Free full-thickness vaginal epithelium graft in correction of recurrent genital prolapse.

Recurrence of a cystocele, rectocele or enterocele following a previous vaginal repair procedure can be an awkward problem to correct. This preliminary report suggests a simple yet very effective method of dealing with such defects.

Aggressive angiomyxoma of the female pelvis.

A 42 year old female presented with a 6 year history of a perineal mass. Clinically it had all the features of a perineal hernia. Two previous attempts to repair the 'hernia' had been performed. At operation an aggressive angiomyxoma of the female pelvis was identified and resected via an abdomino-perineal combined approach. The case is discussed with reference to the literature.

Abdominoperineal urethral suspension in the management of recurrent stress incontinence of urine- a 15-year experience.

Since 1965, the procedure of abdominoperineal urethral suspension has been applied as the sole method of surgical correction in the management of patients suffering from recurrent urinary stress incontinence. During a 15-year period (1965 to 1980), 194 women were selected for this procedure by entirely clinical methods. Ancillary aids to diagnosis were not used. Long-term follow-up indicates that careful selection followed by accurate surgery based upon macroscopic anatomy can produce excellent long-term results. The overall cure rate of 77.5% rises to 84.37% if the patients who have improved are included.

Pulsion enterocele: review of functional anatomy of the pelvic floor.

Pulsion enterocele has a well-deserved reputation as a difficult surgical problem; the multiplicity of suggested solutions attests to this. Until the functional anatomy of the pelvic floor is better understood, particularly the specific anatomic defects involved, planning of a rational surgical attack will remain elusive. Both the pelvic cellular tissues and the levator ani complex are involved in the genesis of the condition, and both require correction during any surgical procedure. The supporting effect of the levator complex and the positioning effect of the cellular tissues must be restored.

Pulsion enterocele: long-term results of an abdominoperineal technique.

Surgical correction of large pulsion enterocele is a contentious subject and until a technique is founded upon proper anatomic facts, the arguments will continue. Pulsion enterocele follows changes in the pelvic cellular tissues and levator ani complex; both defects must be corrected. Synchronous abdominoperineal repair attends to both defects with accuracy, and in a healthy woman who wishes to regain normal vaginal function, it should be the procedure of choice. During the past 11 years, 66 patients, many of whom had been unsuccessfully treated by other techniques, have been managed with this procedure. Accurate follow-up has been possible in 60 patients, and of these women, 56 have been cured.

Grafting as a principle in the surgical management of vesicovaginal and rectovaginal fistulae.

The treatment of 49 genital fistulae in the past 18 years is reported from the Department of Gynaecology, Alfred Hospital, Melbourne. The series included 32 vesicovaginal fistulae, 15 rectovaginal fistulae and 2 double fistulae. Whilst utilising the accepted principles of fistula closure, the high success rate is believed due, in large measure, to the additional step of grafting which has been used extensively. It is advocated as a most important principle in all genital fistula surgery.

Abdominoperineal urethral suspension: a ten-year experience in the management of recurrent stress incontinence of urine.

The most important factors in the management of recurrent stress incontinence in the absence of genital prolapse are proper case selection and the proper choice of surgical intervention. All suitable patients at the Alfred Hospital, Melbourne, since 1965 have been managed by the technic of abdominoperineal urethral suspension, which involves passing two aponeurotic bands, cut from the anterior abdominal wall, through the paraurethral attachment of the posterior pubourethral ligament on either side. It is our conviction that urinary continence control in the human female is effected by this upper urethral anatomy and that for a technic to be successful it must exert its influence at this precise point. It is suggested that this technic is the procedure of choice in the management of recurrent stress incontinence.

Spironolactone and acute mountain sickness.

Thirteen adults trekking in Nepal in 1974 to altitudes between 4,300 m and 5,500 m remained free from acute mountain sickness while taking spironolactone as a prophylactic measure. Two years previously five of these adults trekking at similar altitudes, but without treatment, had suffered from acute mountain sickness. The regime used was spironolactone in a dosage of 25 mg three times a day for two days preceding and during the periods spent at altitudes above 3,000 m.