Questions related to Gynaecological Surgery
We have recently seen a pregnant lady presented ln last trimester with cyanosis and breadthlesness for the first time and latter found to have pulmonary arteriovenous fistula..
Surgeons who treat patients with vulvar malignancy should be aware of the serious defect (Fig) following radical vulvectomy, which need immediate reconstruction.
Numerous vascularized flaps have been designed and validated for obliterating the dead space and closing the vulvoperineal skin defect. But the reconstructive surgery with flaps is somewhat like a way that rob Peter to pay Paul.
I had systematically searched the relevant articles in Pubmed with the search strategy and selection criteria “vulvar malignancies”; “vulva”, “vulvar”, “vulval”;“vulvectomy” ; “vulvar reconstruction” combined with“vulvovaginal reconstruction”; “quality of life”, no paper regarding the procedure of vulvar transplantation was found.
Is it possible to perform allogeneic vulvar transplantation with anastomosis of the internal pudendal artery aiming at recovering an acceptable cosmetic appearance.
Thank you for your attention.
There is a uterine prolapse (Last degree) and there is an ulcer. The Q is how can the patient apply the cream prescribed for the ulcer along with the antiseptic and Gauze (Also Vaseline is prescribed).
Is the cream (Mebo cream aids in healing) applied on the ulcer only?, and we impregnate the gauze with the antiseptic (Betadine) and apply it on the cervix and the vagina only, or apply it on the entire prolapsed uterus, and if so, how? Because as we previously applied the cream on the ulcer, so there will be overlapping of two ingredients (Mebo and Betadine) ? And finally how we raise the uterus with the Gauze?
I downloaded the image for illustration.
A 7 years old boy with left testis hypotrophy was presented to me. Sonography – left testis 8 mm length, spare perfusion on Doppler; right testis 15 mm length, gut perfusion. At 4 years of age – surgery for left testicular torsion of an undiagnosed retained testis.
The question is – should the hypotroph testis be removed or to be left until puberty?
In all published literature available to me it is stated that in 1848, Henry Hancock, President of the Medical Society of London, presented a paper to that society describing the treatment of a 30-year-old female eight months pregnant in the Charing Cross Hospital in London [Hancock H. Disease of the appendix caeci cured by operation. Lancet. 1848;2:380–2.].
In only one book (published in 1899) it is written that François Mestivier, in 1759, incised an abscess in the right groin, in a woman eight months pregnant, and on autopsy found at the bottom of the abscess, the appendix vermiformis perforated by a pin [Mestivier FF. Observation sur une tumeur, située proche à la région ombilicale, du côté droit, occasionée par une grosse épingle trouvée dans l'appendice vermiculaire du cécum. J Méd Chir Pharmacol. 1759;10:441-2.].
I cannot reach the full-text of that article to confirm that this is the first published case. In all texts that mention Mestivier's article, a male patient is described and there is no mention of pregnancy (of course).
Please if someone has the full-text of that article send it to me or if anyone has the knowledge of some earlier descriptions of appendectomy during pregnancy or postpartum inform me.
A 35 years old lady, a known case of Psoriasis is on Homeopathic treatment. She has been married for the last 2 years and has now reported for evaluation for infertility. She has normal menstrual periods. Her general, systemic and pelvic examinations are within normal limits except for psoriatic patches. Laboratory investigations are normal. On pelvic USG, uterus is normal size and endomyomtrial echotexture is normal. There are 2 small subserous fibroids, one small cyst in right adnexa adjacent to ovary (? parovarian cyst) and an endometrial polyp of 13 x 8 mm size. Planning for hysteroscopic polypectomy. Can one go ahead with laparohysteroscpic evaluation in this case along with polypectomy?
A 23 years old girl has been having recurrent vaginitis for the last one year.She has been in relationship for the last few years. Barrier contraception is being used with the present partner. She used to have unprotected intercourse with the previous partner. The clinical picture is that of fungal vaginitis. Local antifungal agent, Clotrimazole (at times along with Clindamycin) have been administered few times. She was put on once a week Flucanozole tablet for 6 weeks. The couple had taken combination of Azithromycin, Flucanozole and Secnidazole few months back. GTT done recently is WNL. HIV and VDRL were done in February and repeated few days back. They are non reactive. High vaginal swab has been taken for culture. Vaginal secretions have been collected for cytology. Report is awaited. How to manage this case?
For 90 year old women, uterine prolapse can be a daily struggle, but surgery is not worth the risk, pessaries are not comfortable and result in putrid discharge sometimes. In a woman who is no longer having intercourse, why not sew up the lips to keep the uterus in? Has anyone tried this?
After diagnosing umbilical cord prolapse, in order to remove compression of the presenting part (the head) the doctor elevated the presented part with the hand in the vagina. After several minutes he changed the hand with the midwife. Do you consider this acceptable? In what situations the hand should not be removed or changed?
Direct trocar insertion through Palmer's point with 10 mm trocar OR Veress needle insufflation prior to trocar entry through Palmer's point? Which one is preferable or practiced?
Two different obstetrical cases were observed in female camels. In both cases, severing straining of mothers resulted in prolapse of the (uterus???) or (vagina??). Meanwhile with continuous straining, this prolapsed part was teared with appearance of the fetal parts. In the second case, the intestines were dislocated after fetal removal.
The questions are:
1. Is this prolapsed/teared part vagina or uterus? I suggest it is uterus, it seem very similar to the endometrium.
2. What is the pathogensis? How did this part come to outside during parturition? Is this the non-pregnant horn?
We would like to understand both cases.
Does anyone still use Voluven, a colloid in a pressure bag during spinal anesthesia administration to decrease incidence of spinal hypotension ? If not what are your alternatives to reduce hypotension incidence in C-section ?
I mean: in order to have clear margins at extemporaneous pathological examination. You stick to preoperative design of removal? Use intra-operative ultrasound? Aim larger margins?...
A 18-year-old girl with primary amenorrhoea having well developed secondary sexual characters and lower one third of vagina consulted me for pain and swelling of lower abdomen for last two months. The pain is dragging and not happening monthly. It was a hard mass with smooth surface moving side to side. The mass was freely moving above-downward on per-rectal examination. USG features were suggestive of a fibroid but did not reveal any cervix. What would be the differential diagnosis? I did laparoscopy and MRI and finally removed the mass.
We have isolated a pure culture of Bifidobacterium in a endocervical and endometrial swab collected during a surgical process from a woman who has endometritis postpartum.
Is it possible that this "commensal" has caused the infection?
All the other exams are negative for all the microorganism we could test.
In the third cesarean section, should uterine incision be performed above the former uterine incision or under the former uterine incision or in situ of the former uterine incision?
Is there laparoscopic training box especially for laparoscopic Gynaecology now? and do you think that is it useful?
Could someone help me with the case of a patient who underwent surgery of Wertheim-Meigs for cervical cancer for 15 days ago, and has been showing urinary retention. She referred to feel of bladder fullness but can't urinate. We are making intermittent catheterization.
What are some reports in the literature about what the risk factors are for the recurrence for POP surgery? What is the most recurrent area in POP surgery? Little about ideal procedure for recurrent POP surgery.
14 year old (24kg) phenotypic female operated 8 days back for 28 wks size torsion of solid (mostly) ovarian tumor in emergency. She also had large cliteromegaly. Clinical diagnosis was dysgerminoma. LDH was very high. Alpha fetoprotein came next day was very high. 'Y' chromosome could not be assessed prop as it was taking at-least 10-15 days. Clitoral reduction was planned but laparotomy had lot of adhesions and most probably she would require another surgery to remove another gonad. Uterus was present with b/l fallopian tubes. Vagina is narrow with separate opening for urethra. Other side gonad was looking streak with a mount on one side. HPR came yesterday - Malignant Mixed germ cell tumor (Dysgerminoma with Yolk sac tumor) and biopsy from other gonad as seminiferous tubule. Surgical stage was Ic. She is planned for chemo followed by clitoral reduction. Karyotype still awaited. 17 Hydroxyprogesterone and testosterone was normal.
There seems to be an rising incidence of prolapse of the vaginal vault following vaginal hysterectomy in the area I practice presumably because the primary procedures are mainly performed by practitioners with inadequate experience in conducting vaginal hysterectomy; and also because of wrong choice of treatment method in cases of procidentia
Many women with pelvic organ prolapse detected during pelvic examination do not have complaints related to it. Should repair surgeries be done on them?
What is the opinion regarding site specific repair of vaginal wall prolapse? Some gynaecological operative books do not mention it, especially for posterior vaginal wall prolapses. If site specific repair is followed, then anterior and posterior colpoperineorrhaphy should go into oblivion. Is there any role of approximating levator ani for rectocele? Does the latter procedure cause stress urinary incontinence in some women?
During tubal reanastomosis one cannot achieve exact apposition between mucosal layers of both sides of fallopian tube. Methylene blue is introduced to assess the success of the tubal anastomosis. In case there is no spillage through the fimbrial end, does it always mean that the surgery has not been successful? Is there is any role for repeat surgery in the same sitting in such cases? Are guide wire/ probes encouraged during tubal recanalisation? What postoperative management can be carried out in order to retain tubal patency? Some surgeons advocate hydrotubation to increase the success of the surgery. I would like to see if there are references with regard to this or any other method that helps during and after such kind of surgery.