Seromuscular vascularized ileal loop patch for the repair of radiation induced vesico-vaginal fistula after radical hysterectomy for cervical carcinoma

The use of Vascularized pedicled seromuscular Heal loop patch as a well Vascularized interposition tissue flap, between bladder and vaginal walls for repair of radiation induced vesico-vaginal fistula -was studied on nine patients from the period of April 2000 till January 2003 in the national cancer institute. Those patients were referred to the surgical department with adiagnosed vesico-vaginal fistula, that developed after completion of an external beam and intracavitary radiotherapy post hysterectomy for cervical carcinoma. Through transabdominal, Transvesical approach, with stinting of the ureters during dissection of the fistulous tract, an ileal loop flap is mobilized with its mesenteric blood supply to become technically amenable for enforcement of the repair or reconstruction of the deficient vesical wall after excision of the scarred fistulous tract simulating cystoplasty technique. The outcome of this approach and flap technique showed successful healing of all fistulae in all patients, without complications either post operatively or during follow up. This study recommended the use of seromascular Vascularized Heal loop patch for the repair of radiation induced vesico-vaginal fistula after radical hysterectomies

Cervical gland area [CGA]: a new sonographic parameter in predicting preterm birth

The purpose of this study was to determine whether a new sonographic cervical findings [absence of cervical gland area] in midgestation gestation could predict spontaneous preterm birth. Between September 2002 to July 2003, 83 patients were involved in this study and were classified into 2 groups [a study group included 58 women at risk of preterm labor and a control group that included 25 women not at risk of preterm labor]. Transvaginal ultr and sonography was done to detect cervical length, cervical diameter and cervical gland area [CGA] at gestational age between 24 and 32 weeks. The primary outcome was preterm birth at < 37 weeks of gestation. Eighty-three pregnancies met the study criteria and were included in the analysis. The mean transvaginal sonographic cervical length was 28.69 +/- 4.03 mm in pregnancies which delivered <37 weeks [n = 42], and 34.85 +/- 3.73 mm in those delivering at term [n =41] [P < 0.05]. The mean transvaginal sonographic cervical diameter was 7.17 +/- 7.56 mm in pregnancies which delivered <37 weeks [n = 42], and 5.56 +/- 1.23 mm in those delivering at term [n = 41] [P < 0.05]. Cervical Gland Area [CGA] was absent in 80.95% [34/42] of pregnancies which delivered <37 weeks while it was present in all pregnancies which delivered at term [P < 0.05]. All variables tested [cervical length, cervical diameter, and CQA] were independent risk for a spontaneous onset of labor <37 weeks in both univariate and multivariate analysis. The absence of cervical gland area [CGA] is a novel and useful sonographic parameter for predicting spontaneous preterm birth