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Biomedical subjects

C F Langmade

Publications and source records attributed to C F Langmade.

10 recordsLinked to original sources

Partial colpocleisis.

Partial colpocleisis, in comparison with complete colpocleisis, offers several advantages. The most obvious advantage is the avoidance of recurrent prolapse in sexually nonactive, older patients. Historically, colpocleisis has been reported to produce stress incontinence, which may be avoided by partial colpocleisis. Careful attention to avoiding anterior wall adhesions by leaving anterior and posterior vaginal walls separated and a very small, nonfunctional vagina will prevent scarring with fixation at the bladder neck, which in most instances will result in stress incontinence. To leave a functional vagina in an elderly widow, not active for many years and with no plans for sexual activity, will leave the patient with the possibility of recurrent prolapse. Partial colpocleisis, a relatively short procedure with minimal blood loss and with careful attention to the avoidance of scarring between the anterior and posterior walls, will obviate the reported stress incontinence following complete colpocleisis. One hundred two cases from 1970 will be analyzed and reported.

Aged

Cooper ligament repair of vaginal vault prolapse twenty-eight years later.

Sir Astley P. Cooper, a British surgeon, first described Cooper's ligament in 1841; in 1949 this ligament was, to our knowledge, first used to support prolapse of the vaginal vault. The first preliminary report in 1965 was based on anatomical dissection of 60 autopsy cases and stressed mainly the length, thickness, width, and strength of the Cooper ligament strip and the adjacent fascia overlying the symphysis pubis. The preliminary report suggested that this was indeed a strong fascial support and would support the vaginal vault. Since 1965, some 85 cases have been treated and in each case, since 1965, every effort has been made to incorporate all of the available extra fascial planes in the pelvic structure to add further support to the vaginal vault prolapse. No major complications have been encountered. The risk of infection of Mersilene strips and synthetics is avoided by using homologous Cooper ligament strips and adjacent fascia. No postoperative stress incontinence was encountered in any of the 63 cases.

Female

Pelvic endometriosis and ureteral obstruction.

Pelvic endometriosis may completely obstruct the ureters and destroy the kidneys with little or no gynecologic symptoms. Five cases are discussed, all causing ureteral obstruction. Two patients suffered the complete loss of a kidney and in each case the remaining kidney was in jeopardy because of partial obstruction due to endometriosis. All these patients were treated by complete removal of all ovarian tissue, dissection of the ureter, and dissection of the scar tissue. In severe cases, retroperitoneal clamping of the infundibular pelvic ligament with clear exposure of the ureter is mandatory to avoid leaving small remnants of ovary in the infundibular ligament clamp. With complete removal of all ovarian tissue, postoperative estrogen therapy will not cause recurrence of the disease.

Adult