Bilateral tubal torsion treated by laparoscopy: a case report.

The history is described of a patient with bilateral torsion of the fallopian tubes successfully managed by laparoscopy.

A method for the repair of vesicovaginal fistulas.

OBJECTIVE: To determine the efficacy of the sliding layers method for repairing vesicovaginal fistulas caused by surgical trauma. METHOD: Twenty one women suffering from vesicovaginal fistulas after surgical trauma, operated on between 1990 and 1995 using the sliding layers method, were included in an uncontrolled prospective study and followed 24 months after the procedure. Patient outcome was assessed according to subjective estimation, gynecological examination and objectively by instillation of diluted methylene blue to the urinary bladder. RESULTS: Sixteen out of 21 patients suffered vesicovaginal fistulas after being subjected to abdominal hysterectomy and five patients after vaginal surgery. Fourteen fistulas were located 5 to 10 mm over the interureteric edge, five fistulas were in the trigone and two fistulas were in the bladder neck region. Fistula size ranged from 5 to 35 mm in diameter but 72.1% of patient fistulas were less than 10 mm in diameter. Only one patient had a large bladder defect of 35 mm in diameter. According to subjective estimation and objective assessment the overall success rate of the procedure after 2 years was 95.2%. Only one patient had to be subjected to a second successful attempt for fistula closure. CONCLUSION: The sliding layers method is a safe and reliable vaginal surgical approach for the repair of vesicovaginal fistulas after surgical trauma.

[Radiotherapy treatment of lymphoma]. / Radioterapija u lijecenju limfoma.

Radiotherapy and/or chemotherapy are primary treatment modalities in the therapy of lymphoma. The treatment depends on the lymphoma type, stage of disease and patients general condition. Radiation therapy is applied with curative or palliative intent, either as a single or combined modality treatment. In patients with stage I and stage IIA Hodgkin's lymphoma (HL) and no adverse risk factors, radiotherapy is applied as a single modality treatment. Moreover, treatment modalities in early-stage HL (I and IIA) consisting of either chemotherapy alone or combined with radiotherapy are the subject of ongoing clinical trials. In addition to the region/s with clinically involved lymph nodes, the target volume of radiation therapy applied as a primary radical treatment modality (stages I and IIA) also includes non-involved lymph nodes of adjacent regions aimed at their prophylactic irradiation. Such extended radiation fields are, for instance, the "mantle-field" and the "inverted-Y" field. On the other hand, with radiation therapy applied in combination with chemotherapy, the target volume depends on both the stage of the disease and the number of chemotherapy cycles. Likewise, the combined treatment is dependent on whether the role of radiotherapy is only the control of clinically involved regions, or of regions with potential subclinical disease too. Chemotherapy is the most frequently applied treatment modality in the management of non-Hodgkin's lymphoma (NHL). Radiation therapy as a single modality treatment with curative intent is applied in patients with, according to the histopathologic classification of the disease, the indolent NHL type and pathological stages I and II in continuation. The target radiation volume includes the clinically involved region, and possibly other adjacent clinically non-involved regions. In higher stages of disease or other, more aggressive NHL chemotherapy is applied either alone or in combination with adjuvant radiotherapy.

A single, continuous spiraling suture for uterine wall reconstruction after laparoscopic enucleation of intramural myomas.

After laparoscopic enucleation of intramural myomas in eight women, the uterine wall defect was reconstructed with a single continuous spiraling suture. The procedure contained cost and reduced operating time. No patients had postoperative intramural hematoma. Although this is a reproducible method of laparoscopic uterine wall reconstruction, long-term results must be obtained to determine safety in pregnancy and extent of postoperative adhesions.