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PubMed1989

[Intraperitoneal insemination].

Intra-perineal insemination is a technique used in assisted reproduction. The principle is to stimulate the ovaries, to obtain the partner's sperm and to prepare it by similar techniques to those used in in-vitro fertilization so that the sperm can be placed near the ovaries in the Pouch of Douglas by a direct puncture of the posterior vaginal fornix without using anaesthesia. The woman's pelvis has to be absolutely normal. This technique is useful in cases of unexplained sterility, cervical sterility and inadequate sperm function.

Adult↗
PubMed1989

[Fundamental and clinical study on source of CA 125 antigen in cul-de-sac fluid and translation into systemic circulation].

CA125 levels in cul-de-sac fluid were measured in patients with endometriosis and patients with myoma uteri in order to investigate the participation of CA125 of endometrial tissue origin in peritoneal fluid levels. The translation of peritoneal fluid CA125 into the systemic circulation was also examined in an experiment on rabbits. 1. The CA125 concentrations in peritoneal fluid in patients with endometriosis and those with myoma uteri were similar. 2. High concentrations of CA125 in peritoneal fluid were also observed in patients who had undergone hysterectomy with bilateral salpingo-oophorectomy. 3. There is little correlation between the extracted tissue weight and CA125 concentrations in cul-de-sac fluid in patients with adenomyosis. 4. In patients with endometriosis, although CA125 concentrations in peritoneal fluid decreased transiently during conservative hormonal treatment, an increase in CA125 concentrations in peritoneal fluid was observed again after treatment. 5. CA125 concentrations in serum and in peritoneal fluid in ovarian cancer patients with peritonitis carcinomatosa were significantly higher than those without peritonitis carcinomatosa. 6. The experiment on rabbits indicates that the translation rate of CA125 antigen and the degree of chemical peritonitis treated with CH3COOH are in inverse proportion. Consequently, CA125 antigen in peritoneal fluid seems to be derived from others such sources as the peritoneum in addition to endometrial tissues.

Adult↗
PubMed1988

Laparoscopic and vaginal colpotomy for the excision of infiltrating cul-de-sac endometriosis.

Palpable endometriotic nodules deep in the cul-de-sac and vagina represent the extension of intraperitoneal disease. Although such nodules used to be excised with vaginal colpotomy and by tracing the endometriosis to the peritoneum, the dissection of these lesions under laparoscopic visualization had aided in their removal. Of seven patients who were approached with a plan for combined laparoscopic and vaginal excision, five underwent the procedure. The last two required laparotomy due to bowel muscularis involvement.

Douglas' Pouch↗
PubMedDate not supplied

[Improved diagnosis of extrauterine pregnancy by endosonography].

Between July 1987 and January 1988, 44 patients with a tentative diagnosis of ectopic pregnancy underwent sonographic examination by means of vaginal probe at the Department of Gynecology and Obstetrics of the RWTH Aachen. The sonographic findings, all of which were confirmed by subsequent clinical and or surgical clarification, were as follows: an ectopic pregnancy was diganosed in 16 cases, an early intrauterine pregnancy in seven, an intrauterine abortion in seven, and in one case a uterine malformation-a dermoid cyst and a functional cyst. In 11 cases sonographic examination showed the interior genital region to be normal, with no sign of pregnancy. In the 16 ectopic pregnancies diagnosed, it was possible in 13 cases to visualize the pregnancy directly by sonography, including the amniotic sac, and to make measurements. In one case a normally developed ectopic pregnancy with living embryo was seen at the end of the seventh week of gestation post menstruationem. In the remaining three cases the diagnosis was established on the basis of an empty cavum uteri associated with a slightly enlarged uterus and demonstration of fluid in the pouch of Douglas. In two cases the ectopic pregnancy was correctly localized by "feeling" with the intravaginal probe to establish the cause of circumscribed pain. In three case the tentative diagnosis of an ectopic pregnancy made on the basis of sonographic findings was not confirmed by subsequent clarification procedures. The results described show that in most cases ectopic pregnancies can be demonstrated directly by sonography using an intravaginal probe.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMed1988

[Heterotopic twin pregnancies. Review of the literature after a case where the 2 children survived].

A combination of an extra-uterine and an intra-uterine pregnancy is defined as heterotopic twin pregnancy. A case is reported where the 2 infants were born alive and have had a normal psychomotor development at 3 years of age. It is a case where the first observation taken by ultrasound made the diagnosis possible at 27 weeks of the pregnancy and therefore gave rise to the crucial problem of how to manage the case. Because of this case history we have discussed the frequency (one in every 30,000 pregnancies), the aetiological factors, the clinical factors, the prognostic factors and what is to be done. The discussion takes note of the modern ways of diagnosing it (ultrasound), of monitoring it and of handling in a specialised unit this exceptional kind of "high risk" pregnancy.

Adult↗
PubMed1987

Diagnostic modalities in gynecologic and obstetric emergencies.

Gynecologic emergencies are an integral part of the practice of an emergency physician. In fact, the occurrence of one of these, ectopic pregnancy, has increased dramatically in recent years. Fortunately, the diagnostic modalities available to emergency physicians, particularly serologic pregnancy testing and ultrasonography, have kept pace by undergoing tremendous technologic improvements that allow more rapid and accurate diagnosis of these potential life threats. Armed with the still valuable procedure of culdocentesis as well, the emergency physician has never been in a better position to cope with the distressed gynecological patient.

Douglas' Pouch↗
PubMed1987

Ectopic pregnancy.

Ectopic pregnancy is a potentially lethal disorder that is often difficult to diagnose clinically. More than 70,000 ectopic pregnancies are reported annually in the United States, and the incidence is rising. A thorough knowledge of predisposing factors, clinical presentation, common misdiagnoses, and recent advances in diagnostic modalities should help the Emergency Department physician avoid the pitfalls that lead to misdiagnosis with resulting morbidity and, occasionally, mortality.

Diagnosis, Differential↗
PubMed1987

[Ultrasonographic diagnosis of cul-de-sac endometriosis].

Fifty-six women with endometriosis were examined for cul-de-sac endometriosis by ultrasonography and laparoscopy. Ultrasonographic cul-de-sac findings were classified into 3 groups; i.e. Group A (n = 21): no remarkable findings, Group B (n = 16): several nodular hyperechoic or cystic hypoechoic areas, and Group C (n = 19): multiple nodular or cystic areas and/or discontinuation of the contour of the posterior uterine wall. Laparoscopic cul-de-sac findings were classified into 3 groups; i.e. Group alpha (n = 6): no endometriosis, Group beta (n = 28): minimal or mild endometriosis, and Group gamma (n = 22): advanced endometriosis with or without cul-de-sac obliteration. Over-all coincidence of both findings was 50%. The rate of coincidence was significantly higher (p less than 0.05) in Group gamma (15/22) than in Group beta (9/28). This indicates that the diagnosis of minimal or mild cul-de-sac endometriosis by means of ultrasonography is difficult but that ultrasonography might be useful in diagnosing advanced cul-de-sac endometriosis.

Culdoscopy↗
PubMedDate not supplied

Detached ciliary tufts in female peritoneal washings. A common finding.

Detached ciliary tufts (DCTs) have been observed in sputum, in cervicovaginal smears and, rarely, in fluid from the pouch of Douglas. DCTs occur frequently in peritoneal washings from female patients. Twenty-five consecutive peritoneal washings were studied for DCTs. Fourteen specimens were from women in the reproductive age group (21 to 47 years); all contained DCTs. All of these 14 patients, except for one in the 14th week of pregnancy, were in the secretory phase of the menstrual cycle. The 11 patients without DCTs in their peritoneal washing had an age range of 23 to 88 years. Three were postmenopausal, seven were in the proliferative phase of the menstrual cycle, and one had had a previous hysterectomy and bilateral salpingo-oophorectomy. DCTs most likely represent a physiologic process of cyclic shedding of cilia from the cells of the fallopian tubes during the luteal phase of the menstrual cycle.

Adult↗
PubMed1987

[Clinical studies of BRL 28500 (clavulanic acid/ticarcillin) in the treatment of pelvioperitonitis and Douglas' abscess].

Clinical studies were conducted on BRL 28500 (a formulation containing 15 parts ticarcillin plus 1 part clavulanic acid). BRL 28500 was administered at doses of 1.6 g or 3.2 g b.i.d., generally for 10 days by drip infusion to patients with pelvioperitonitis or Douglas' abscess. The results obtained were summarized as follows. 1. Clinical efficacy was evaluated in 18 patients (pelvioperitonitis 14, Douglas' abscess 4), but 8 patients out of a total of 26 patients were excluded. 2. In the evaluation of clinical improvement by doctors in charge, clinical improvement rates were 44.4% on day 3, 88.2% on day 5. 3. On the basis of committee judgement, the clinical efficacy rate was 100%. 4. The bacteriological eradication rate of causative organisms was 100% in 11 patients (15 strains). Five strains out of a total of 15 strains produced beta-lactamase. 5. As a side effect, nausea was observed in 1 case. In laboratory examination, liver function abnormalities were observed in 1 case. 6. Regarding usefulness as judged by doctors in charge, the satisfactory rate was 83.3%. From the above results, it has been concluded that BRL 28500 is very useful in the treatment of pelvioperitonitis and Douglas' abscess.

Abscess↗
PubMed1986

Endometriosis: pathogenetic implications of the anatomic distribution.

The authors have reassessed the anatomic distribution of ectopic endometrium by the laparoscopic study of the location of implants, adhesions, and uterine position in 182 consecutive patients with infertility and endometriosis. The ovary was the most common site of implants with 54.9% having either unilateral or bilateral involvement. This was followed, in order of frequency, by the posterior broad ligament (35.2%), the anterior cul-de-sac (34.6%), the posterior cul-de-sac (34.0%), and the uterosacral ligament (28.0%). Adhesion formation followed the same anatomic distribution. No patients were noted to have endometriosis of the cervix and vagina. Endometriosis of the anterior compartment (anterior cul-de-sac, anterior broad ligament, and anterior uterine serosa) was significantly more common in patients with anterior uteri (40.7%) versus patients with posterior uteri (11.8%, P less than .0005). Exclusive anterior compartment disease was found only in patients with anterior uteri, and significantly more commonly in patients with severely anteflexed uteri (P less than .005). These data suggest that factors influencing implantation of retrograde menstrual debris include: the dependent pooling of peritoneal fluid as affected by uterine position; epithelial cell type at the site of implantation; unique ovarian susceptibility; route of entry; and mobility of the pelvic structures. The data support the Sampson hypothesis of retrograde menstruation as the primary model of development of endometriosis.

Broad Ligament↗
PubMed1985

Value of culdocentesis in the diagnosis of ectopic pregnancy.

The diagnostic value of culdocentesis was examined in all patients admitted with hemoperitoneum during a three-year period. There was a total of 158 women with positive culdocentesis, of whom 132 (83.5%) had tubal ectopic pregnancies and 26 had other diagnoses. Of the 132 patients with ectopic gestations, the majority (62%) had unruptured tubes. A nondiagnostic culdocentesis should not be used either to raise or to lower the clinician's suspicion of ectopic pregnancy as 16% of patients with an ectopic pregnancy had a nondiagnostic culdocentesis, of which one-quarter were ruptured and three-quarters had hemoperitoneum diagnosed at the time of surgery. A positive culdocentesis along with a positive serum human chorionic assay was associated with an ectopic pregnancy in 99.2% of cases. This procedure should not be limited to the evaluation of patients with classic peritoneal signs, as 45% of the authors' patients with a positive culdocentesis did not have such findings.

Biopsy, Needle↗
PubMedDate not supplied

Ovarian adhesions impair ovulation.

The concentration of progesterone in peritoneal fluid, aspirated from the pouch of Douglas by laparoscopy, 72 hours after the peak of the luteinizing hormone in serum is believed to indicate whether the ovarian follicle has ruptured or not. Twenty six patients were studied. The volume of peritoneal fluid 72 hours after the peak of the luteinizing hormone was markedly decreased when bilateral ovarian adhesions were present. Progesterone concentrations, assayed during the early luteal phase in peritoneal fluid of women with bilateral ovarian adhesions, were significantly lower than in women with a corpus luteum presenting an ovulation stigma and even significantly lower than in those without ovulation stigma (luteinized unruptured follicle syndrome). The assay of progesterone in peritoneal fluid during the early luteal phase may be of value in women with ovarian adhesions.

Estradiol↗
PubMed1985

[Perforation of the urinary bladder with retroperitoneal abscess formation and septic shock following diagnostic curettage].

A case of perforation of the urinary bladder is presented which occurred occasionally a diagnostic curettage. At admission there was a severe septic shock. After intensive treatment the diagnosis of perforation of urinary bladder was made by intravenous urography and cystography. Laparotomy with closure of the perforation, lavage of abdomen and drainage of the pouch of Douglas made a total recovery.

Abscess↗