Abdominal wall reconstruction for a large caesarean scar endometrioma.

Endometrioma formation is an uncommon complication of caesarean sections. Frequently the diagnosis is delayed, due to a failure to include it in the differential diagnosis for an abdominal wall mass. The case of a thirty-six year-old female, presenting with the classical triad of a mass and cyclical pain arising in a caesarean section scar, is reported. Wide excision was performed via a transverse lower abdominal ellipse, similar to that used for abdominoplasty. The involved rectus muscle was excised and the abdominal wall was reconstructed using polypropylene mesh. An abdominoplasty-like approach affords clear margins for large caesarean section scar endometriomas thus reducing the recurrence risk. Abdominal wall reconstruction may be required for extensive lesions.

A flexible approach to infrapopliteal vein grafts in patients with diabetes mellitus.

From October 1985 to August 1989, we performed 156 dorsalis pedis artery bypasses in 146 patients, 139 (95%) of whom had diabetes mellitus. A variety of surgical techniques were used to shorten surgery, limit incision length, and optimize size-matching between vein grafts and arteries whenever possible. Arterial inflow was from the common femoral artery in 58 cases, from the distal superficial femoral or popliteal artery in 88 cases, from a tibial artery in three cases, and from a preexisting bypass in seven cases. In situ (75 cases), ex situ reversed- or nonreversed-vein (62), composite vein (nine), and polytetrafluoroethylene (one) bypasses were constructed. Four patients (2.7%) died, and seven grafts (4.5%) failed within 30 days. Actuarial patency and limb salvage 6 to 52 months after surgery were 87.1% and 91.6%, respectively. There were no significant differences in patency between in situ and ex situ vein grafts (93.2% vs 89.7%) or between common femoral artery inflow site and distal superficial femoral/popliteal artery inflow site (89.3% vs 88%).

Biophysical fetal assessment--the Rotunda experience.

The evaluation of fetal health using ultrasound to establish a biophysical profile in the Rotunda Hospital in 1987 is reported. The corrected perinatal mortality rate fell from 10.0 in 1986 to 6.9 per 1,000 for babies over 500g and from 5.9 in 1986 to 3.4 for babies over 1,000g. This was achieved without significant alteration in induction and caesarean section rates. The results indicate that this type of fetal assessment does lead to a reduction in perinatal mortality.

Pregnancy following simple repair of the ruptured gravid uterus.

Eighteen pregnancies, occurring in 15 patients in whom a simple repair of a ruptured gravid uterus had been performed previously, are reviewed. Seventeen of these had a successful outcome. There was no case of recurrent rupture.