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PubMed1980

[Acute upper genital tract infections. II. A. bacteriological study and the therapeutic consequences].

The authors have studied a prospective series of 62 cases of acute upper genital tract infections of different severities. Aerobic and anaerobic bacteriological examination were carried out from different sites: urine, blood, vagina, endocervix, intra-uterine devices and the pouch of Douglas. It is absolutely necessary to follow a strict technique according to the clinical examination in order to interpret the results according to a methodological plan. The results show that the gonococcus was found in 9 out of the 62 cases, which had a very varied flora. The value of the different smears and swabs is then discussed. In this way it is shown that specimens taken from the endocervix are definitely of great value although the ideal is to culture directly from intra-uterine devices or from specimens taken laparoscopically from the tubes. It is possible to give different courses of antibiotics: these should include however active substances against the group of anaerobes, which justifies adding metronidazole routinely. The use of corticoids which are often prescribed to limit the sequelae has not been proven to be of value.

Anti-Bacterial Agents↗
PubMed1995

[Pelvic pain related to pelvic ligament support].

In the context of organic pelvic pain, alongside post-infectious pain or pain related to endometriosis, ruptured ligaments of the pelvic fascia are an important cause of the pelvic congestion syndrome well known to classical authors. Surgical treatment combines two procedures: suture of the tear and exclusion of the pouch of Douglas.

Broad Ligament↗
PubMed1994

[Surgical treatment of genito-urinary prolapses by abdominal approach. Results in a continuous series of 203 operations].

A series of 203 abdominal operations for correction of genital prolapse performed between 1985 and 1992 is reviewed. We performed abdominal sacral colpopexy systematically associated with a Burch retropubic uretropexy. Resection of the peritoneum of the pouch of Douglas, and myorraphy of the levator ani were performed according to the findings of the clinical examination. 94 patients underwent a sacral colpopexy using a single suture of the cervix to the promontory, 41 had an anterior mesh, 33 had a suture associated with an anterior mesh, and 35 had 2 meshes (anterior and posterior). 96% of the patients were between 41 and 65 years old, and 90% were perimenopausal. 78.6% were multiparous and 32% had a neonate weighting 4kg or more. Urinary stress incontinence was isolated in 38%, and associated with another disorder in 57.8%. Urodynamic studies revealed detrusor instability in 12.3% of patients, and sphincter incompetence in 15.2%. Urinary tract insection was the most frequent postoperative complication (61.5%). One month post-surgical evaluation showed good anatomic results in 94.2 to 100% of cases, and good functional results in 56 to 70.5%. The longterm results were anatomically good in 86.7 to 100% of the patients, and functionally good in 53.3 to 80.5% (mean follow-up = 32.5 months). Results were not significantly different between the 4 surgical procedures.

Adult↗
PubMed1995

[Pelvic pain and external endometriosis. Physiopathology and treatment].

New data on the pathophysiology of pain associated with endometriosis are available. The predominant role of deep endometriosis has been stressed. In multivariate analysis, superficial endometriosis and even adhesions and ovarian cysts do not appear to be related with pain. Deep endometriosis is usually located posterior to the vagina and cervix, involving the pouch of Douglas, the rectovaginal septum and the uterosacral ligaments. In such cases, pelvic examination shows a painful induration or a nodule in this area. The anterior cul-de-sac and the lateral pelvic wall may also be involved. Two histological and clinical aspects may be observed: deep endometriosis arising under the peritoneal surface, or adenomyosis arising from the uterine cervix. Only complete surgical excision may be curative, but recurrences may occur after surgery. Hormonal therapy is only suspensive. However, surgical therapy involves a significant risk of complication. Surgery for deep endometriosis may be one of the most difficult gynecologic operations. It should be performed only by experienced surgeons, with skills in oncological dissections of the pelvis. The guidelines for therapy are thus clear. Superficial endometriosis does not cause pain and should not be treated by itself; symptomatic relief of pain may be obtained by therapeutic amenorrhea or by the placebo effect of surgery. Endometriomas are managed in the same way as all organic ovarian cysts. Adhesions are lysed if infertility is associated with pain, or to gain access to the retroperitoneal area. Etiologic therapy is acceptable only in case of deep endometriosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Endometriosis↗
PubMed1976

[Bridging extensive peritoneal defects with terminal mesoileum].

Extended intestinal operations such as right hemicolectomies and operations in the pouch of Douglas can cause considerable difficulties in restoring the missing peritoneum. In the authors' four cases the problems were solved anatomically and functionally by suturing only the mesenterium of the terminal ileum to the edge of the previously cut peritoneum. With this technique of peritonealization the mobility and function of the gut was left intact. The resulting retroperitoneal space was drained separately.

Aged↗
PubMed1994

[The M. Kapandji hysteropexy: a laparoscopic technic and preliminary results].

OBJECTIVE. To develop a laparoscopic-assisted technique for the treatment of genital prolapsus. MODALITY. With the Kapandji's technique the vagina and the uterine isthmus is suspended transversally with a subperitoneal prosthesis. This technique has been favourably assessed in comparison with posterior suspension to the lumbo-sacral junction and is easily performed laparoscopically. Details of the technique will be given. CONCLUSION. This technique was simpler and less dangerous than colposuspension to the lumbo-sacral disc and gave functional results which were as good or better. This method also has the advantage of being performed via laparoscopy. Since the immediate post-operative convalescence is shorter and complete recovery can be achieved more rapidly, this is the method of choice for the treatment of genital prolapsus in young women.

Douglas' Pouch↗
PubMed1994

Pelvic granulomata mimicking endometriosis following the administration of oil-based contrast media for hysterosalpingography.

BACKGROUND: Hysterosalpingography is used commonly in the evaluation of infertility and in the diagnosis of anomalies of the uterus and fallopian tubes. There is continued debate over the safety and diagnostic or therapeutic efficacy of water-soluble versus oil-based contrast media. CASE: A 29-year-old woman with secondary infertility underwent hysterosalpingography with both water-soluble and oil-based contrast. The fallopian tubes appeared normal. Six months later, a plain abdominal radiograph obtained at the occasion of a minor motor vehicle accident revealed evidence of retained loculated pelvic contrast material. Subsequent laparoscopy identified adhesions and cul-de-sac implants strongly suspicious for endometriosis. Biopsy and pathologic study documented lipogranuloma. CONCLUSION: Oil-based contrast media instilled into the pelvis at hysterosalpingography can persist for prolonged periods and create granulomatous lesions mimicking endometriosis. In view of the controversy whether oil-based contrast materials are superior to water-soluble media, the routine use of oil-based contrast media should be considered carefully.

Adult↗
PubMed1993

[Celioscopic appendectomy. Results in 137 consecutive patients].

Between September 1990 and August 1992, laparoscopic appendicectomy was attempted in 137 patients: 98 females and 39 males (sex-ratio: 2.5:1) with a mean age of 31 years (range: 15-85). The patients were operated on by 9 surgeons. Laparoscopic appendicectomy was possible in 120 patients (87.6%). In 19 patients the procedure was converted into open surgery. The main causes of unsuccessful laparoscopic procedures were: retrocaecal appendix (n = 5) and injury of appendiceal artery (n = 4). The rate of unsuccessful procedures was 31% in retrocaecal appendix and 9.4% in the other cases (P < 0.02). In exclusively laparoscopic procedures, the mean operating time was 63 (2.9) minutes. It was 49 (3) minutes for experienced surgeons and 69 (3.3) for other surgeons (P < 0.05). Histological examination of the appendix revealed inflammatory signs in 97 specimens (71%). There were no wound infections after successful laparoscopic appedicectomy. One female patient developed an abscess in the pouch of Douglas. The median postoperative hospital stay was 3 days (range: 1-16). These results suggest that laparoscopic appendicectomy is a safe technique, with low morbidity allowing short postoperative hospital stay.

Adolescent↗
PubMed1993

[Abdominal approach of rectocele and colpocele].

The authors report a series of 62 female patients operated for rectocele and/or elytrocele via an abdominal approach. The technique was based on insertion of a retrovaginal prosthesis attached to the sacrum. Other surgical procedures can be performed at the same operation: hysterectomy, insertion of a prevaginal prosthesis, retropubic colpopexy. The anatomical and functional results were excellent in these patients previously operated for urinary incontinence or prolapse (99%). The indication for total hysterectomy during the same operation must be limited as this procedure increases the morbidity and impairs the functional results. Dyschexia is improved, but may be followed by postoperative constipation. Abdominal treatment of rectoceles and/or elytroceles by interposition of an interrectovaginal prosthesis attached to the sacrum is particularly indicated after hysterectomy in the case of associated or recurrent genitourinary prolapse.

Douglas' Pouch↗
PubMed1993

[Evaluation of intra-uterine pathology and tubal patency by contrast echography].

The contrast ultrasonography (CUS) is a new development of the pelvis ultrasounds. A contrast medium is injected through the cervix and is screened through the uterine cavity, the tubes and the peritoneal cavity. The contrast medium creates a new acoustic interface which improve the quality of the ultrasound imaging and the ability to diagnose endouterine pathologies. Further, tubal patency may be assessed by tracking fluid into the pouch of Douglas. The aim of this study was to assess the feasibility, the accuracy and the side effects of this technique when compared with the conventional procedures. Included were two groups of patients: the group 1 (10 cases) was of patients with menometrorrhagia before undergoing an hysteroscopy; the group II (11 cases) was of infertile patients before undergoing a laparoscopic tubal patency test. This technique, of low cost and without any radiation exposure, seems to be at least as accurate as the conventional methods for the intrauterine diagnostics. It is less effectiveness for the evaluation of the tubal patency. No side effect occurred in this study.

Contrast Media↗
PubMedDate not supplied

Ciliated bodies in ovarian cyst aspirates.

Ciliated bodies, or detached ciliary tufts, are ciliated fragments of cytoplasm from columnar epithelial cells. In gynecologic cytology they have been observed in cervicovaginal smears and peritoneal washings and very occasionally in fluids from the pouch of Douglas. They occur frequently in the fluids of ovarian cysts. The authors detected ciliated bodies in 30 of 326 ovarian cyst fluid samples (9.20% of cases) taken from 27 patients aged 14-68 years. Ciliated bodies were found in the fluids from both bilateral cysts in one patient and in slides from both former and recurrent cysts in two. Surgery was performed in 14 of the cases, with histologic examination revealing 5 simple serous cysts, 3 paraovarian cysts, 3 serous papillary cystoadenofibromas, 1 serous cystoadenoma and 2 mature cystic teratomas. In the remaining cases the pertinent clinical data, including ultrasound ecography, revealed benign paraovarian and ovarian cysts. The existence of ciliated bodies in the fluids of ovarian cysts indicated the presence of ciliated columnar epithelial cells on the wall of the cysts, which would exclude cysts of follicular origin.

Adolescent↗
PubMed1993

[Anterolateral hysteropexy via abdominal approach. Results and indications. Apropos of a series of 92 patients].

Of the possible surgical techniques for the treatment of genito-urinary prolapses, abdominal suspension is reserved for young patients in whom retention of sexual function is desirable. Fixation to the sacral promontory is the reference method but has some contraindications. Anterolateral suspension of the uterine isthmus to the anterior superior iliac spines by a strip of non-absorbable mesh, as described by Kapandji, is then a good alternative. We report our results with this technique over an 8-year period in 92 patients. Mean follow-up was 5 years. There was no intraoperative mortality nor major complications. Anatomical results were satisfactory in 87% of cases at 5 years, with however 4 reoperations for total recurrent prolapse, of which one was posterior. Functional results showed two cases of deep dyspareunia and 12% post-operative stress urinary incontinence, of gradual onset. In conclusion, anterolateral hysteropexy associated with removal of the pouch of Douglas is a reliable procedure with no particular danger. It can be a good alternative to fixation to the sacram promontory when the latter is contraindicated or dangerous.

Adult↗