ABSTRACT
OBJECTIVE: To determine the success rate and complications of transvaginal sacrospinous colpopexy for symptomatic uterine/vault prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 105 women with a symptomatic uterine/vault prolapse were treated with transvaginal sacrospinous ligament colpopexy at samsung cheil hospital. Primary outcome measures were complications (acute and long term) and success rate, with failure defined as any degree of uterine/vault prolapse requiring repeat operation, any degree of symptomatic isolated uterine/vault prolapse, any pelvic organ prolapse at or beyond the introitus. Statistical analysis was performed using simple descriptive technique. RESULTS: During the study period, 105 transvaginal sacrospinous ligament colpopexy were performed: 41 with vaginal hysterectomy, 38 without hysterectomy, 25 for post-hysterectomy vault prolapse and 1 cervical amputation. The mean duration of follow-up was 17.7 months (0-66) There were no acute hemorrhage and no deaths. There were four intraoperative complications - three rectal wall injury and one bladder wall injury. There was a complaints of postoperative right buttock pain in 8 of the 105 procedure (7.6%), with this persisting on a chronic basis in 2 patients (1.9%). Postoperatively, there were 11 patients with uterine/valut prolapse, 4 with a cystocele and 1 with a rectocele. Of these 105, there were 6 failures (5.7%). CONCLUSION: Transvaginal sacrospinous colpopexy for the correction of uterine/vault prolapse, when performed by a surgeon experienced in the procedure, is safe and effective surgical procedure and rare major complications.
Subject(s)
Female , Humans , Amputation, Surgical , Buttocks , Cystocele , Follow-Up Studies , Hemorrhage , Hysterectomy , Hysterectomy, Vaginal , Intraoperative Complications , Ligaments , Outcome Assessment, Health Care , Pelvic Organ Prolapse , Prolapse , Rectocele , Urinary Bladder , Uterine ProlapseABSTRACT
The retroperitoneal space of the posterior abdomen and the pelvic retroperitoneum contain the major neural, vascular and lymphatic supply to the pelvic viscera, the urinary system and colorectal system. A pain or mass in the pelvis may arise primarily from the reproductive organs, but it may just as easily arise from the retroperitoneal space, include the urinary tract and the gastrointestinal tract. Therefore, the gynecologic surgeon should be aware of the various conditions associated with retroperitoneal mass and the correct management of these disorders. Hydroureter may misdiagnose as a pelvic mass or retroperitoneal mass. The cause of hydroureter is mainly secondary obstruction such as malignancy, idiopathic retroperitoneal fibrosis and pelvic disease but primary obstructive megaureter should be considered. This report describes a case of marked hydroureter, misdiagnosed as a hydrosalpinx by ultrasound.
Subject(s)
Abdomen , Gastrointestinal Tract , Pelvis , Retroperitoneal Fibrosis , Retroperitoneal Space , Ultrasonography , Urinary Tract , VisceraABSTRACT
The retroperitoneal space of the posterior abdomen and the pelvic retroperitoneum contain the major neural, vascular and lymphatic supply to the pelvic viscera, the urinary system and colorectal system. A pain or mass in the pelvis may arise primarily from the reproductive organs, but it may just as easily arise from the retroperitoneal space, include the urinary tract and the gastrointestinal tract. Therefore, the gynecologic surgeon should be aware of the various conditions associated with retroperitoneal mass and the correct management of these disorders. Hydroureter may misdiagnose as a pelvic mass or retroperitoneal mass. The cause of hydroureter is mainly secondary obstruction such as malignancy, idiopathic retroperitoneal fibrosis and pelvic disease but primary obstructive megaureter should be considered. This report describes a case of marked hydroureter, misdiagnosed as a hydrosalpinx by ultrasound.
Subject(s)
Abdomen , Gastrointestinal Tract , Pelvis , Retroperitoneal Fibrosis , Retroperitoneal Space , Ultrasonography , Urinary Tract , VisceraABSTRACT
OBJECTIVE: The aim of our study is to apply the Pelvic Organ Prolapse staging system to women seen for gynecologic care to generate normative data for Korean population women. METHODS: The study population considered of 486 women aged to 19 to 72 years old who seen for annual Papanicolau test and pelvic examination. Pregnant or patients within 6 weeks postpartum were not recruited. All pelvic examinations were performed by a single examiner with the subject placed in the dorsal lithotomy position by means of pelvic examination chair. All nine measurements, with the exception of total vaginal length, were taken with the patient performing maximal Valsalva maneuver. RESULTS: The subjects had a mean age of 41.3 years (range 19-72), mean parity of 1.6 (0-6) and a mean body mass index of 22.2 kg/m2 (15.7-30.9). Mean scores that described the position of the cervix, the position of the posterior forinx and the total vaginal length were as follows: C: -5.0 D: -6.6 and tvl: 7.0 cm. The overall distribution of pelvic organ prolapse quantification system stages were as follows: stage 0, 66.5%; stage 1, 21.8%; stage 2, 11.5%; and stage 3, 0.2%. No subjects examined had stage 4 prolapse. CONCLUSION: Vaginal size of Korean population women differs from that of Western population women. We are hopeful that the normative data presented in this study may provide a useful reference for physician as they evaluate prolapse an attempt to restore normal pelvic anatomy.
Subject(s)
Aged , Female , Humans , Body Mass Index , Cervix Uteri , Gynecological Examination , Hope , Parity , Pelvic Organ Prolapse , Postpartum Period , Prolapse , Valsalva ManeuverABSTRACT
Endometriosis generally occurs in the pelvis, particularly in the broad ligament, round ligament, ovaries, fallopian tubes or uterosacral ligament. However, many unusual sites have been described, including the umbilicus, cesarean section scars, hernia sacs, appendix, vagina, vulva, omentum and perineum. We experienced a case of perineal endometriosis diagnosed according to cyclic perineal pain associated with menstration and report it with brief review of literature.
Subject(s)
Female , Pregnancy , Appendix , Broad Ligament , Cesarean Section , Cicatrix , Endometriosis , Episiotomy , Fallopian Tubes , Hernia , Ligaments , Omentum , Ovary , Pelvis , Perineum , Round Ligament of Uterus , Umbilicus , Vagina , VulvaABSTRACT
The increasing use of the laparoscopic surgery in the management of gynecologic disease resulted in an increasing incidence of complication and the development of new complications. Incisional hernia through laparoscopic trocar site is an unusual complication of laparoscopy. A rare form of port-associated complication is omental herniation. This report describes a case of omental herniation through a 10-mm subumbilical incision following uneventful laparoscopic surgery.
Subject(s)
Female , Genital Diseases, Female , Hernia , Incidence , Laparoscopy , Surgical InstrumentsABSTRACT
A case of intermediate differentiated Sertoli-Leydig cell tumor with elevated Alpha-fetoprotein (AFP) levels occurred in a 15-year-old girl. No germ cell component and no heterologous elements were identified. Secretion of AFP by Sertoli-Leydig cell tumor has rarely been mentioned previously, and its mechanism is difficult to explain. We present this case with review of related literatures.
Subject(s)
Adolescent , Female , Humans , alpha-Fetoproteins , Germ Cells , Ovary , Sertoli-Leydig Cell TumorABSTRACT
Congenital myotonic dystrophy is a severe and early-onset form of myotonic dystrophy (DM) with a prevalence of 2.5-5.5/100,000 live births. Expansion of the trinucleotide CTG repeat in the 3 untranslated region of the DM gene, which is located at a chromosome 19q13.3 is a common mutation in DM. Clinical features are generalized hypotonia (floppy infant), respiratory and feeding difficulty, and the neonatal mortality rate is approximately 40%. We experienced a case of recurrent congenital myotonic dystrophy, and report with a review of related literatures. Women with recurrent neonatal hypotonia or ultrasonographic evidence of hypotonia, including positional abnormalities of the extremities and idiopathic polyhydramnios, should be offered testing for the genetic studies for myotonic mutation, such as PCR (Polymerase chain reaction) analysis and Southern blot analysis.
Subject(s)
Female , Humans , Infant , Blotting, Southern , Diagnosis , Extremities , Infant Mortality , Live Birth , Muscle Hypotonia , Myotonic Dystrophy , Polyhydramnios , Polymerase Chain Reaction , Prenatal Diagnosis , Prevalence , Untranslated RegionsABSTRACT
Congenital myotonic dystrophy is a severe and early-onset form of myotonic dystrophy (DM) with a prevalence of 2.5-5.5/100,000 live births. Expansion of the trinucleotide CTG repeat in the 3 untranslated region of the DM gene, which is located at a chromosome 19q13.3 is a common mutation in DM. Clinical features are generalized hypotonia (floppy infant), respiratory and feeding difficulty, and the neonatal mortality rate is approximately 40%. We experienced a case of recurrent congenital myotonic dystrophy, and report with a review of related literatures. Women with recurrent neonatal hypotonia or ultrasonographic evidence of hypotonia, including positional abnormalities of the extremities and idiopathic polyhydramnios, should be offered testing for the genetic studies for myotonic mutation, such as PCR (Polymerase chain reaction) analysis and Southern blot analysis.
Subject(s)
Female , Humans , Infant , Blotting, Southern , Diagnosis , Extremities , Infant Mortality , Live Birth , Muscle Hypotonia , Myotonic Dystrophy , Polyhydramnios , Polymerase Chain Reaction , Prenatal Diagnosis , Prevalence , Untranslated RegionsABSTRACT
Polymorphonuclear leukocytes (PMNs) play an important role in myocardial ischemia/reperfusion (MI/R) injury. Moreover, platelets are also important blood cells that can aggravate myocardial ischemic injury. This study was designed to test the effects of PMNs and platelets separately and together in provoking cardiac dysfunction in isolated perfused rat hearts following ischemia and reperfusion. Additional control rat hearts were perfused with 75 X 106 PMNs, with 75 X 106 platelets, or with 75 X 106 PMNs+75 X 106 platelets over a five minute perfusion followed by a 75 min observation period. No significant reduction in coronary flow (CF), left ventricular developed pressure (LVDP), or the first derivative of LVDP (dP/dt max) was observed at the end of the observation period in any non-ischemic group. Similarly, global ischemia (I) for 20 min followed by 45 minutes of reperfusion (R) produced no sustained effects on the final recovery of any of these parameters in any group of hearts perfused in the absence of blood cells. However, I/R hearts perfused with either PMNs or platelets alone exhibited decreases in these variables of 5 ~ 10% (p < 0.05 from control). Furthermore, I/R hearts perfused with both PMNs and platelets exhibited decreases of 50 to 60% in all measurements of cardiac function (p < 0.01). These dual cell perfused I/R hearts also exhibited marked increases in cardiac myeloperoxidase (MPO) activity indicating a significant PMN infiltration, and enhanced P-selectin expression on the coronary microvascular endothelium. All cardiaodynamic effects as well as PMN accumulation and P-selectin expression were markedly attenuated by a recombinant soluble PSGL-1 which inhibits selectin mediated cell adhesion. These results provide evidence that platelets and PMNs act synergistically in provoking post-reperfusion cardiac dysfunction, and that this may be largely due to cell to cell interactions mediated by P-selectin. These results also demonstrate that a recombinant soluble PSGL-1 reduces myocardial reperfusion injury by platelet and PMNs interaction.