ABSTRACT
OBJECTIVE: To evaluate the efficacy of metronidazole versus no treatment for the empiric treatment of inflammatory cytologic changes. MATERIALS AND METHODS: Patients with inflammatory changes on Pap smear were serially assigned to receive no treatment or metronidazole by one of three regimens: 2 grams orally as a single dose, 500 milligrams orally twice daily for 7 days, or 5 grams (in gel form) vaginally twice daily for 5 days. Smears were repeated 3 months after treatment. RESULTS: The repeat smear was normal in 47 of 63 patients treated with a single dose, 40 of 62 patients treated orally for 7 days, 14 of 21 patients treated with vaginal gel, and 29 of 49 of the control group. Chi-square analysis showed no statistical significance between groups. CONCLUSION: There is no statistically significant difference in the resolution of cytologic inflammatory changes among the study groups. Empiric metronidazole treatment has no benefit.
ABSTRACT
A 27-year-old woman, gravida 3, para 2002, underwent repeat cesarean section and inadvertent cystotomy, with subsequent development of a vesicouterine fistula. The fistula did not resolve with prolonged bladder catheterization and required total abdominal hysterectomy with resection of the fistula tract and primary closure for definitive treatment.
Subject(s)
Cesarean Section/adverse effects , Fistula/etiology , Urinary Bladder Fistula/etiology , Uterine Diseases/etiology , Adult , Female , Fistula/therapy , Humans , Hysterectomy , Pregnancy , Urinary Bladder Fistula/therapy , Urinary Catheterization , Uterine Diseases/therapyABSTRACT
A case of squamous cell carcinoma in situ of the anal canal was discovered incidentally during a hemorrhoidectomy in a man. The anal canal was evaluated by colposcopy prior to ablation of the lesion with a CO2 laser. To our knowledge, this technique has not been reported previously.
Subject(s)
Anus Neoplasms/surgery , Carcinoma in Situ/surgery , Carcinoma, Squamous Cell/surgery , Laser Therapy/methods , Adult , Anus Neoplasms/complications , Carcinoma in Situ/complications , Carcinoma, Squamous Cell/complications , Colposcopy , Hemorrhoids/complications , Hemorrhoids/surgery , Humans , MaleABSTRACT
BACKGROUND: Neovaginal reconstruction after pelvic exenteration has several advantages. Besides the obvious psychosocial benefit to the patient and her partner, the incorporation of viable tissue into the pelvic cavity decreases the incidence of infection and small-bowel complications. Several surgical techniques are available to the gynecologic oncologist for construction of a functional vagina. Recently, myocutaneous flaps incorporating the rectus abdominis and gracilis muscles have been used. Disadvantages of the gracilis myocutaneous flap are the 10-20% incidence of flap loss due to vascular compromise and the potential for prolapse. The rectus abdominis myocutaneous flap is a large flap with a reliable blood supply that allows mobilization without tension on the vascular pedicle, resulting in a much lower incidence of vascular compromise. CASE: We present two case reports, a review of the gynecologic and surgical literature, and the techniques for vaginal reconstruction using the rectus muscle as a myocutaneous flap. CONCLUSIONS: The outcome for both patients was a satisfactory functional vagina that was technically easy to construct. The rectus abdominis myocutaneous flap can provide an adequate neovagina with minimal morbidity.
