[Perineal endometriosis. Clinical experience with 8 patients]. / Endometriosis perineal. Experiencia clínica en 8 pacientes.

We report our experience with 8 women with perineal endometriosis managed in a period of 20 years. All were multiparae women presenting with cyclical perineal painful masses related to menstrual periods. Symptomatology started 6 months to 16 years after last delivery. Three patients had partial involvement of the anal sphincter. The endometriosis area was locally resected in all women. There were no complications and no problems with anal continence. Two patients had local recurrences. The different lapses between delivery and symptomatic presentation can be related to the amount of endometrial basal cells implants in the episiotomy. The treatment is always surgical. All endometrial implants must be resected and sphincteric structures must be repaired posteriorly.

Ventilatory drive and respiratory muscle function in pregnancy.

It has been demonstrated that during pregnancy expiratory reserve volume (ERV) decreases and minute ventilation (VE) increases initially and then stabilizes. In order to determine the role of thoracoabdominal mechanics, control of breathing, and inspiratory muscle function in these alterations, we studied inspiratory pressures, lung volumes, thoracic configuration, and respiratory drive in 18 normal pregnant women at Weeks 13, 21, 30, and 37 of pregnancy. Ten of them were studied 6 months after delivery. Transdiaphragmatic pressure (Pdi) was measured at Week 37 and 3 months after delivery in an additional group of seven women. VE as well as VT/TI increased early during gestation and remained unchanged thereafter. In contrast, mouth occlusion pressure (P0.1) increased progressively during pregnancy, from 1.53 +/- 0.16 (mean +/- SE) to 2.02 +/- 0.18 cm H2O, and fell significantly to 1.1 +/- 0.15 cm H2O after delivery, indicating that effective respiratory impedance increases during pregnancy. Mean P0.1 correlated with progesterone plasma levels (r = 0.918 p less than 0.05). No changes in Plmax, PEmax, and Pdimax, were observed. End-expiratory gastric pressure (Pga) increases significantly during pregnancy: 11.8 +/- 0.8 versus 8.4 +/- 1.12 cm H2O after delivery (p less than 0.012). This increment was correlated with the fall in ERV observed in late pregnancy (r = 0.74 p less than 0.05). Our results demonstrate that during pregnancy ventilatory drive and respiratory impedance increase with the consequent stabilization of VE, but our data do not permit us to differentiate whether the increment in P0.1 is secondary to the increase in impedance or to the rise in progesterone. Respiratory muscle function remains normal despite the alteration of thoracic configuration.

[Importance of the suture material in the surgery of genuine stress urinary incontinence]. / Importancia del material de sutura en la cirugía por incontinencia urinaria de esfuerzo genuina.

Between July 1978 and November 1985, 73 abdominal operations were performed for the surgical correction of genuine stress incontinence using the Marshall-Marchetti-Krantz technique. Non-absorbable suture materials were used in the vesicourethropexy in 30 case (41%) and absorbable suture materials in 43 cases (59%). A relapse was not observed after two years of follow-up in the group of patients operated on with nonabsorbable suture materials while a relapse of 5% after one month, 14% after six months, 22% after one year and 44% after two years was observed in the group of patients operated on with absorbable suture materials. A statistically significant difference was found between both groups after one year (p = 0.031) and after two years (p = 0.012) of follow up. The postoperative complications were similar in both groups, urinary infection being the most frequent one. We conclude that nonabsorbable suture materials offer definitive advantages with respect to absorbable suture materials in the abdominal surgical correction of genuine stress incontinence.