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At least 163 records · Page 9Linked to original sources
PubMed1989

Clinical trial with surgery and intraperitoneal hyperthermic perfusion for peritoneal recurrence of gastrointestinal cancer.

To treat six patients with peritoneal recurrence after radical operation for gastrointestinal cancer, an intraperitoneal hyperthermic perfusion (IPHP), combined with surgical resection of recurrent tumors, intestinal by-pass anastomosis, or both, was carried out. Immediately after complete resection of the intraperitoneal recurrent tumors, a 2- to 3-hour IPHP was performed under hypothermic general anesthesia at about 32 degrees C, using a perfusate containing 10 micrograms/ml or 20 micrograms/ml of mitomycin C (MMC) warmed at the inflow temperature of 46.6 degrees C to 46.9 degrees C. The apparatus used for IPHP was designed for intraperitoneal perfusion as a closed circuit. Although five of the six patients had a malignant peritoneal effusion at the time of admission, the effusion disappeared soon after IPHP, and no cancer cell was present in the lavage from Douglas' pouch. The other patient had a recurrent tumor at the anastomotic region after low anterior resection for rectal cancer and complete resection of the recurrent tumor, combined with IPHP, was carried out. One patient with a recurrent gastric cancer died of hepatic metastasis and cancerous pleuritis 5 months after this treatment, and the other five are in good health 12.8 +/- 5.1 months after IPHP. On the other hand, five patients with intra-abdominal recurrent gastric cancer, who received only surgical treatment within the same period of time, died 3.0 +/- 2.1 months after the surgery. Postoperatively, in the six patients with IPHP, transitory hepatic dysfunction, hypoproteinemia, and thrombocytopenia occurred. These results show that IPHP using MMC combined with surgery is a safe, reliable treatment for patients with peritoneal recurrence of gastrointestinal cancer.

Adult↗
PubMed2002

An extremely rare case of adenoma malignum with large cystic tumor which resulted in urinary obstruction.

BACKGROUND: Adenoma malignum is a rare variant of uterine cervical adenocarcinoma. In this report, we present an extremely rare case of adenoma malignum with large cystic lesions (diameter of more than 10 cm) which elicited urinary obstruction. CASE: A 46-year-old Japanese woman, gravida 2, para 2, visited her local doctor for urinary obstruction, and 950 ml of urine was catheterized. Since abdominal ultrasonography suggested ovarian cystic tumor, she was referred to our hospital. Vaginal examination and ultrasonography revealed a child-head-sized multilocular cystic tumor in the Douglas pouch. Abnormal massive discharge was not observed at the time of admission. During preoperative examination, massive mucinous discharge suddenly occurred without pain. The cystic tumor size shrank from x10 cm to x4.0 cm in maximum diameter. Emergent abdominal hysterectomy was performed. The operative findings revealed collapsed cystic lesions in the posterior wall of the uterine cervix. Microscopically, the multiple cysts in the cervix were composed of high columnar and slightly atypical monolayer cells similar to endocervical mucinous cells. Vaginal invasion was also partly observed. Most of the tumor cells were positive for carcinoembryonic antigen and HIK1083 in their cytoplasm, and scattered chromogranin A-positive endocrine cells were also found in tumor glands, corresponding to minimal deviation adenocarcinoma (adenoma malignum). These lesions were diagnosed as FIGO stage IIa. The patient is disease-free 2 years after primary surgery. CONCLUSION: In the present report, we describe an extremely rare case of adenoma malignum with large cystic lesions reaching a diameter of 12 cm which resulted in urinary obstruction.

Adenocarcinoma↗
PubMed1979

Shunt metastases of pineal tumors presenting as a pelvic mass.

Three children with pineal area tumors and ventriculoperitoneal shunts developed pelvic masses. In two, the solid masses reflected tumor cells seeded to the Pouch of Douglas while the third developed a loculation of fluid and tumor cells at the shunt tip.

Adolescent↗
PubMed1997

Pelvic anatomy and pathology is influenced by distention of the rectum: defecoperitoneography before and after rectal filling with contrast medium.

PURPOSE: The aim of the present study was to evaluate how distention of the rectum with contrast medium at defecoperitoneography affected pelvic anatomy, i.e., position, form, and size, of organs and pouch of Douglas. PATIENTS AND METHODS: Twenty-six female patients with a peritoneocele at defecoperitoneography were selected for the present study. Radiographs taken at the start, before, and after filling the rectum with contrast medium were compared. RESULTS: There was an obvious change in the position of the organs in the pelvis when the rectum was distended with contrast medium. The peritoneocele disappeared completely in 19 of the patients and was reduced in size in the remaining 7 patients, and the enterocele disappeared completely in 13 patients. The small bowel and vaginal portion of the uterus moved cranially. CONCLUSIONS: A distended rectum may conceal existing pathology, such as peritoneocele and enterocele, at defecoperitoneography. Defecoperitoneography should, therefore, include a radiograph before the rectum is filled. This radiograph shows the habitual anatomy of the patient in the sitting position and may demonstrate pathologic findings.

Adult↗
PubMed1992

Culdocentesis is an obsolete diagnostic tool in suspected ectopic pregnancy.

We studied 332 patients with proven pregnancies. Prediction of hemoperitoneum by assessment of the Douglas pouch during bimanual examination had a false negative rate of 42.1%. The false negative rate for culdocentesis was 14.8%. It is therefore concluded that culdocentesis is not a useful tool in the diagnosis of suspected ectopic pregnancies.

Culdoscopes↗
PubMed1981

Comparative studies on cytological and histological evaluations of disseminating peritoneal metastasis in gastric cancer.

Macroscopic disseminating peritoneal metastasis of gastric cancer (P) was investigated in relation to its compatibility with microscopic findings (p) in 52 (P1 19, P2 21, P3 12) cases among 240 gastrectomized cases by cytological, histological, clinical and postmortem findings. In total, numbers of the evaluations for yes (P is p), probable (P is probably p), possible (P is possibly p), probably not (P is probably not p) and no (P is not p) were 28 (53.8%), 8 (15.4%), 14 (26.9%), 2 (3.8%) and 0, respectively, These results indicate that macroscopic disseminating peritoneal metastasis is compatible with microscopic findings, in most cases. Although histology is the most contributory factor for the evaluation of peritoneal dissemination, cytology of lavaged saline from the Douglas pouch also is important.

Adult↗
PubMed1984

Rectopexy to the promontory for the treatment of rectal prolapse. Report of 257 cases.

From 1953 to 1982, 257 patients with complete rectal prolapse were operated upon. To the procedure described by Orr, we have added mobilization of the rectum prior to its suspension and eliminated the pouch of Douglas, and nylon strips have been used for suspension in most patients. There were 57 male and 200 female patients. Ages ranged from 11 to 90 years. Sixty-one patients had already undergone surgery for rectal prolapse with another procedure and prolapse had recurred. The postoperative course was uneventful in 96 per cent of patients. Two patients, aged 79 to 83 years, died of cardiac failure. Follow-up of 115 patients ranged from five to 23 years. Recurrent rectal prolapse was observed in 4.3 per cent of the patients in whom nylon strips were used to suspend the rectum. In 136 patients anal incontinence was associated with rectal prolapse. Normal continence was restored in 84.1 per cent of 107 patients with rectopexy alone and in 64.2 per cent of 14 patients who underwent rectopexy and anal sphincter repair. It is concluded that rectopexy to the promontory with nylon strips after mobilization of the rectum is a safe and efficient procedure for the treatment of rectal prolapse.

Adolescent↗
PubMed1999

Noninvasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy.

A prospective study was performed to investigate the feasibility and benefit of evaluating blunt abdominal trauma (BAT) without diagnostic peritoneal lavage (DPL) or other invasive methods. Diagnostic algorithms were designed by using ultrasonography (US) as a screening method. For unstable patients, a free fluid >/= 2 mm thickness on US images over any one of the intraperitoneal spaces (bilateral subphrenic, Morrison, and Douglas pouch) was used as an indicator for laparotomy. For stable patients, any intraabdominal free fluid detected by US was used as an indicator for further investigations. Computed tomography served as a principal complementary method. To further clarify the clinical results, the rate of nontherapeutic laparotomy (NTL) was compared with that from a previous 5-year review done before this study. During studying period of 1 year, 170 patients were consecutively enrolled. There was no delayed diagnosis, and 66 patients were found to have BAT; 17 patients were initial unstable, among whom 15 had free fluid shown by US and 13 patients had confirmed BAT. Eight of the unstable patients with free fluid on US were saved from NTL, of whom six had retroperitoneal hematoma. There was no NTL in unstable patients. Twenty-two patients underwent laparotomy. Two laparotomies done for a suspicion of bowel injury turned out to be NTL. The rate of NTL in the present study was significant lower than that in a previous review (9.1% vs. 32.2%, p = 0.025). Hence following well designed algorithms, noninvasive evaluation of BAT can proceed with safety, and NTL is minimized.

Abdominal Injuries↗
PubMed2001

Primary abdominal pregnancy associated with severe ovarian hyperstimulation syndrome.

An uncommon case of primary abdominal pregnancy that was detected after rapid resolution of OHSS is reported. A 27-years-old nulligravida woman underwent ovarian hyperstimulation with human menoposal gonadotrophin (hMG) at another clinic and was admitted to our hospital with severe OHSS. Intravenous fluid therapy, albumin supplementation, and abodminal paracentesis was performed. The patient's massive ascites rapidly resolved, and she was discharged from our hospital. However, 4 weeks later, at about the 8th gestational week, she was readmitted to our hospital because of strong suspicion of abdominal pregnancy. Ultrasonography revealed a gestational sac (GS) and fetus with heartbeat in Douglas' pouch and an emergency laparotomy was performed. Both fallopian tubes, both ovaries and the uterus were completely intact and the GS was found on the anterior surface of the rectum. After removing GS, the muscle layer and serosal layer of the rectum were repaired. No bowel complications developed, and the post operative course was uneventful. To our knowledge, this is the first report of this very rare variant of ectopic pregnancy complicated by OHSS.

Adult↗
PubMed2002

Small bowel incarceration in a broad ligament defect.

We report the case of a 33-year-old woman whose medical history included three normal pregnancies without previous abdominal or pelvic surgery. She presented with small bowel obstruction. An abdominal computed tomography (CT) scan study revealed air fluid levels in the pelvis. Laparoscopic exploration revealed a viable ileal loop incarcerated through the mesoligamentum teres. The intestinal loop was reduced and the broad ligament defect was closed with a laparoscopic absorbable clip. Among internal hernias, hernias through a defect in the broad ligament represent only 4-7%. Defects within the broad ligament can be either congenital (ruptured cystic structures reminiscent of the mesonephric or mullerian ducts) or secondary to operative trauma, pregnancy and birth trauma, or prior pelvic inflammatory disease. CT scan may be diagnostic by showing incarceration of a dilated intestinal loop in the Douglas pouch with air fluid levels. This is the first reputed case of a totally laparoscopic repair of a bowel incarceration through a broad ligament defect.

Abdominal Pain↗
PubMed2003

Stage IVB uterine endometrial cancer successfully salvaged by chemoradiotherapy and surgery.

A case of stage IVB adenoacanthoma of the uterine corpus is described. The patient was admitted with a large amount of atypical genital bleeding. Computed tomography and magnetic resonance imaging revealed a large tumor accompanied by lymph node involvement in the left inguinal, multiple pelvic, and paraaortic regions. She was diagnosed as having stage IVB endometrial adenoacanthoma. Neoadjuvant chemotherapy with carboplatin (CBDCA) and 5-fluorouracil (5-FU) was performed, followed by radiotherapy. The tumor responded very well, but still remained in Douglas' pouch after treatment. The patient therefore underwent a simple hysterectomy, pelvic and paraaortic lymphadenectomy, and partial rectal resection. Histopathologically, viable cancer cells were observed only in the fundus of the uterus. The patient is alive with no evidence of recurrence 4 years after the initiation of chemoradiotherapy.

Adenocarcinoma↗
PubMed2006

Enterocele: what is the clinical implication?

PURPOSE: Because of the rarity of diagnosis, the clinical implication of enterocele remains unclear. This study was designed to clarify the characteristic symptoms and the role of surgical treatment for enterocele. METHODS: We reviewed a defecography database prospectively maintained from 1998 to 2004. Defecography was performed with oral barium to opacify the small bowel in all patients. Enterocele was defined as the small bowel falling down beyond the level of the vaginal vault practically, it was <3 cm from the anorectal angle in the lateral view. Patients' clinical information was collected using a questionnaire. Patients with intractable symptoms underwent surgical repair. RESULTS: Among 912 patients on defecography, 104 patients (11 percent) revealed an enterocele (18 males mean age, 63 (range, 21-86) years). Concomitant abnormal findings, such as perineal descent, rectocele, and rectal intussusception, were encountered in 79 patients (76 percent). Only 25 patients (24 percent) had isolated enteroceles. Characteristic symptoms were difficulty emptying (61 patients), postevacuation discomfort (54 patients), and pelvic pain (28 patients). Eleven patients (10 females) underwent Douglas' pouch repair. Three of the 11 patients reported complete resolution of pelvic pain. The remaining eight patients experienced reduced symptoms, mainly resolution of pelvic heaviness, but still had difficulty emptying or postevacuation discomfort. CONCLUSIONS: This study suggests that the characteristic symptoms of enterocele are: difficulty emptying, postevacuation discomfort, and pelvic pain or heaviness. Selected patients with pelvic pain rather than obstructed defecatory symptoms might benefit from surgical repair.

Adult↗
PubMed1991

Pregnancy rates after peritoneal ovum-sperm transfer.

We present the technique of peritoneal ovum-sperm transfer as an option for treatment in couples with unexplained infertility factors. In 1989 we reported the first successful pregnancy, in the United States, after transferring sperm and oocyte into the peritoneal cavity. We now report the results of a prospective study of this procedure. Twelve women with unexplained infertility underwent 23 cycles of peritoneal ovum-sperm transfer. Ovulation stimulation was achieved with human menopausal gonadotropin. Ultrasonographically directed oocyte recovery was performed by the transvaginal route with the patient under local anesthesia and sedation. After oocyte recovery, 4.5 +/- 0.4 (mean +/- SE) oocytes and 13.3 +/- 1.0 (mean +/- SE) x 10(6) motile spermatozoa were transferred into the pouch of Douglas. Six clinical pregnancies occurred in 23 stimulated cycles for a pregnancy rate of 26% per cycle. This value compares with the overall pregnancy rates of 16% for in vitro fertilization and 27% for gamete intrafallopian transfer reported by the In Vitro Fertilization Registry. Thus these preliminary data suggest that peritoneal ovum-sperm transfer is at least as successful as in vitro fertilization and gamete intrafallopian transfer. Advantages of peritoneal ovum-sperm transfer over gamete intrafallopian transfer include its being an office nonsurgical procedure not necessitating a general anesthetic and decreased cost. Therefore peritoneal ovum-sperm transfer is a reasonable first approach in couples with unexplained infertility.

Adult↗
PubMed1984

Prognostic value of peritoneal fluid cytology in patients with endometrial cancer stage I.

With increasing depth of invasion of the endometrial adenocarcinoma in the myometrium an increasing number and percentage of patients with endometrial adenocarcinoma cells in the pouch of Douglas are found. The presence or absence of endometrial tumour cells can be used as an indicator of the depth of invasion in the myometrium. Survival is correlated with the presence of endometrial adenocarcinoma cells in cases with deep invasion; 50% recurrent disease was observed when the fluid was positive, no recurrent disease when negative. No correlation between survival and presence or absence of tumour cells in the Douglas fluid was found in cases with superficial invasion of the tumour in the myometrium.

Adenocarcinoma↗
PubMed1988

Radiation therapy for advanced gastric cancer.

A retrospective study of 75 patients with advanced inoperable gastric cancers, referred to the National Cancer Center Hospital between 1962 and 1982, was performed. According to the Borrmann classification based on X ray findings, Type 1 was found in 3 patients, Type 2 in 5, Type 3 in 40, and Type 4 in 15. Twelve patients could not be classified. The histological type was papillary adenocarcinoma in 7 patients, tubular adenocarcinoma in 23, mucinous carcinoma in 6, poorly differentiated adenocarcinoma in 14, signet ring cell carcinoma in 12 and others in 13. The site of remote metastasis in 19 patients was Virchow's lymph node in 8 patients, Douglas pouch in 3, liver and lung in 2 each and others in 4. All patients were treated by a either telecobalt 60 unit or a linear accelerator using 6 Mv photon and the total dose to primary lesion was 4000 cGy in 5 weeks to 7000 cGy in 8-9 weeks. Complete response (CR) was achieved in 6 patients or 8.0%, partial response (PR) in 46 or 61.3%, and no change (NC) in 23 or 30.7%. The response rate based on the sum of CR and PR was about 70%. The 50% survival period in months was 26.5, 7.3, and 3.2, respectively for patients with CR, PR, and NC. For the response of advanced gastric cancer to chemotherapy in the National Cancer Center Hospital, the combined use of UFT and Mitomycin C gave the highest rate, 46%. As for as local response is concerned, the response rate to radiation was 70%, a better result than that of chemotherapy alone.

Adenocarcinoma↗
PubMed2004

Surgical procedure in patients with ovarian cancer diagnosed at the time of prophylactic oophorectomy. Analysis of two cases, literature review and surgical implications.

The aim of this study was to discuss the surgical management for ovarian or tubal cancers diagnosed at the time of prophylactic oophorectomy. Two patients with BRCA1 & BRCA2 mutations carriers had ovarian cancer diagnosed during laparoscopic oophorectomy. Conversion to laparotomy was performed in order to complete surgery (hysterectomy, multiple peritoneal biopsies, omentectomy, pelvic and para-aortic lymphadenectomy). These two patients were upstaged on the basis of para-aortic lymphadenectomy and had massive nodal spread into para-aortic area. One of them had no intra-peritoneal disease and the other one had minor peritoneal disease (only one positive pelvic biopsy in the Douglas pouch). These two patients are alive, one of them with 3.5 years of follow-up after the end of adjuvant treatment. In order to ensure the exact spread of the disease. Lymphadenectomy should be performed in patients with ovarian cancer diagnosed at the time of prophylactic surgery.

BRCA1 Protein↗
PubMed2006

[Transvaginal mesh perineal repair of the rectovaginal septum in the treatment of rectocele and enterocele. Outcomes in 77 patients].

OBJECTIVE: Anatomical and functional outcomes after transvaginal perineoplasty of the vaginal septum using polypropylene mesh in 77 patients with rectocele, enterocele, or both were studied. The frequency of other associated pelvic floor defects was also analyzed. PATIENTS AND METHOD: Between 1997 and May 2005, 77 patients underwent surgery (30 for enterocele, 33 for rectocele and 14 for both defects). In all patients, complete dissection of the rectovaginal space, resection of the redundant vaginal wall tissue, suturing of the polypropylene mesh to the lateral bundles of the puborectal muscle, and posterior colporrhaphy were performed. In enteroceles, Douglas' pouch was resected before the mesh was placed. RESULTS: During follow-up, there were 3 minimal vaginal dehiscences requiring partial extirpation of the mesh in 2 (12.1%), and 1 (1.2%) rectocele recurrence. No subsequent mesh extrusions or recurrences were detected during follow-up. The frequency of associated pelvic floor disorders was 92%. CONCLUSIONS: In our experience, placement of polypropylene mesh in the rectovaginal septum with lateral suturing to puborectal muscle bundles provides excellent results compared with other approaches and meshes that are not sutured and fixed in the rectovaginal space, leading to mesh infection, extrusion or complete removal.

Aged↗
PubMed2002

Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis.

OBJECTIVE: To investigate whether specific types of pelvic pain are correlated with the anatomic locations of deeply infiltrating endometriosis (DIE). DESIGN: Retrospective data analysis. SETTING: University tertiary referral center. PATIENT(S): Two hundred and twenty-five women with pelvic pain symptoms and DIE. INTERVENTION(S): During surgery, we recorded the anatomic locations of DIE implants and associated endometriosis. MAIN OUTCOME MEASURE(S): We studied the incidence of pelvic pain symptoms including severe dysmenorrhea, deep dyspareunia, noncyclic chronic pelvic pain, painful defecation during menstruation, urinary tract symptoms, and gastrointestinal symptoms as related to the location of DIE. RESULT(S): The frequency of severe dysmenorrhea increased with Douglas pouch adhesions and decreased with parity. The frequency of dyspareunia increased with a uterosacral ligament DIE location and decreased when it involved the bladder. The frequency of noncyclic chronic pelvic pain was higher when it involved the bowel and was lower for women who were treated for infertility. The frequency of painful defecation during menstruation was higher when DIE involved the vagina; lower urinary tract symptoms were more frequent when DIE involved the bladder and less frequent in women with a lower body mass index. Gastrointestinal symptoms were associated with bowel or vaginal DIE locations. CONCLUSION(S): The types of pelvic pain are related to the anatomic location of DIE. Knowledge of the characteristics of pelvic pain symptoms is important in the preoperative assessment of patients with suspected DIE.

Adult↗