[Vaginal ultrasound of surgical gynecologic complications].
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Cesarean Section↗
Biomedical subjects
P W Klug
Publications and source records attributed to P W Klug.
[Vaginal sonographic contrast imaging of the endometrium with gel].
In many cases, the sonography of the endometrium requires an exact pre-therapeutical interpretation. Apart from a hysteroscopy, this can take place by means of an improved version of a contrast hysterosonography, i.e. the Gel-KHSG. The technique and examination results are described here. This simple examination method can--like hysteroscopy--precisely define or exclude anomalies of the endometrium, and, beyond that, it has the advantage of the sono-tomographic depiction of the uterine wall. Moreover, it can be taken assumed, that the vagino-sonomorphological diagnostics at the endometrium could--for instance, analogous to the colposcopy of the uterine portion--become part of a system of preventive diagnostics for the cavum uteri. However, such a system has not been set up to date.
Aged↗
[Rare pelvic tumors. A case report].
Two cases of rare pelvic masses of obscure origin are presented. The first was a giant pyometra, simulating an ovarian cyst, detected accidentally 13 years after conisation. The second was hematoma of lower parts of rectus muscles, also detected accidentally. The woman had a history of long-lasting anticoagulation, but couldn't remember any trauma. The difficulties of differential diagnosis are discussed.
Abscess↗
[Role of vaginal sonography in the assessment of adnexa tumors].
Ultrasound has for a long time been established as an essential part of the gynecological examination. Vaginal Ultrasound, which was introduced some years ago, renders more precise pictures as well as better diagnostic results in comparison to abdominal ultrasound. This is especially true for obese and/or old patients. We expected, therefore, that the vaginal ultrasound method would not only lead to a better and more precise structure-analysis but also to a better evaluation and characterization of findings, especially concerning pelvic masses. Our expectations that we would be able to make a diagnosis which would be very close to the findings of histology or to make prognoses on the basis of the sonographic results of 125 female patients with pelvic masses were, however, largely disappointed. Although its application is simpler and it produces pictures of a better quality, the variety of morphological symptoms of adnexal masses remains the limiting factor, which makes it impossible in most cases to predict the histologic findings. Pelvic masses must still be evaluated--in spite of the better quality of the pictures--through a synopsis of clinical, chemical and picture-giving methods.
Adult↗
[Differential diagnosis of pelvic tumors. Abscess forming ileovesical fistula in Crohn's disease. A case report].
A report is given about a case of preoperatively unrecognized ileovesical-fistula caused by Crohn's-disease. Despite of uncharacteristic symptoms a more extensive medical history might have brought to also more extensive diagnostic methods and to suspicion of the intestinal disease.
Abscess↗
[Comparison of vaginal ultrasound and histologic findings of the endometrium].
Transvaginal ultrasound makes it possible to show pelvic structures much more precisely than the abdominal method. As a consequence structures, which have hardly been seen so far, especially in the uterine cavity and the adnexal region, can be seen and analysed more distinctly. This is of vital importance for women of advanced age. We examined 450 women in pre- and postmenopause and studied in detail the structures of the endometrium shown by transvaginal ultrasound according to their respective shapes. In 215 cases they were compared with histological findings. It became evident that the size and structure of the endometrium can indicate its histological state. Premalignant or malignant formations of tissue occurred almost only in an endometrium with a thickness of more than 10 mm or in polyp-like structures. We conclude that in case of thick or extraordinarily structured endometrium - even without any symptoms of bleeding - a curettage should be performed. Vaginal ultrasound, which is, compared to other methods of examining the endometrium, very simple and non-invasive, can be applied any time. For these reasons it represents, in our opinion, another step towards improving the possibilities of diagnosing carcinoma of the endometrium at an early stage.
Dilatation and Curettage↗
[Prenatal diagnosis of complex abnormality syndromes. A case report].
Two cases of complex and serious fetal malformations are presented, which have only been diagnosed in a relatively late stage of pregnancy. In both cases unspecific difficulties had already arisen during ultrasound screening, but they were not considered to be of any vital importance. The problems of diagnosing malformations by ultrasound and the serious consecutive consequences are discussed.
Abnormalities, Multiple↗
[Prevention of postoperative complications following vaginal hysterectomy].
In a prospective study on infectious morbidity after vaginal hysterectomy we examined the clinical symptoms of an infection and partly also the microbial conditions of the vaginal wound. With a group of 49 patients without antibiotic prophylaxis we tried to find out if the type of vaginal occlusion might have any influence on the microbial situation and the healing process. The results of this first group were compared to those of a second group consisting of 31 patients, who had received antibiotic prophylaxis before the operation with a cephalosporin. Though it was not possible to make any microbial analyses in the second group, the clinical evaluation showed distinctly that antibiotic prophylaxis is an important contribution to the prevention of infections after vaginal hysterectomy. The careful consideration of septic-surgical precautions, however, and this was proved by the first part of the study, contributes as well to the prevention of infections.
Bacteria↗
[Primary diagnosis in acute adnexitis].
Though acute salpingitis is the most frequent gynecological illness of a young woman, it occurs nevertheless less frequently than it is diagnosed. The reason for this is to be found above all in the fact, that the criteria of the findings are judged too superficially. If simple anamnestic, clinical or biochemical parameters such as the characteristics and duration of the pain, the findings of gynecological examination, BSR and considerations about differential diagnosis were rated more precisely, considerably fewer cases would have to be assigned to laparoscopy and the elucidation of the indistinct abdominal pains could be started more efficiently.
Adult↗
[Assessment by sonography and palpation of the cervical closure system].
Sonography or palpation alone are inadequate procedures in evaluating cervical function. Only by combining both methods cervical incompetence can be detected at an early stage, adequate therapy instituted and unnecessary cerclage operations prevented. The value of sonography lies in the possibility of studying the functional changes of the cervix in premature labour.
Cervix Uteri↗
[Postmenopausal bleeding: a neglected problem?].
Postmenopausal bleeding (PMB) is a symptom not to be underestimated. In 13% of our series of 300 cases the bleeding was caused by neoplastic disease of the genital tract. Bleeding in the postmenopause should be evaluated by invasive diagnostic measures; endometrial and/or cervical biopsies and exploration of the uterine cavity by polyp forceps. The screening methods for endometrial cancer are not as effective as those for cervical cancer.
Biopsy↗
[Rare complications of endometriosis--2 case reports].
An endometrial lesion of the terminal ileum led to a mechanic ileus following vaginal hysterectomy in the first case. In the second case endometrioid carcinoma developed in an endometriotic lesion of the cul-de-sac 6 years after hysterectomy and bilateral salpingo-oophorectomy; during this period the patient had taken conjugated estrogens continuously.
Adenocarcinoma↗
[Sonography of postoperative complications].
Postoperative complications can be localised and identified via sonography. This is of special interest in haematomas and abscesses situated subfascially or in the true pelvis, where they often produce misleading clinical signs and symptoms. Of equal importance is the detection of an intraperitoneal or subperitoneal haemorrhage and an estimation of its amount, even if it is only a rough estimate. Effective therapy can be instituted as soon as an exact diagnosis has been established.
Abscess↗
[Hydatidiform mole in an elderly female; a differential diagnostic problem--a case report].
A case of a 54-year-old woman with hydatidiform mole is presented. Preoperatively the enlarged uterus was mistaken for a fibroid. Diagnostic considerations and therapy of trophoblastic disease in perimenopausal women are discussed, as well as pitfalls in diagnosis.
Adult↗
[Significance of surgical technics in the prevention of infectious complications following cesarean section].
Serious infectious complications after caesarean sections may be avoided by a meticulous operative technique. The closure of the uterotomy with resorbable sutures placed at a distance of 15 to 20 mm to approximate the wound edges without tension creates an effective barrier of viable myometrium which prevents the progression of intracavitary inflammation. A prophylactic intra- or perioperative regimen seems to be of minor importance.
Bacteriuria↗
[The significance of sonography in the early puerperium].
620 single measurements of the length of the uterus were performed on 220 women in the early post partum period. Our results show that post partum involution progresses continuously. An exact evaluation of the length of the uterus can be made only by sonography; palpation is influenced by the angle in the uterine axis. Of equal clinical importance is the sonographic examination of the uterine wall, the contents of the uterine cavity and of other structures of the true pelvis.
Female↗
[Sling operations with fascia lata strips].
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Fascia↗
[Pathologic changes in fetal brain ventricles and their prognostic significance. Case reports].
Enlargement of fetal ventricular system is found accidentally in most cases. The significance of the sonographic findings must be assessed with regard to the extent and progress of the lesion and to the presence of concomitant malformations. The decision to terminate the pregnancy must be considered carefully and in accord with the full informed parents.
Abnormalities, Multiple↗