cells and the postoperative survival rate were also studied. Patients whose free cancer cells were present in clusters were associated with a more favorable prognosis than were those with no such clusters. Patients with small numbers of free cancer cells survived longer than did those with large numbers of free cancer cells.

Adenocarcinoma↗
PubMed1990

[Surgical microscopy in various stages of vaginal hysterectomy].

This article reports on a new application for operating microscopes to reduce risks when performing a vaginal hysterectomy. Magnification helps to perform the following steps: dividing the vesicocervical ligament, mobilizing the rectum, opening the plica vesicouterine and opening the pouch of douglas.

Female↗
PubMed1985

[Transformation of ovarian yolk sac tumor to immature teratoma following chemotherapy].

The patient, a 28-year-old woman, in her ninth week of pregnancy, was operated on for stage Ia, mixed germ cell tumor (grade 3 immature teratoma + yolk sac tumor) of AFP decreased to the normal level. Eight months later, an intrapelvic mass and raised AFP were found. The extirpated recurrent tumor in the pouch of Douglas was a grade 2 immature teratoma with no yolk sac element. FAM chemotherapy was given again, and the patient is alive and well after taking oral UFT. As in testicular germ cell tumors, ovarian germ cell tumors can be converted to a more differentiated tumor following chemotherapy.

Adult↗
PubMedDate not supplied

Vaginal trauma at sexual intercourse in Ilorin, Nigeria. An analysis of 36 cases.

Over a six-year period (1982-1987), 36 cases of vaginal trauma at sexual intercourse managed in the gynaecological unit of the University of Ilorin Teaching Hospital are presented. The serious nature of this accident is stressed. The frequent involvement of the posterior fornix of the vagina, accounting for 50% of the cases is shown. Perforation of the pouch of Douglas with possible intestinal prolapse, and involvement of the urinary bladder resulting in vesicovaginal fistula are not common in Ilorin. The predisposing factors like rough coitus, first sexual intercourse, puerperium, surgical alteration of the vagina, peno-vaginal disproportion and multiparity are discussed. The importance of adequately preparing the women emotionally and physically for coitus, a matter which certain males tend to ignore, is emphasized. The necessity for thorough digital as well as speculum examination in all cases of vaginal bleeding is made. There was no death recorded, while the morbidity was mainly hypovolaemic shock with haemorrhagic anaemia.

Adolescent↗
PubMed1989

[Spontaneous hemoperitoneum complicating intraperitoneal paraganglioma].

A young man of 27 years was admitted to the medical ward because of increasing ascites over 3 months. There were no signs of portal hypertension and a diagnostic tap produced hemorrhagic liquid. Ultrasound confirmed ascites associated with an abdomino-pelvic mass. Anemia progressed and right aorto-iliac axis arteriography was carried out and demonstrated a poorly vascularised mass. Emergency surgery was carried out and demonstrated an encapsulated firm and cystic abdomino-pelvic mass of 23/18 cm with a rich vascular supply from the greater omentum and a hemoperitoneum of 7 litres secondary to rupture of this pseudo-lymphangiomatous mass. Besides large vessels from the and some loose fibrous adhesions in the pouch of Douglas there was no true implantation site attaching this mass to retroperitoneal structures, gastrointestinal tract or bladder. After ligation of the vessels the entire mass was easily resected. The post-operative course was uncomplicated. Pathological examination confirmed a paraganglioma. A full clinical pathogenic, therapeutic and evolutive study is described.

Abdominal Neoplasms↗
PubMed1989

Embryologic theory of histogenesis of endometriosis in peritoneal pockets.

A novel presentation of endometriosis is described in which the lesion is identified within the brim or floor of peritoneal pockets located within a crescentic band in the posterior pelvis. The predictability of these peritoneal pockets and their strong association with other anomalies of the Mullerian and urinary tracts raises the possibility of a congenital origin.

Douglas' Pouch↗
PubMed1989

[Endometriosis--new perspectives. 1. Pathology and physiopathology].

Endometriosis is a disease characterized by the occurrence of ectopic endometrium, most frequently in the pouch of Douglas and the ovaries. The disease is diagnosed at operation and occurs practically exclusively in women of fertile age. The symptoms are, in particular, diffuse low abdominal pain, dyspareunia, infertility and dysmenorrhoea. The prevalence of the disease is unknown but has been estimated as about 1-2%. The etiology is still unknown. The classical theories about 1) retrograde implantation of endometrium from menstruation and 2) metaplasia of the coelom epithelium are still current. A series of recent observations of increased macrophage activity, reduced cellular immunity and deviations in the complement system suggest, however, that special immunological factors also play a causal role. Endometriotic tissue has great morphological and biochemical similarities with endometrium and contains, similarly, receptors for steroid sex hormones but in lower concentrations and with an increased relationship between progesterone and oestrogen receptors. The pathophysiological basis for the infertility correlated with the disease is only partially understood. Apart from obvious anatomical causes, the occurrence of the luteinized unruptured follicle syndrome and alterations in the content of steroid hormones and prostaglandins in the peritoneal fluid are possible causes.

Endometriosis↗