Pacreaticoduodenectomy.

Pancreaticoduodenectomy, the Whipple operation, is a reasonable operation for carcinoma if used in the absence of distant metastases or regional spread to vital structures. It can be performed with an acceptable in-hospital mortality. It is primarily a palliative surgical procedure. Occasionally, a patient will survive more than five years. At times, the operation is fully justified or cannot be avoided for nonmalignant conditions.     

Outpatient cervical conization

One hundred outpatient cervical conizations were performed over a 2.5-year period. A circumferential suturing technique was used which provided excellent hemostasis and restoration of normal cervical anatomy. The complication rate was low. One patient had significant intraoperative hemorrhage, one experienced postoperative bleeding within 24 hours, and two had delayed bleeding. Three patients developed infection, and one patient was found to have asymptomatic cervical stenosis on follow-up examination. No patient required blood transfusion or admission to the hospital. It is concluded that cervical conization can be performed on an outpatient basis in the nonpregnant patient with an acceptable rate of complications.     

Transverse vaginal septum in the upper part of the vagina and pregnancy

Transverse vaginal septum is a congenital Mullerian malformation resulting from a failure of the fusion or canalization of the urogenital sinus and the Müllerian ducts. It may cause hematocolpos, dyspareunia and infertility in adult patients. In some cases, it is associated with congenital malformations such as coarctation of the aorta or atrial septal defects. A case of a transverse vaginal septum identified during a vaginal check-up of a 39-week pregnant patient during labour is reported. A cesarean surgery was performed with no complications. Septal defect was diagnosed due to heart murmur. It was decided to treat the transverse vaginal septum as soon as the puerperium was over. The patient left the hospital after proper response to treatment.     

Sterilization: legal problems

Various legal aspects concerning the performance of sterilizations with regard to West German criminal and civil law are discussed. Sterilization is legal only when performed under a legally acceptable indication according to the criminal code. There are no objective guidelines for the legality of performing voluntary sterilizations; each case must be considered on its own merits. The physician must personally inform his patient about possible risks and complications of the operation. He must also keep in mind the interests of the society as a whole in deciding whether or not a sterilization is indicated. "Convenience sterilizations" are illegal and unethical. According to civil law, sterilization is considered to be performed under a "service contract". The physician must operate according to his best knowledge and ability. It is also his duty to inform the patient fully about possible consequences of the operation and maintain strict confidentiality. The patient is required to compensate the physician for services rendered. The physician can be held legally responsible for complications or failure of the operation if it can be shown that he was negligent whether in informing his patient about the risks of the operation or in performing the operation. This responsibility can include maintenance of a child born after an unsuccessful sterilization due to the negligence of the physician.     

Endoscopic placement of feeding tubes in the critically ill patient

Placement of the nasojejunal feeding tube under direct visual guidance using endoscopy offers an alternative method to those currently used. We found it to be a safe method easily performed by house staff. It is less burdensome than other described endoscopic techniques and does not require patient transfer or fluoroscopic facilities.     

Recommendations to increase the validity and comparability of peripheral measurements by near infrared spectroscopy in neonates. 'Round table', section of haematology, oxygen transport and microcirculation, 48th annual meeting of ESPR, Prague 2007

Several studies of peripheral measurements with near infrared spectroscopy (NIRS) and venous or arterial occlusion have been performed in neonates. Results have been variable. Reasons include differences in patient populations, technical aspects of the devices used or the way measurements were made. It is therefore important that there should be common elements for measurement protocols. This statement proposes a standardised approach to allow comparison between different study populations and devices.     

Laparoscopic ovarian biopsy in seventy-one amenorrhoeic patients.

During laparoscopy we performed 132 ovarian punch biopsies in seventy one amenorrhoeic patients. With increasing experience, laparoscopic ovarian biopsy is a valuable element in the examination of amenorrhoeic patients. Biopsy specimens with an edge length of 4-5 mm for surface and depth can be obtained during laparoscopy under general anaesthesia without any great risk or difficulty. When performed bilaterally, it provides a representative picture of the cellular structure and function of the ovaries and thus makes a contribution to the prognosis of a disturbance in the endocrine regulating-circuit of ovarian function. In addition, the ovarian biopsy provides information about the basic gonadotrophic situation of the patient as a longitudinal section. It should be included in the synopsis of all endocrine and genetic parameters of a patient, particularly in clinic in which the morphological substrate of disturbed functions and apparent diseases is still examined.     

Myomectomy: a review of surgical technique

Fibroids are common amongst women of reproductive age. In women wanting to retain their fertility and/or uterus open myomectomy remains the most widely performed procedure. It is important to carefully counsel the patient about the pros and cons of surgery versus expectant management. Meticulous pre-operative evaluation and preparation will help ensure the procedure goes smoothly. Attention to the operating technique used is paramount in ensuring patient safety and surgical peace of mind. This review addresses the important aspects of open myomectomy including operative technique.     

Myomectomy: A review of surgical technique

Fibroids are common amongst women of reproductive age. In women wanting to retain their fertility and/or uterus open myomectomy remains the most widely performed procedure. It is important to carefully counsel the patient about the pros and cons of surgery versus expectant management. Meticulous pre-operative evaluation and preparation will help ensure the procedure goes smoothly. Attention to the operating technique used is paramount in ensuring patient safety and surgical peace of mind. This review addresses the important aspects of open myomectomy including operative technique.     

Choosing the right technique for deep endometriosis

The surgical management of bowel endometriosis is a real challenge. In addition to the fact that only symptomatic patients should undergo surgery, no consensus has been approved in the literature.Among the surgical techniques, the surgeon has to choose between rectal shaving, disc excision, or segmental colorectal resection. All those procedures are associated with complications, but the risk of rectovaginal fistula is higher if a disc excision or segmental colorectal resection is performed. It is therefore of utmost importance to evaluate preoperatively the bowel infiltration by several imaging techniques to estimate the feasibility of a deep rectal shaving with possible incomplete removal of the endometriotic lesions or to discuss with the patient about the indication of a segmental bowel resection. Because of the risk of major preoperative and postoperative complications, proper patient counseling is mandatory.     

Diagnostic laparoscopy for infertile patients as a training program

During a 3-year period, 2650 cases of diagnostic laparoscopy were performed on selected infertility patients in a training program on gynecologic laparoscopy at hospitals in Egypt, the Sudan and Saudi Arabia. All cases were attended by the senior author. Most of the procedures were performed by physicians who either had never performed the procedure or had not had significant experience with it. This report presents the laparoscopic findings, complications and problems encountered. It shows that with emphasis on equipment care and handling, careful patient selection and observation of simple precautions during and after the operation, the procedure can be safely included in the training program of residents in obstetrics and gynecology.     

Appendectomy and carcinoma ovarii. Cytoreduction, palliation, or simple tradition?

The present article is based on a review of 187 patients with an ovarian cancer who had a "second-look" or debulking operation performed. Seventy-nine patients underwent appendectomy prior to or in connection with the primary cytoreductive surgery and were observed for a average of 16.6 months before secondary oncologic surgery was performed. The remaining 108 patients had their appendix in situ during the same period and were observed for an average of 14.7 months and 1 patient developed acute appendicitis. A total of 125 appendectomies were performed in patients with cancer of the ovary and 14 (11%) showed metastatic growth. The two groups were similar as regards age, period of observation, tumor type and stage. The risk of developing acute appendicitis did not exceed the incidence in healthy women and no surgical problems were experienced in observing either of the two groups during the total period of 2,900 months. The need for surgical surveillance, however, was significantly greater for those who kept their appendix during the medical oncologic treatment. It is concluded that the cytoreductive effect of an appendectomy is limited, but that the appendix should be extirpated if possible as part of the primary staging effort. Leaving an appendix in situ at primary cytoreductive surgery does not expose the patient to any significantly increased risk, but an appendectomy prevents the patient from experiencing the additional burden of an acute appendicitis during medical oncologic treatment.     

Verhalten in kritischen Rechtssituationen

The legal situation for patient information, performing surgery and liquidation of aesthetic surgery lies between the art of plastic surgery, ethics, empathy and certain financial aspects. Aesthetic surgery in gynecology is performed in the psychosexually sensitive areas of the breast, the abdomen and the external genitals. Therefore a particularly sensitive form of communication in terms of patient objectives, motivation and informed consent is required. Prior to cosmetic operations specific, unsparing and extensive patient information is required even on rare complications. It is also important to inform about possible follow-up costs for the patient in case of complications or necessary additional surgical procedures for correction. Of special relevance is the assessment of the potential individual benefit to each patient. Specific problems arise out of the necessity for an evaluation of physical and psychological maturity in teenagers requesting aesthetic surgery. A specialized surgical training in aesthetic surgery according to the curricula of national gynecological associations including special courses is mandatory.     

A rare case of ovarian cancer in a patient treated for secondary sterility

The authors described a rare case of ovarian cancer in a young woman who looked for gynecological help because of secondary sterility. There were found cysts of the both ovaries, which were conservative treated by insistence of the patient for three months. After unsuccessful gestagenic therapy there was performed a gynecological laparoscopy, which showed that on one of the ovaries there was an exophyte growths suspected for carcinoma tissue. It was offered an emergency operation, which was made only after 1,5 months because of personal causes of the patient. It was taken a sample that was with unconvincing data for ovarian cancer. The clinical experience and professionalism of the surgical team were put on the test. It was performed a radical operation with removal of the uterus, adnexa uteri, partial peritoneoectomy, total lymph dissection, appendectomy, total omentectomy. The patient was discharged from hospital in good condition and she is liable to postoperative chemotherapy.     

Ambulatory surgery in urogynaecology

Ambulatory surgery offers advantages to both patients and providers. It is imperative to ensure appropriate case selection, pre-operative counseling, a suitable environment, trained staff, adequate analgesia and post-operative care both in the hospital and the community. Many well-established urogynaecological procedures such as cystoscopy and vaginal repair may be performed in an ambulatory setting. Newer procedures such as injection of botulinum toxin or peri-urethral bulking agents and tension-free tapes for stress incontinence may also be performed in this way. To date, the literature is deficient in robust studies comparing outcomes and patient satisfaction between conventional and ambulatory surgical procedures, and randomized controlled trials are required.     

Renal cell carcinoma during pregnancy

The authors present a detection of right renal cell carcinoma in 32 week of gestation. The course of pregnancy was without complications. The delivery was conducted by cesarean section in 38 week of pregnancy. The right nephrectomy was performed in 15 day of uncomplicated puerperium. It was renal cell carcinoma, which was located only right kidney and wasn't penetrated kidney's vessel or renal capsule. At present the patient requires the oncological care. CONCLUSIONS: The renal USG should be performed in pregnancy.     

Inguinal pelviscopy. A new approach for examining the pelvic organs

Inguinal pelviscopy is a new approach for examining structures in the extra- and intraperitoneal pelvic cavity. The total number of patients studied was 70. The method was used to visualize and take biopsies from masses in the presacral area (3 patients) and in the ovaries (8 patients). Ovarian biopsies were taken from 26 patients (14 with primary amenorrhea and 12 with elevated follicle-stimulating hormone), and ovarian cyst aspiration and biopsy were performed in 12 patients. Tubal sterilization was done in 18 cases and lysis of pelvic adhesions in 3 infertile patients. The procedure comprises entry of the extraperitoneal pelvic cavity through the inguinal canal. Intraperitoneal pelvic cavity examination can also be done by piercing the peritoneum at the deep inguinal ring or close to the fallopian tube. No complications were encountered except urinary retention in 1 patient with presacral tumor and abdominal wall hematoma in another patient. The approach is safe, direct and easy. It is performed on an outpatient basis.     

The value of endometrial curettage in the follow-up of hydatidiform mole

Multiple curettages in the follow-up of patients with hydatidiform mole are often performed in Sweden. Of 36 patients developing trophoblastic neoplasia after molar evacuation, 24 underwent one or more endometrial curettages. The objective was generally to verify a diagnosis of malignant disease. However, in only one patient was a histopathological proof of choriocarcinoma obtained. In 3 other patients, malignancy could not be ruled out. It is demonstrated that development of malignancy after hydatidiform mole is rarely proven by endometrial curettage.     

Difficulties in the diagnosis of ovarian carcinoma: case report of squamous cell ovarian carcinoma in a 26-year-old woman

A 26-year-old woman who was admitted to the Gynecology Department with abdominal pain was later diagnosed with a multi-chamber tumor in the left ovary. Neoplastic markers were within normal limits. It was proposed that the patient should be operated on in order to remove the tumor, and a left salpingo-oophorectomy was performed. During the intraoperative histopathological examination, the tumor was described as being benign. However, in the final histopathological examination, a malignant neoplasm, a squamous cell carcinoma (G-2) of the ovary (pT1a), was found. It was decided that a hysterectomy and a right salpingo-oophorectomy should be performed. No other neoplastic foci were found in the postoperational material. The patient is currently undergoing periodic control examinations.     

Congenital partial atresia of the Fallopian tube

Partial tubal atresia is a rare anomaly of unknown pathogenesis. It can occur unilaterally or bilaterally, mainly including the proximal isthmic portion or the proximal ampullary segment ('mid-portion'), and is especially associated with uterine anomalies. Any more extensive pelvic surgery, including preoperative diagnosis of associated urological anomalies, must be well planned in such patients. Salpingostomy and fimbrial approximation is a realistic option in patients with congenital ampullary atresia who wish to have a child. A MEDLINE search was performed and 18 patients found with partial atresia of different tubal portions. This report describes a further patient and reviews the available literature.