-
International Urogynecology Journal Aug 2018We present a video reviewing the key steps involved in safe anterior cul-de-sac entry during vaginal hysterectomy, including tips for troubleshooting difficult cases... (Review)
Review
INTRODUCTION AND HYPOTHESIS
We present a video reviewing the key steps involved in safe anterior cul-de-sac entry during vaginal hysterectomy, including tips for troubleshooting difficult cases such as: uterine procidentia, cervical elongation, and multiple prior cesarean sections.
METHODS
Anterior cul-de-sac entry is a critical step in performing a vaginal hysterectomy. In this video, we review our approach to anterior entry in patients with normal anatomy, followed by a discussion of techniques that may be useful in cases with challenging anatomy. To start, we drain the bladder, set up exposure with Deaver retractors, and make a circumferential incision at the cervicovaginal junction. In cases with normal anatomy, using sharp, followed by broad blunt finger dissection, the vesicocervical space is opened, and the peritoneal reflection is identified and sharply entered. If this is not possible, additional techniques such cystoscopic bladder illumination, posterior entry first, securing pedicles with extraperitoneal ties, or additional sharp dissection may be utilized. With all techniques, proper intraperitoneal entry should be verified by the visualization of small bowel or fat.
CONCLUSION
This video reviews technical considerations for anterior cul-de-sac entry during vaginal hysterectomy in patients with normal anatomy and provides tips for troubleshooting challenging cases.
Topics: Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Pregnancy; Video Recording
PubMed: 29644380
DOI: 10.1007/s00192-018-3646-y -
AJR. American Journal of Roentgenology Oct 2020This article reviews the embryologic development, relevant anatomy, and imaging features, on CT, of pathologic processes involving the lesser sac and foramen of... (Review)
Review
This article reviews the embryologic development, relevant anatomy, and imaging features, on CT, of pathologic processes involving the lesser sac and foramen of Winslow. The lesser peritoneal sac is an intricate anatomic region involved in many disease processes. It is a significant conduit for the spread of disease within the peritoneal cavity. The spectrum of pathologic processes pertaining to the lesser sac can be classified on the basis of the type of involvement, such as a fluid collection (e.g., transudate, exudate, bile, and blood), a mass (e.g., neoplastic or nonneoplastic conditions and lymphadenopathy), or an internal hernia into the lesser sac.
Topics: Humans; Peritoneal Cavity; Peritoneal Diseases; Tomography, X-Ray Computed
PubMed: 32783559
DOI: 10.2214/AJR.19.22749 -
World Journal of Gastrointestinal... Aug 2015Peritoneal encapsulation (PE) is a rare congenital malformation, characterized by a thin accessory peritoneal membrane which covers all or part of the small bowel,...
Peritoneal encapsulation (PE) is a rare congenital malformation, characterized by a thin accessory peritoneal membrane which covers all or part of the small bowel, forming an accessory peritoneal sac. Most cases are asymptomatic and diagnosed incidentally during surgery and/or autopsy. Clinical presentation with intestinal obstruction is extremely rare and we report a case. A 25-year-old male, referred to emergency department with diffuse abdominal pain, crampy, with 8 h evolution, associated with nausea, vomiting and constipation in the last 48 h. The abdominal examination revealed an asymmetric and fixed distension, with hard consistency on palpation of lower abdominal quadrants. The abdominal radiography reveals a small bowel distension and fluid levels. Submitted to laparoscopic surgery that recourse to conversion because there is a total peritoneal encapsulation of the small bowel. After opening the peritoneal sac, we find a rotation of mesentery, at its root, conditioning twisting of small bowel and consequently occlusion. Uneventful postoperative with discharged at the 6(th) day. The PE is a very rare congenital anomaly characterized by abnormal bowel back into the abdominal cavity in the early stages of development. Your knowledge becomes important because, although rare, it might be diagnosis in patients with intestinal obstruction, in the absence of other etiologic factors.
PubMed: 26328038
DOI: 10.4240/wjgs.v7.i8.174 -
Advances in Clinical and Experimental... Jul 2021We don’t understand Alzheimer, its origin and disease mechanisms. The absence of disease-modifying treatments for Alzheimer today is due to the amyloid...
We don’t understand Alzheimer, its origin and disease mechanisms. The absence of disease-modifying treatments for Alzheimer today is due to the amyloid hypothesis, a misguided hypothesis of Alzheimer’s disease etiology, which has dominated Alzheimer research, drug development, and clinical trials for 30 years. However, the hypothesis is not dead yet, as exemplified by the recent resurrection of clinical trials with aducanumab. Recent advances in Alzheimer research include astrocytes, synaptic function and glutamate signaling. Many studies indicate EAAT2 as a promising target in drug discovery and clinical development for novel therapies in Alzheimer’s disease, and other neurologic and psychiatric diseases.
Topics: Alzheimer Disease; Douglas' Pouch; Humans
PubMed: 34313409
DOI: 10.17219/acem/139501 -
BMC Women's Health Mar 2021Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological...
BACKGROUND
Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital.
CASE PRESENTATION
Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses-one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints.
CONCLUSIONS
Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.
Topics: Endometriosis; Female; Follow-Up Studies; Groin; Humans; Laparoscopy; Neoplasm Recurrence, Local; Round Ligament of Uterus
PubMed: 33653321
DOI: 10.1186/s12905-021-01235-2 -
Organogenesis Jul 2017Endometriosis is defined by the presence of endometrial ectopia. Multiple hypotheses have been postulated to explain the etiology of endometriosis to understand various... (Review)
Review
Endometriosis is defined by the presence of endometrial ectopia. Multiple hypotheses have been postulated to explain the etiology of endometriosis to understand various clinical evidences. The etiology of endometriosis is still unclear.The primary question to understanding the etiology of endometrial ectopia (endometriosis) is determining the origin of eutopic (normally cited) endometrium.According to the new theory, primordial germ cells migrate from hypoblast (yolk sac close to the allantois) to the gonadal ridges. The gonadal ridges which composed of primordial germ cells derive to the: eutopic endometrium, ovary, ovarian ligament and ligamentum teres uteri.There are 2 principal processes in uterine organogenesis: the intersection of gonadal ridges with mesonephral ducts to form the uterine folds with an endometrial cavity and the fusion of the both uterine folds together to form the unicavital (normal) uterus. In the uterine folds there are closer cell-to-cell communications, polypotential germ cells differentiate and grow into myometrium and endometrial layers.Some of the polypotential germ cells fail to reach the ridges and stay in the peritoneal cavity, where they may be transforming into external endometrial heterotopies.The main insight in the etiology of endometriosis is polypotential germ cells origin, which may explain its potency, pathogenesis and expansion.
Topics: Endometriosis; Female; Germ Cells; Humans; Models, Biological
PubMed: 28486048
DOI: 10.1080/15476278.2017.1323162 -
Radiologia 2022Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The... (Review)
Review
Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The main indication for lumboperitoneal shunting in children is idiopathic intracranial hypertension, but the technique is also useful in the treatment of postinfectious, posthemorrhagic, and normotensive hydrocephalus, as well as in the treatment of postsurgical pseudomeningocele or leakage of cerebrospinal fluid. This article reviews nine cases treated at our centre to show the normal imaging findings for lumboperitoneal shunts in children and to provide a succinct review of the possible neurological and abdominal complications associated with this treatment.
Topics: Cerebrospinal Fluid Shunts; Child; Humans; Hydrocephalus; Neurosurgical Procedures; Peritoneal Cavity; Pseudotumor Cerebri
PubMed: 35504679
DOI: 10.1016/j.rxeng.2022.03.004 -
Journal of Ultrasound in Medicine :... Oct 2021To determine usefulness of the "speckle sign" in the diagnosis of deep invasive endometriosis. (Review)
Review
OBJECTIVE
To determine usefulness of the "speckle sign" in the diagnosis of deep invasive endometriosis.
MATERIALS AND METHODS
This HIPAA-compliant, institutional review board-approved retrospective study with informed consent waived included 25 women (mean age 20-69 years) with histopathologically confirmed posterior cul-de-sac endometriosis between 2013 and 2018. Transvaginal ultrasound exams of these patients were reviewed by 2 expert radiologists searching for the "speckle sign," defined as irregular obliteration of the posterior cul-de-sac and bright (hyperechoic) internal echoes. The frequency of additional findings such as "kissing ovaries," endometriomas in the adnexa, bowel tethering in the posterior pelvic compartment, retroflexed uterus, adenomyosis, and pelvic free fluid were also analyzed. Data regarding clinical features, histopathologic findings and management were collected through a review of the medical record.
RESULTS
Reader one identified posterior compartment endometriosis in 20/25 patients, and reader two in 22/25 patients, with 96% agreement. Adnexal endometriomas were found in 21/25 patients for both readers (k = 0.70) and were bilateral in 23% of patients. The ovaries were adherent to each other in the midline ("kissing ovaries") in 50% of patients; the bowel was tethered anteriorly in 20%; the presence of adenomyosis was seen in about 27%, and a retroflexed uterus was seen in 24% of patients.
CONCLUSIONS
The speckle sign could be helpful in making the diagnosis of posterior compartment endometriosis, and the sign is often found in conjunction with other imaging features of endometriosis.
Topics: Adenomyosis; Adult; Aged; Douglas' Pouch; Endometriosis; Female; Humans; Middle Aged; Retrospective Studies; Ultrasonography; Young Adult
PubMed: 33417291
DOI: 10.1002/jum.15611 -
Birth Defects Research Apr 2019Recent advances have now made it possible to speak of gastroschisis narrowly in morphogenetic terms invoking the Rittler-Beaudoin (R-B) model. This proceeds from the... (Review)
Review
Recent advances have now made it possible to speak of gastroschisis narrowly in morphogenetic terms invoking the Rittler-Beaudoin (R-B) model. This proceeds from the appreciation of gastroschisis as a congenital intestinal herniation (without cover or liver) within the primordial umbilical ring, mostly to the right side of a normally formed umbilical cord. Presently, it is unresolved whether this visceral prolapse represents failure of ring closure before return of the physiological hernia into the abdomen or rupture of the delicate amniotic/peritoneal membrane at the ring's edge to the right of the cord. Animal observations and experiments will be required to address this question effectively. If gastroschisis is, in fact, a primary malformation with the primordial umbilical ring as the developmental field involved, then homology implies potential gastroschisis in all amniotes with corresponding nourishment from yolk sac (aka omphalomesenteric) vessels going into the embryo and excretory products out via the ancient umbilical connection. It also implies homology of corresponding morphogenetic signal transduction cascades. We review the history of gastroschisis, its presumed pathogenesis, and the developmental biology of the amniotic umbilical ring from this perspective. Therefore, based on the animal and human evidence to date, we propose that gastroschisis is a primary midline malformation that involves the umbilical canal from amniotic to peritoneal space and its primordial umbilical ring, either through nonclosure or rupture of the membrane covering the area, mostly to the right, between the cord and the edge of the ring.
Topics: Abdominal Wall; Biological Evolution; Developmental Biology; Embryonic Development; Gastroschisis; Humans; Infant; Infant, Newborn; Umbilical Cord
PubMed: 30816021
DOI: 10.1002/bdr2.1481 -
JPMA. the Journal of the Pakistan... Apr 2023To evaluate the short-term outcome of the needlescopic hernia sac disconnection and peritoneal closure in the treatment of primary paediatric inguinal hernia.
OBJECTIVES
To evaluate the short-term outcome of the needlescopic hernia sac disconnection and peritoneal closure in the treatment of primary paediatric inguinal hernia.
METHOD
The prospective study was conducted from April 2019 to April 2021 at the Paediatric Surgery Unit of the General Surgery Department at Kafrelsheikh University Hospital, Egypt, and comprised patients aged 6-144 months having uncomplicated paediatric inguinal hernia. The patients were subjected to needlescopic hernia sac disconnection and peritoneal closure. The follow-up protocol included outpatient visits at 1 week and at 1, 3 and 6 months postoperatively to check for recurrence and other complications. Data was analysed using SPSS 24.
RESULTS
Of the 50 patients with 65 hernias, 37(74%) were males and 13(26%) were females. The overall mean age was 50.78± 31.74 months (range: 9-120 months) and mean internal ring diameter was 11.90±3.518mm (range: 8-20mm). The mean operative time was 20.66±2.94 minutesfor unilateral cases and 30.60±5.15 minutesfor bilateral cases. There was no conversion to conventional laparoscopy or to open herniotomy. All cases were followed up for a mean of 11.56± 3.99 months. No recurrence was encountered in any case and the scars were invisible in 40(80%) cases 6 months postoperatively.
CONCLUSIONS
Needlescopic hernia sac disconnection and peritoneal closure wasfound to be feasible,safe and effective in the treatment of primary paediatric inguinal hernia.
Topics: Male; Female; Child; Humans; Infant; Child, Preschool; Hernia, Inguinal; Prospective Studies; Laparoscopy; Herniorrhaphy; Operative Time; Treatment Outcome; Recurrence; Retrospective Studies
PubMed: 37482832
DOI: 10.47391/JPMA.EGY-S4-14