Abscess formation in Gartner's duct cysts associated with ipsilateral renal agenesis. A report of two cases.

The occurrence of both urinary and genital abnormalities in the same female patient is well known. Two cases of abscess formation in a Gartner's duct cyst associated with ipsilateral renal agenesis are presented. Marsupialization is recommended as a satisfactory method of treatment.

Automatic stapling techniques in abdominal hysterectomy.

A method for abdominal hysterectomy using automatic stapling techniques is presented, and a series of 130 cases using metal staples is reported. Advantages and disadvantages are discussed. A new development using Lactomer absorbable staples is introduced.

Bacterial contamination at abdominal hysterectomy: a comparison of staple closure with regular suture closure of the vaginal wall.

Bacterial contamination of the pelvis from the vagina at abdominal hysterectomy is assumed to be a major cause of infectious complications. A pilot study was completed to compare the bacterial contamination that occurred when the vaginal vault was closed using an automatic stapling technique with a regular suture method. The findings suggested that there was considerably less contamination using the staple technique and that infectious complications were associated with heavy bacterial contamination from the vagina. More extensive studies of this association are needed to confirm the presented data.

Laser treatment of cervical intraepithelial neoplasia and the endocervical button.

A prospective randomized clinical trial was undertaken to investigate the relationship between the shape of cervical tissue vaporized with CO 2 laser and the postoperative location of the squamocolumnar junction. It has been suggested that a button of columnar epithelium may be everted onto the exocervix by vaporizing a shallow 1 mm trench around the endocervical canal after the evaporization cone has been completed. Eighty-eight patients with cervical intraepithelial neoplasia (CIN) suitable for treatment by CO 2 laser were randomized into two groups. The transformation zone was ablated to 6 mm in all patients. In the flat group (n = 45), the base of the cervical defect was flat. In the contour group (n = 43), an additional 1 mm trench was vaporized at the periphery of the defect. Both groups were similar with respect to age, use of oral contraceptives, parity, operative complications, degree of CIN, and volume of tissue ablated. On follow-up at 6 months, significantly more patients in the contour group had an endocervical button of columnar epithelium compared to the flat group. No difference was seen at 3 and 12 months. There was a moderate relationship between the volume of tissue vaporized and the area of the button in the contour groups (p less than 0.001) but not in the flat group. The presence of squamous metaplasia tends to increase with time. There were 2 recurrences of CIN at 1 year follow-up.

Opinions of physicians assisting births in Ottawa-Carleton about the licensing of midwives.

The Ontario Ministry of Health announced in January 1986 that midwives would be licensed to practise in Ontario. In September of that year we surveyed all physicians in Ottawa-Carleton who were assisting at births to determine their opinions on midwifery. A total of 78 (74%) of the eligible physicians completed the questionnaire. Almost half thought that midwives should be licensed. Most felt that midwives should be trained as nurses first and should work under the supervision of a physician in hospital-based clinics or in a group practice with physicians. A small proportion thought that midwives should be able to practise as independent practitioners. Some obstetricians thought that legalization of midwifery would allow them to concentrate on high-risk obstetrics, and some family physicians thought this would make it easier for them to continue to be involved in maternity care. Those opposed to the introduction of midwives did not think the public would benefit, and some were concerned that midwives would reduce the size of their own obstetric practices.

A prospective comparison of abdominal hysterectomy using absorbable staples.

Forty-eight abdominal hysterectomies performed using Polysorb (United States Surgical Corporation) [corrected] absorbable staples were compared prospectively with 46 hysterectomies performed using a regular suture technique. The two groups were demographically similar and it was found that the time of operation (p = 0.001) and the amount of blood loss at operation was significantly reduced (p = 0.03). The incidence of granulations at the vaginal vault at six weeks was significantly reduced (p = 0.001) and return to activity (p = 0.02) and work (p = 0.01) were also significantly reduced for the patients who had a hysterectomy performed using Polysorb staples. There was no statistical difference in morbidity, complications, use of analgesics and period of hospitalization. The continued use of absorbable staples in abdominal hysterectomy is supported, related to the advantages that were statistically significant.

Colposacropexy with Prolene mesh.

A retrospective analysis of 59 patients who underwent colposacropexy (CSP) using Prolene (polypropylene) mesh is presented. Fifty-eight of the patients had undergone previous surgical treatment, including either vaginal or abdominal hysterectomy. Twenty-two patients underwent CSP alone, 24 had CSP and retropubic urethropexy (RPU), eight had CSP with anterior or posterior repair, or both, and five had CSP and RPU with anterior and posterior repair. The operations were associated with a minimum of intraoperative complications and acceptable postoperative problems. A postoperative questionnaire was sent to the patients with an 89 per cent response rate. None of the patients complained of protrusion from the vagina. It is concluded that, in the hands of experienced surgeons, CSP is a safe, efficacious operative procedure that should remain the procedure of choice for vaginal vault prolapse since it restores the normal vaginal axis, maintains existing vaginal length and provides permanent care.