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PubMedDate not supplied

Correlation of computed tomography with second-look laparotomy in ovarian carcinoma.

BACKGROUND: Cancer of the ovary is the second commonest gynaecological malignancy after cancer of the cervix. Surgery followed by cisplatin-based chemotherapy is the standard treatment approach. In patients with persistent disease, second-look laparotomy offers an opportunity to debulk the tumour. This is usually followed by an alternative method of chemotherapy. We compared the findings at surgery (second-look laparotomy) with the preoperative computed axial tomography scan assessments. METHODS: Thirty-seven patients with epithelial ovarian carcinoma were assessed with computed axial tomography scans of the abdomen and pelvis prior to undergoing a second-look laparotomy. RESULTS: Tumour was correctly identified on computed axial tomography scan in 11 patients who had macroscopic evidence of cancer at laparotomy. In 6 patients, both computed axial tomography scan and surgery showed no disease recurrence. In the remaining 20 patients, there was a mismatch between the computed axial tomography scan and the surgical findings. In 16 of the 20 (80%) patients, computed axial tomography scans were negative but tumour was present. When the tumour was less than 1.5 cm in diameter it was missed in 8, and when equal to or greater than 1.5 cm, it was missed in 5 patients. These small tumour deposits were located in the retroperitoneal area, under the dome of the diaphragm, omentum or peritoneum, liver surface, and in the pouch of Douglas. In one case each, infiltration of the urinary bladder, sigmoid colon and rectum was also not detected. In 4 patients, computed axial tomography scans showed tumour when none was present. CONCLUSION: Computed axial tomography scan cannot detect small nodules often present in ovarian cancer, and thus even if a computed axial tomography scan is normal it should not exclude a second-look laparotomy.

Adolescent↗
PubMedDate not supplied

[The surgical treatment of urinary stress incontinence following hysterectomy or operation for genital prolapse (author's transl)].

Thirty patients suffering from stress incontinence of urine following hysterectomy or operation for genital prolapse underwent operation after study of the colpocystogram. This examination, practically painless and free of risk, visualises pelvic visceral kinetics and is felt by the author to be essential. It confirms the existence of stress incontinence, reveals the usual cause, detects associated abnormalities and indicates the appropriate surgical technique. The method of treatment was paramedial or medial fixation of the uterus, vagina or residual cervix to the public promontory, complemented in some cases by excision of the pouch of Douglas or posterior myorraphy. Apart from in certain special cases (irritable tirgone syndrome) the cure of mictional problems can be guaranteed.

Aged↗
PubMed1995

Clinics in diagnostic imaging (7). Omental caking due to ovarian carcinoma.

A 52-year-old Chinese woman with previously resected ovarian carcinoma was found to have ascites and a mass in the Pouch of Douglas on follow-up examination. A large omental cake was detected on computerised tomography (CT), and subsequently confirmed during laparotomy. After completion of four cycles of chemotherapy, a near complete resolution of omental metastases was demonstrated on both CT and laparotomy. The role of CT in ovarian cancer is discussed and the CT appearances of omental tumour are described.

Adenocarcinoma↗
PubMedDate not supplied

Vaginal hysterectomy.

The authors report on their experience of vaginal hysterectomy in a prospective series of 14 patients with myomatous uteri of the size of 14 to 20 weeks' gestation. The mean uterine volume at the time of surgery was that of 16 1/2 weeks' gestation. The largest myoma had a diameter of 11.6 cm. Five of the patients were also scheduled to undergo bilateral oophorectomy. The paracervical tissues were infiltrated with a dilute solution of lignocaine and adrenaline. Circumferential incision and reflection of the vaginal wall, dissection of the bladder cephalad, opening of the vesico-uterine fold anteriorly and the pouch of Douglas posteriorly were performed initially. This was followed by clamping, division and ligation of the sacro-uterine and cardinal ligaments and of the uterine vessels, as is done during a vaginal hysterectomy. The next step depended on the size and other features of the uterine corpus and included bisection, myomectomy, morcellation and coring. BISECTION: The cervix was grasped on both sides and the uterus was bisected sagittally towards the fundus, using a knife. The bisection, carried out first along the posterior uterine wall, was aided by the repeated repositioning of the vulsella close to the apex of the incision, combined with rotation of the cervical portion of the uterus around the public arch. If necessary, the uterus was rotated back to its original position and the bisection pursued anteriorly. Complete bisection often allowed half the uterus to be delivered through the vagina and the ovarian pedicle to be secured; the same was then done with the other half of the uterus. Myomectomy was frequently combined with bisection or morcellation. Smaller myomas were removed in one piece while larger ones were morcellated and removed in fragments, one of the vulsella always being attached to the residual bulk of the myoma. Morcellation was carried out on the uterus when despite bisection or myomectomy no further descent was possible. Bisection was recommenced as soon as further descent of the uterus could be achieved after myomectomy and morcellation. Coring was performed instead of bisection when dealing with smaller uteri without any distinct large myoma. A circumferential incision was made at the level of the uterine isthmus about 5 mm into the substance of the corpus. A central core of tissue around the uterine cavity was then excised by progressively undercutting the serosal surface of the uterus towards the fundus. Once the uterus was delivered into the vagina, the hysterectomy was completed in the usual fashion. All 14 procedures with or without oophorectomy or salpingo-oophorectomy were completed successfully. The mean weight of the uteri was 639 g (range 380-1100 g), the mean operating time was 84 minutes (range 30-150 minutes) and the mean operative blood loss was estimated at 296 ml (range 100-800 ml). One patient was given a blood transfusion immediately postoperatively. Six women had macroscopic haematuria that cleared up within 24 hours. There were no other important complications. Postoperative hospital stay averaged 3.7 days (range 2-9 days). Only 2 patients remained in hospital for more than 4 days after surgery. All women had recovered fully by the time of their follow up appointment.

Contraindications↗
PubMed1998

[A case of ovarian cyst presenting as urinary retention].

A 54-year-old woman presented with repeated episodes of urinary retention during an approximately 7-month period of dysuria. Computerized tomography scan revealed a right ovarian cyst and a small uterine myoma. At operation, the ovarian cyst was deeply incarcerated into the pouch of Douglas displacing the bladder neck and the uterine cervix in the anterocephalad direction. Histological diagnosis of the resected cyst was benign mucinous cystadenoma. This is the 5th reported case of urinary retention caused by ovarian cyst in the Japanese literature.

Cystadenocarcinoma, Mucinous↗
PubMed1998

[Vestigial retrorectal dermoid cyst. Apropos of a case].

A case of recto-rectal congenital development cyst is described in 35-year-old man. This cyst presented in the form of voiding symptoms. Computed tomography revealed the relation and components of the development cyst. Treatment consisted of complete surgical excision via a transabdominal approach.

Adult↗
PubMedDate not supplied

Observations on surgical anatomy for rectal cancer surgery.

BACKGROUND/AIMS: The investigators studied the surgical anatomy of the main structures involved in the mobilization of the rectum (Denonvilliers' fascia, mesorectum, middle rectal artery, superior and inferior hypogastric plexuses). METHODOLOGY: The study was carried out on 20 cadavers (17 unembalmed and 3 embalmed). To study Denonvilliers' fascia, ten embryos and fetuses (11 mm to 80 mm CRL) were also examined. RESULTS: Denonvilliers' fascia originates from the fusion of the primary pouch of Douglas. The two leaves making up this structure are easily separated. The mesorectum surrounds the rectum on three sides; it is easily separated from the presacral fascia and its connective tissue is bordered by a thin membrane. The middle rectal artery varies in appearance rate, origin, size, distribution and anastomosis. It runs under the lateral ligament and also sends branches to the genital apparatus. Of the two hypogastric plexuses, the inferior is the most difficult one to identify. Its superior branches extend to the rectum, and the inferior ones to the genital apparatus. Because the anterior part contains the parasympathetic nerves and the middle rectal artery, this region is at major risk during surgical dissection. CONCLUSIONS: A sound understanding of the surgical anatomy of the rectum enables the surgeon to perform a more correct and reasonable procedure in terms of both the extent of surgical treatment and the preservation of important anatomical structures.

Adolescent↗
PubMedDate not supplied

MRI appearance of ruptured corpus luteum.

A 20-year-old woman was admitted complaining of lower abdominal pain. Transabdominal ultrasound revealed a fluid collection in the pouch of Douglas and an irregularly shaped ovary with cystic lesions. Malignant cystic mass of the right ovary was highly suspected from the ultrasound findings. Transvaginal peritoneal centesis yielded a bloody fluid, but the pregnancy test was negative. On the third day of admission, menstruation began. MR examination performed four days after the initial onset of pain showed a subacute hematoma just adjacent to the right ovary, and segmental interruption of the right ovarian cortex. Based on these MR findings and the patient's history, subacute hemorrhage from the right ovarian corpus luteum was suspected, and this was confirmed with surgical exploration.

Adult↗
PubMed1998

[The diagnostic value of rectal examination of patients with acute appendicitis].

The results of rectal digital examinations performed on 477 patients upon admission with histopathologically proven acute appendicitis from a total of 2280 patients with acute abdominal pain were analyzed. Although 13.7% of the patients experienced pain on the right side and 7.4% pain in the pouch of Douglas during rectal examination, none of the rectal examination parameters was statistically significant for the diagnosis of acute appendicitis. There are well established and statistically significant clinical indications, such as guarding, rigidity, rebound tenderness or abdominal distention that actually make the unpleasant rectal-digital examination superfluous for patients with suspected appendicitis.

Abdomen, Acute↗
PubMed2006

Hepatoid carcinoma with serous component of the fallopian tube: a case report with immunohistochemical and ultrastructural studies.

A very rare case of hepatoid carcinoma with serous component arising in the fallopian tube of a 79-year-old woman is presented. The lesion was a 5.0-cm unencapsulated, yellowish-white soft mass. The tumor was composed of hepatoid carcinoma (90%) and serous carcinoma (10%) components. The hepatoid carcinoma was histologically characterized by a proliferation of round to polygonal cells arranged in a trabecular, tubular, sinusoidal, papillary, or solid pattern. The serous component in the fallopian tube also showed in situ lesions. Both components showed an infiltration into the surface of the left ovary, omentum, peritoneum including the pouch of the Douglas, and serosa of the colon. Immunohistochemically, the hepatoid carcinoma was positive for alpha-fetoprotein, polyclonal carcinoembryonic antigen (CEA), hepatocyte paraffin 1, albumin, epithelial membrane antigen, and cytokeratin (CAM5.2). Ultrastructurally, the cytoplasm contained abundant ribosomes, moderate amounts of mitochondria, and rough endoplasmic reticulum that developed into a meshwork and contained mitochondria within it. Microbile channel-like structures and desmosomes were occasionally observed. The association with serous carcinoma indicates mullerian origin rather than germ cell origin. The patient received chemotherapy and was alive without disease at 10 months after surgery.

Aged↗
PubMed1998

New retroperitoneal culdoplasty and colpopexy at the time of laparoscopic total abdominal hysterectomy (L-TAH).

BACKGROUND: After a laparoscopic total abdominal hysterectomy, the safety of the translaparoscopic, prophylactic, retroperitoneal pouch of a Douglas reconstruction and vaginal vault suspension was evaluated. METHODS: This operation was adapted from the laparotomy approach and has been investigated from July, 1992, to July, 1996. Modest modifications have been introduced to meet laparoscopic technology requirements. Observational clinical trials have been conducted on 112 women. The surgery was performed through laparoscopy by suturing and tying method, with no vaginal approach. RESULTS: This clinical trial showed positive results for the operation, with no complications observed in this group of patients. After the operation, there were no symptoms or signs of a dysfunctional vagina, or pelvic relaxation. CONCLUSION: This preventive operation is safe and it restores the pelvic topography, functional anatomy, and it prevents post-hysterectomy vaginal dysfunction disorders.

Adult↗
PubMedDate not supplied

[Characteristics of the Douglas' cul-de-sac in women with rectocele and enterocele].

Our objective in this study was to measure the depth of the Douglas' cul-de-sac in women with and without genital prolapse. The depth of the posterior rectouterine pouch was measured while performing laparotomy in 22 nulliparal and 33 parous women free from signs of genital prolapse and in 13 female subjects presenting with genital prolapse. In those having prolapse the posterior Douglas' appeared to have extended for a more considerable depth than in other examined subjects. The relative value for the Douglas' cul-de-sac exceeding 50% of the vaginal length was recordable in the major proportion of the above group. Congenital deep Douglas' cul-de-sac tends to increase the risk for a further development of enterocele and rectocele.

Female↗
PubMed2003

Functional outcome and quality of life after ileal pouch-anal anastomosis in children and adults.

BACKGROUND: In the past, children with ulcerative colitis were treated with a total colectomy, ileostomy and mucous fistula; ileal pouch-anal anastomosis was postponed until adulthood. The aim of the present study was to assess the functional outcome and quality of life after ileal pouch-anal anastomosis and determine whether it is justified to perform the operation in children when surgery is indicated. METHODS: A retrospective review of 38 medical records was carried out, of which there were 19 paediatric patients and 19 adult patients (control). A questionnaire survey was conducted. Telephone interviews were carried out for the non-respondents. RESULTS: Sixteen patients in the paediatric group (nine boys, mean age: 12 years) and 16 patients in the adult group (10 men, mean age: 39 years) were available for analysis. There was no operative mortality. The mean bowel frequency per week was 37 and 42. Furthermore, bowel frequency during the day was slightly lower in the paediatric group. Children had marginally better continence than adults. In the quality of life assessment, the mean utilities in the paediatric group were 0.69 and 0.84 in the preoperative and postoperative status, respectively. These were similar to those in the adult group (0.62 and 0.82). Both groups achieved significantly favourable postoperative responses in terms of ability to perform social activity, recreation and enjoying food. CONCLUSIONS: Ileal pouch-anal anastomosis in children is safe, results in good functional outcome and improves the quality of life. Hence, it is justified to perform ileal pouch-anal anastomosis as soon as surgery is indicated rather than as a delayed procedure.

Adolescent↗
PubMed1981

Ultrasonic study of hepatic and splenic traumatic lesions.

Traumatic lesions involving the parenchyma of liver and spleen give heterogeneous echo patterns on sonograms. Associated haematomas appear as sonolucent or sonotransparent areas. Subcapsular haematomas appear as peripheral sonolucent or sonotransparent areas. High resolution sectorial real-time ultrasound demonstrates such abnormalities. When examining for splenic or hepatic lesions, associated lesions such as renal contusion, juxta-renal or retroperitoneal haematoma and haemoperitoneum are sought. Haemoperitoneum may be shown in Morrison's pouch, in the vicinity of the spleen (moon-crescent sign) and also in the sac of Douglas. None of the abnormalities is entirely specific for trauma. However, the sensitivity of ultrasound in the evaluation of trauma is sufficient to render other diagnostic procedures such as C.T. and angiography only rarely necessary.

Humans↗
PubMed2003

Esthetic soft tissue ridge augmentation using an acellular dermal connective tissue allograft.

UNLABELLED: Residual ridge defects present significant limitations to the esthetic restoration of edentulous tooth sites. Augmentation techniques can aid in the re-establishment of natural ridge contours. This article describes a technique in which an acellular dermal connective tissue allograft is used to augment a buccolingual residual ridge defect. A single vertical incision enables the allograft to be placed laterally into a buccal pouch. Augmentation of this edentulous site permitted a three-unit bridge to be placed with a highly esthetic pontic. CLINICAL SIGNIFICANCE: This article presents a simplified method of esthetic ridge augmentation that reduces patient discomfort.

Aged↗
PubMed2000

Partial transcriptome of the developing pituitary gland.

The anterior lobe of the pituitary gland is composed of five hormone-producing cell types and develops from Rathke's pouch, an invagination of oral ectoderm. In mice, rapid cell proliferation occurs in the pouch from embryonic day 12.5 (e12.5) to e14.5, preceding the appearance of most hormone transcripts. Cell-type-specific commitment probably occurs prior to e14.5, but cell differentiation can be demonstrated only by detection of hormone transcripts. Although several transcription factors critical for pouch expansion are known, few of their target genes have been identified. To identify putative transcription factor target genes and cell-type-specific markers, we used differential display PCR analysis of RNA prepared from e12.5 and e14.5 Rathke's pouches. We present an expression profile of the developing pituitary gland including 83 transcripts, 40% of which are novel. The tissue distribution, cell specificity, and developmental regulation were determined for a subset of the transcripts.

Animals↗