scholarly journals Repair of vesicouterine fistula by not using traditional o connor method

2020 ◽  
pp. 1-8
Author(s):  
Lubna ◽  
Raheela Mohsin Rizvi
Keyword(s):  
Uterine Cavity ◽  
Posterior Wall ◽  
Polyglycolic Acid ◽  
Anterior Wall ◽  
Lower Uterine Segment ◽  
Fistula Tract ◽  
Care Hospital ◽  
Fistulous Opening ◽  
Abdominal Approach ◽  
Tissue Flap

Abstract A 25-year-old female patient visited our clinic with complaint of cyclic haematuria. She had previous two Caesarean Sections at a secondary care hospital. Her complete urinalysis showed abundant red blood cells. Through computed tomography a fistula tract between the posterior wall of the bladder and the anterior wall of the lower uterine segment was diagnosed. The Cystoscopy revealed a fistulous opening with a diameter of nearly 1.5 cm localized between the bladder and uterine cavity. Fistulae was repaired by abdominal approach without transection of bladder. Surgery was performed by mobilization of bladder and wide anterior uterine dissection. A 2cm defect in the lower uterine segment was identified and was closed with 0 polyglycolic acid suture. Bladder defect was repaired in two layers. Then omental tissue flap was placed between the two surfaces. At 6 months follow the up patient was asymptomatic. Keywords: cyclic menouria; vesicouterine fistulas; Youssef’s syndrome. Continuous..

Comparative Study of Ultrasound Signs of Scar Pregnancy in Patients with Cesarean Section and Their Clinical Outcomes

2021 ◽  
Vol 11 (3) ◽  
pp. 886-893
Author(s):  
Shasha Xie ◽  
Wei Dong ◽  
Yeting Liu ◽  
Haixiao Gao
Keyword(s):  
Cesarean Section ◽  
Uterine Cavity ◽  
Clinical Work ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Clinical Value ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
First Choice ◽  
New Type

Caesarean scar pregnancy is the implantation of fertilized eggs in the scar of the previous cesarean section in the lower uterus. It is a serious long-term complication after cesarean section. Ultrasound examination, as the first choice to evaluate cesarean scar pregnancy plays an important role in its diagnosis, treatment and follow-up. This study first tried to propose new ultrasound diagnostic indicators to distinguish cesarean scar pregnancy from non-scar pregnancy of the lower uterine cavity; Logistic regression analysis was used to screen for risk factors related to scar pregnancy bleeding, with a view to providing clinical ultrasound indicators to predict bleeding risk; Secondly, the use of contrast-enhanced ultrasound and three-dimensional ultrasound to observe the scar diverticulum of cesarean section more than six months after the different surgical treatments of scar pregnancy, and to evaluate whether surgical scar repair can improve the scar diverticulum. Finally, using ultrasound to predict the position of the embryonic placenta, the new type of scar pregnancy in cesarean section is divided into three types: anterior wall placenta, anterior wall posterior placenta and posterior wall placental. The three types of CSP have significant differences in the thickness of the muscular layer in the scar of the lower part of the anterior wall of the uterus, the blood flow in the scar of the lower part of the anterior wall of the uterus, the number of days of hospitalization, the treatment method, and the treatment effect, which indicate that the new type is used for the diagnosis of CSP. Treatment and prognosis evaluation have high clinical value, can be used to guide clinical work, and provide a new idea for clinical diagnosis and treatment.

scholarly journals A case of post-caesarean vesico-uterine fistula: A rare entity becoming common?

2017 ◽  
Vol 6 (11) ◽  
pp. 5145
Author(s):  
Pallavee P. ◽  
Jeetendra Behera ◽  
Rupal Samal
Keyword(s):  
Caesarean Section ◽  
Uterine Cavity ◽  
Abdominal Distension ◽  
Posterior Wall ◽  
Rare Entity ◽  
Fistulous Opening ◽  
Lower Section ◽  
Vesicouterine Fistula ◽  
Uterine Incision ◽  
Operative Findings

Vesicouterine fistula (VUF) is rare, with an incidence estimated at 1-4% of all genitourinary fistulas. We report a case of VUF which was referred to our institute on the 6th postoperative day following an emergency repeat lower section caesarean section (LSCS) at 39 weeks, with complaints of hematuria and watery discharge per vaginum for further management. Patient had stable vitals with slight abdominal distension and tenderness and watery discharge per vaginum having an ammoniacal odour. USG examination showed Foley’s bulb inside uterine cavity. CT abdomen confirmed the findings and showed presence of contrast inside uterine cavity. Patient was re-operated on 9th postoperative day in concurrence with urologists. Cystoscopy showed a 2 cm size fistulous opening. Intra-operative findings revealed a fistulous track between posterior wall of bladder and uterine incision. Appropriate reparative surgery was done. Obstetricians need to be aware of this condition particularly while operating on previous caesarean sections.

scholarly journals Hysteroscopy is Gold standard in Uterine evaluation for Infertility, but HSG still has a place

2021 ◽  
Vol 12 (4) ◽  
pp. 98-104
Author(s):  
Manisha Bajaj ◽  
Rajib Roy ◽  
Motiur Rahman ◽  
Joydeb Roychowdhury
Keyword(s):  
Predictive Value ◽  
False Negative ◽  
Screening Method ◽  
Uterine Cavity ◽  
High Specificity ◽  
Filling Defect ◽  
Endometrial Polyp ◽  
Care Hospital ◽  
Saline Infusion Sonography ◽  
First Choice

Background: Uterine abnormalities, congenital or acquired are implicated as causal factor in 10%-15% of infertile couplesreporting for treatment. Hysteroscopy, hysterosalpingography (HSG), saline-infusion-sonography and USG are available for evaluation of uterine cavity. HSG helps in initial evaluation of a sub-fertile woman, but hysteroscopy is gold standardas itallows direct visualisation ofintrauterine pathology and treatment in same-setting, if required. Aims and Objective: To describe hysteroscopic findings of infertile patients and compare the observations with their respective HSG findings. Materials and Methods: It’s a prospective analysis of 105 women with infertility who attendedtertiary-care hospital during 18 monthsfulfilling pre-defined inclusion and exclusion criteria. All cases were evaluated with both HSG and hysteroscopy, observations were recorded and co-related with each other. Results: Among 105 cases, maximum (76.19%) were 25-35 years of age. The primary infertility accounted for 68.57% cases.Abnormal HSG findings observed in 19 cases (20%), most common being filling-defect.Hysteroscopy detected abnormalities in 39 cases (37.14%), commonest being endometrial polyp. Out of 39 cases of abnormal uterine cavity detected on hysteroscopy only 19 were picked-up by HSG, rest 20 cases failed to be identified. The strength of agreement between hysteroscopy and HSG calculated is moderate (Kappa=0.505). Conclusion: As HSG hadlow false positivity (03%), high positive-predictive-value (90.48%) and negative-predictive-value (76.19%) and high specificity (96.96%) it is still considered as a first-choice screening method of uterine cavity. However, high false-negative-value (51.28%)of HSG makes Hysteroscopy a better diagnostic test. HSG couldn’t differentiate endometrial polyp, adhesions and submucous fibroid, shown them as filling defect only.

scholarly journals The role of local impedance drop in the acute lesion efficacy during pulmonary vein isolation performed with a new contact force sensing catheter—A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257050
Author(s):  
Nándor Szegedi ◽  
Zoltán Salló ◽  
Péter Perge ◽  
Katalin Piros ◽  
Vivien Klaudia Nagy ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Force Sensing ◽  
Lesion Formation ◽  
Force Time

Introduction Our pilot study aimed to evaluate the role of local impedance drop in lesion formation during pulmonary vein isolation with a novel contact force sensing ablation catheter that records local impedance as well and to find a local impedance cut-off value that predicts successful lesion formation. Materials and methods After completing point-by-point radiofrequency pulmonary vein isolation, the success of the applications was evaluated by pacing along the ablation line at 10 mA, 2 ms pulse width. Lesions were considered successful if loss of local capture was achieved. Results Out of 645 applications, 561 were successful and 84 were unsuccessful. Compared to the unsuccessful ablation points, the successful applications were shorter (p = 0.0429) and had a larger local impedance drop (p<0.0001). There was no difference between successful and unsuccessful applications in terms of mean contact force (p = 0.8571), force-time integral (p = 0.0699) and contact force range (p = 0.0519). The optimal cut-point for the local impedance drop indicating successful lesion formation was 21.80 Ohms on the anterior wall [AUC = 0.80 (0.75–0.86), p<0.0001], and 18.30 Ohms on the posterior wall [AUC = 0.77 (0.72–0.83), p<0.0001]. A local impedance drop larger than 21.80 Ohms on the anterior wall and 18.30 Ohms on the posterior wall was associated with an increased probability of effective lesion creation [OR = 11.21, 95%CI 4.22–29.81, p<0.0001; and OR = 7.91, 95%CI 3.77–16.57, p<0.0001, respectively]. Conclusion The measurement of the local impedance may predict optimal lesion formation. A local impedance drop > 21.80 Ohms on the anterior wall and > 18.30 Ohms on the posterior wall significantly increases the probability of creating a successful lesion.

scholarly journals Spade-Shaped Anastomosis after Laparoscopic Proximal Gastrectomy Using Double Suture Anchoring between the Posterior Wall of the Esophagus and the Anterior Wall of the Stomach (SPADE Operation): A Case Series

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 379
Author(s):  
Sin Hye Park ◽  
Harbi Khalayleh ◽  
Sung Gon Kim ◽  
Sang Soo Eom ◽  
Fahed Merei ◽  
...  
Keyword(s):  
Los Angeles ◽  
Anastomotic Stricture ◽  
Bile Reflux ◽  
Proximal Gastrectomy ◽  
Case Series ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Reflux Symptoms ◽  
Laparoscopic Proximal Gastrectomy ◽  
Technical Modifications

We introduced SPADE operation, a novel anastomotic method after laparoscopic proximal gastrectomy (PG). Technical modifications were performed and settled. This report aimed to demonstrate the short-term clinical outcomes after settlement. Data from 34 consecutive patients who underwent laparoscopic PG with SPADE between June 2017 and March 2020 were retrospectively reviewed. Reflux was evaluated based on the patients’ symptoms and follow-up endoscopy using Los Angeles (LA) classification and RGB Classification (Residue, Gastritis, Bile). Other complications were classified using the Clavien–Dindo method. The incidence of reflux esophagitis was 2.9% (1/34). Bile reflux was observed in six patients (17.6%), and residual food was observed in 16 patients (47.1%) in the endoscopy. Twenty-eight patients had no reflux symptoms (82.4%), while five patients (14.7%) and one patient (2.9%) had mild and moderate reflux symptoms, respectively. The rates of anastomotic stricture and ileus were 14.7% (5/34) and 11.8% (4/34), respectively. No anastomotic leakage was observed. The incidence of major complications (Clavien-Dindo grade III or higher) was 14.7%. The SPADE operation following laparoscopic PG is effective in reducing gastroesophageal reflux. Its clinical usefulness should be validated using prospective clinical trials.

scholarly journals Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?

2020 ◽  
Author(s):  
Kiper Aslan ◽  
Adnan Orhan ◽  
Engin Turkgeldi ◽  
Ebru Suer ◽  
Nergis Duzok ◽  
...  
Keyword(s):  
Posterior Wall ◽  
Anterior Wall ◽  
Uterine Wall ◽  
Laparoscopic Myomectomy ◽  
Complication Rates ◽  
Analgesic Requirement ◽  
Hospitalization Period ◽  
Before And After ◽  
Wall Groups ◽  
Type 3

Abstract Objective To determine whether hemorrhage and complication rates vary according location of the dominant fibroid following laparoscopic myomectomy. Background Laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury and conversion to laparotomy may be seen in laparoscopic myomectomy. We don’t know whether fibroid location effect these complications. Materials & Methods Women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4 or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e. anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery, and complication rates were compared across categories. Results 219 women with mean age of 35.7 +/-6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. Other 10 women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 ± 2.6, 6.6 ± 2.3, and 6.7 ± 2.3 cm in the fundal, anterior and posterior groups, respectively (p=0.9). The median (25 th – 75 th percentile) changes in hemoglobin levels were 1.5 (0.8 – 2.2), 1.3 (0.6 – 2.1), and 1.3 (0.9 – 2) g/dl in fundal, anterior and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33). Conclusion Incidence of hemorrhage or complication does not seem to vary depending on fibroid location. However, the sample size was limited, the observed values suggest that fibroid location does not affect hemorrhage and complication rates.

scholarly journals Effects of Long-term Nonylphenol Exposure on Myocardial Fibrosis and Cardiac Function in Rats

2021 ◽  
Author(s):  
Chao Liu ◽  
Chengyu Ni ◽  
Weichu Liu ◽  
Xiaolian Yang ◽  
Renyi Zhang ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Myocardial Fibrosis ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Environmental Estrogens ◽  
Control Group ◽  
Cardiac Structure ◽  
Collagen Iii

Abstract Background: Myocardial fibrosis is a critical pathological basis for the poor prognosis of cardiovascular diseases. Studies have found that myocardial fibrosis is closely associated with exposure to environmental estrogens such as nonylphenol (NP), as a representative of environmental estrogens. The aim of this study was to examine the effects of NP chronic exposure on myocardial fibrosis as well as cardiac structure and function. Forty Sprague Dawley rats were randomly divided into four groups (n = 10): control group (C), low NP dose (0.4 mg/kg, L), medium NP dose (4 mg/kg, M), and high NP dose (40 mg/kg, H) groups. The NP dose groups were gavaged with NP for 180 days. Results: The NP level in the heart of the NP groups was significantly higher than those in the control group (F = 43.658, P < 0.001). Serum aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase isozyme (CK-MB), lactate dehydrogenase (LDH) and α-hydroxybutyrate dehydrogenase (α-HBDH) significantly increased in the NP groups compared with the control group (). Histopathological examination of the heart biopsy illustrates that in the medium and high NP groups, the fibrous connective tissue had a disordered and loose gridding shape, muscle fibers had fractured, and muscle fibers were loose with a widened gap. Extensive inflammatory cell infiltration and fibroblast proliferation in the myocardial interstitium were also found. With increasing NP dose, the degree of muscle fiber loosing and disorder became more significant in the NP treatment groups, and the collagen volume fraction (CVF) was higher than that in the control group (P < 0.01). Compared with the control group, the expression of collagen I and collagen III increased significantly in the medium and high NP groups (P < 0.05). The values of the systolic thickness of the left ventricular anterior wall (LVAWs), the diastolic thickness of the left ventricular posterior wall (LVPWd), the systolic thickness of the left ventricular posterior wall (LVPWs), and the left ventricular anterior wall (LVAWd) in the NP groups are were slightly lower than those in of the control group. The values of left ventricular end systolic dimensions (LVIDs) in the NP groups increased compared with the control group. Conclusions: Long-term NP exposure could lead to fibrosis in the rat myocardium, which is characterized by increased expressions of myocardial collagen I and collagen III, as well as elevated cardiac enzymes. In addition, the cardiac structure was affected and changes were observed in the thinner ventricular wall and as an enlarged ventricular cavity.

scholarly journals ACUTE MYOCARDIAL INFARCTION;

2013 ◽  
Vol 20 (03) ◽  
pp. 332-340
Author(s):  
ATIF SITWAT HAYAT ◽  
MUHAMMAD ADNAN BAWANY ◽  
JAWAD AHMED QADRI ◽  
Kiran Khalil
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Heart Block ◽  
Complete Heart Block ◽  
Tertiary Care ◽  
Anterior Wall ◽  
P Value ◽  
Inferior Wall ◽  
Care Hospital ◽  
Significant Difference

Background: Ischemic heart disease is the most common cause for complete heart block (CHB) and sudden death. Heartblocks may occur as complications of acute myocardial infarction (AMI) and are associated with increased mortality. The aim of thisstudy is to determine the frequency of complete heart block (CHB) in acute myocardial infarction at a tertiary care hospital. Place andduration: This study was conducted in Cardiology Department of Liaquat University of Medical and Health Sciences from 1st August2009 to 31st January 2010. Study Design: Cross sectional and descriptive study. Materials and Methods: ST segment elevation equal toor more than 1mm (0.1mv) in two of these leads II, III and aVF. Rise in serum creatinine kinase level (CPK Level) more than twice thenormal value along with CK-MB fraction more than 6% of CPK value. Patients with history of chest pain, shortness of breath, nausea,vomiting and unconsciousness were enrolled in the study. The cardiac enzymes tropinin T was also performed at bed side by venousblood sample. Results: Total of 87 patients were included, prevalence of heart blocks was 27.58%. Anterior wall MI was in 50(57.5%)patients. Of these, 13(54.2%) had complete heart block. Inferior wall MI was in 37(42.5%) cases, of these, 11(45.8%) were found withcomplete heart block. There was no significant difference between anterior wall MI and inferior wall MI with complete heart block (P value> 0.05). Mortality was 2.3% with anterior wall MI. Conclusions: Development of complete heart blocks has important prognosticsignificance. Complete heart block was frequent complication of myocardial infarction.

scholarly journals Neonatal gastric perforation: is prematurity the only cause?

2020 ◽  
Vol 7 (9) ◽  
pp. 1318
Author(s):  
Manas R. Dash ◽  
S. K. Barma ◽  
Pranay Panigrahi ◽  
P. Parida ◽  
P. K. Mohanty ◽  
...  
Keyword(s):  
Early Detection ◽  
Early Diagnosis ◽  
Gastric Perforation ◽  
Primary Repair ◽  
Surgical Care ◽  
Abdominal Distension ◽  
Anterior Wall ◽  
Care Hospital ◽  
Neonatal Gastric Perforation ◽  
Gastric Ischemia

Background: Neonatal Gastric Perforation (NGP) is a serious and life-threatening emergency and challenging in terms of diagnosis and management.  The precise aetiology remains obscure in most cases. Published literatures provide theories of gastric ischemia, aerophagia & trauma with or without definite inciting pathology.  Owing to its high mortality rate, it requires early detection & urgent intervention to bring out the newborn from this catastrophe.Methods: We report five cases of neonatal gastric perforation over period of 2013-2019 admitted to a tertiary paediatric surgical care hospital managed by early detection, prompt resuscitation along with exploration and primary repair of the defect in gastric wall.Results: The common feature in these five cases were preterm age, low birth weight, hypoxic event   and   marked abdominal distension causing respiratory distress.  Features of imminent or complete septic shock were present in all cases. Perforation was found on anterior wall along greater curvature of stomach in all babies. Four babies out of five survived except in one case of jejunoileal Artesia that developed gastric perforation in post operative period.Conclusions: Neonatal gastric perforation should be suspected in cases of rapidly deteriorating premature newborn with gross abdominal distension and pneumoperitoneum. In our opinion, etiology of NGP is multifactorial. Prematurity, low APGAR score with vigorous resuscitation could be a clue for early diagnosis. Good outcome in our series was due to early diagnosis and prompt pre and postoperative measures. Additionally, sterile gastric content in peritoneum  might lead to survival from this catastrophic event.

Abstract 15692: Voltage Mapping in Atrial Fibrillation vs Sinus Rhythm: Results From the Mavs Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Carola Gianni ◽  
Jerri A Cunningham ◽  
Sanghamitra Mohanty ◽  
CHINTAN TRIVEDI ◽  
Domenico G Della Rocca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Low Voltage ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Inferior Wall ◽  
Voltage Mapping ◽  
First Time ◽  
Mapping Catheter

Background: Left atrial (LA) scar can be identified with bipolar voltage mapping during sinus rhythm (SR). It is not clear whether the same voltage criteria can be applied during atrial fibrillation (AF). Objective: Aim of this study was to compare voltage maps performed in the same patient both in AF and SR. Methods: Voltage mapping was performed using a 10-pole circular mapping catheter in patients with non-paroxysmal AF undergoing first time RF ablation. For descriptive purposes, the LA was divided in 6 regions: septum, posterior wall (PW), inferior wall (IW), lateral wall, anterior wall, and roof. The threshold for low voltage was <0.5 mV (with a color range setting 0.2-0.5 mV). Mild “scar” was defined as an area low voltage 5-20%, moderate 20-35% and severe as >35%. Results: 16 patients (62% persistent AF, 38% longstanding persistent AF) were included in the study. The map density was comparable during AF and SR (mean points per map 551 vs 547, paired t test P = NS). 2 patients displayed normal voltage during both AF and SR. 14 patients showed areas of low voltage during AF, which were still present during SR in 8. All patients with mild “scarring” during AF (n = 4), showed normal voltage during SR. Of the 7 patients with moderate “scarring”, 2 patients showed normal voltage during SR, while in the remaining 5 “scarring” was only mild during SR. 3 patients showed extensive “scarring” during AF, which was only moderate during SR. During AF, areas of low voltage were more commonly observed in the PW (12/14) followed by the IW (6/14) and antero-septum (4/14); while in SR, in the antero-septum (4/8), PW (3/8) and IW (3/8). Interestingly, in all patients both the PW/IW and (less dramatically) the antero-septum showed more “scarring” during AF as compared to SR. Conclusion: Areas of low voltage are more severe and diffuse during AF when compared to SR. When areas of low voltage are detected during AF, they are more commonly seen in the PW, IW and antero-septal areas.

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