RESUMO
A man presents an atypical neurological disorder. The diagnosis of aortic dissection is evoked with anisotension, but it consists in a paradoxical embolism in the presence of a permeable foramen oval since he presents with a proximal pulmonary embolus and a thrombus in the humeral artery.
Un homme se présente avec un trouble neurologique d'allure atypique. Le diagnostic de dissection aortique est évoqué devant une anisotension, mais il s'agit ici d'un tableau d'embolie paradoxale sur foramen ovale perméable puisqu'il présente une embolie pulmonaire proximale et un thrombus dans l'artère humérale.
Assuntos
Dissecção Aórtica/diagnóstico , Pressão Sanguínea/fisiologia , Embolia Paradoxal/diagnóstico , Forame Oval Patente/diagnóstico , Dissecção Aórtica/fisiopatologia , Braço/irrigação sanguínea , Braço/fisiopatologia , Diagnóstico Diferencial , Embolia Paradoxal/complicações , Embolia Paradoxal/fisiopatologia , Forame Oval Patente/complicações , Forame Oval Patente/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologiaRESUMO
BACKGROUND: Livedoid vasculopathy (LV) is a painful ulcerative condition involving white atrophy and livedo; a histopathologic feature seen is occlusive dermal vasculopathy. This may be associated with coagulation disorders such as hyperhomocysteinaemia (HHC). PATIENTS AND METHODS: We report the case of a 52-year-old woman presenting LV in which an abnormal scan image led us to diagnose coeliac disease. This enteropathy had caused vitamin B12 and folic acid deficiency, as well as HHC. Vitamin supplementation and a gluten-free diet resulted in complete healing of the lesions. DISCUSSION: This case underlines the importance of screening for and correction of coagulation disorders in patients with LV. It also suggests that in the event of HHC, coeliac disease should be sought, even in the absence of gastrointestinal symptoms.
Assuntos
Doença Celíaca/complicações , Ácido Fólico/administração & dosagem , Livedo Reticular/etiologia , Vitamina B 12/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Doença Celíaca/diagnóstico por imagem , Feminino , Humanos , Livedo Reticular/dietoterapia , Livedo Reticular/tratamento farmacológico , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
PURPOSE: To compare radiation dose and image quality for CT of the lumbar spine between helical CT and wide volume mode scanning with a 320-detector row CT. PATIENTS AND METHODS: Monocenter prospective study on 20 consecutive patients divided into two groups. All 20 patients underwent lumbar spine CT on the 320-detector row scanner (Aquilion One, Toshiba). The CT examinations for group 1 were performed using the wide volume mode with 320 detector rows while the CT examinations for group 2 were performed using a 64-detector row helical CT mode. The acquisition length and delivered dose corresponding to the DLPe (extended dose length product) as well as qualitative and quantitative image quality were compared between both groups. RESULTS: The mean acquisition length was comparable between both groups. There was a significant dose reduction of about 35% for group 1 compared to group 2 (mean DLPe of 970 mGy.cm for group 1 compared to 1503 mGy.cm for group 2, p<0.028) when using the wide volume mode acquisition at 320-detector row CT compared to the 64-detector row helical CT mode. No significant difference was noted for image quality between both groups. CONCLUSION: The acquisition of lumbar CT using the wide volume mode at 320-detector row CT allows significant dose reduction to patients compared to the 64-detector row helical CT mode while preserving image quality.
Assuntos
Vértebras Lombares/diagnóstico por imagem , Doses de Radiação , Intensificação de Imagem Radiográfica , Tomografia Computadorizada Espiral , Tomografia Computadorizada por Raios X/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não ParamétricasRESUMO
Cranial traumas from gunshot wounds are characterised by the impact of a high velocity projectile. There are therefore serious, life threatening traumas. CT Scan is essential in the emergency setting for initial evaluation of traumatic bone and parenchymatous injuries to determine the indication for neurosurgery and appropriate medical management. In case of survival, CT Scan and MRI can be used to monitor progress and any possible complications, in particular vascular or infectious complications which are specific to this type of injury.
Assuntos
Angiografia Cerebral , Serviço Hospitalar de Emergência , Traumatismos Cranianos Penetrantes/diagnóstico , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/diagnóstico , Artefatos , Edema Encefálico/diagnóstico , Edema Encefálico/cirurgia , Hemorragia Cerebral Traumática/diagnóstico , Meios de Contraste/administração & dosagem , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/cirurgia , Pneumocefalia/diagnóstico , Pneumocefalia/cirurgia , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/cirurgia , Tentativa de Suicídio , Ferimentos por Arma de Fogo/cirurgiaRESUMO
INTRODUCTION: Cytomegalovirus (CMV) infection in the immunocompetent is generally silent or it may present as a mononucleosis like syndrome but, rarely, it can lead to symptomatic manifestations. CASE REPORT: An immunocompetent and previously healthy 43- year-old woman presented with fever, dyspnoea, liver cell necrosis and a mononucleosis syndrome. The CT scan showed diffuse ground-glass opacity. BAL and blood cultures were sterile. Urinary antigens (Legionella pneumophila, Streptococcus pneumoniae) and serology for atypical respiratory pathogens (Mycoplasma pneumoniae and Chlamydia sp.) were negative. A diagnosis of CMV pneumonia was established on serology (presence of anti-CMV IgM) and PCR detection of viral DNA in the serum. Without antiviral therapy, there was a favourable clinical outcome 1 week later and 1 month later the CT scan was normal. CONCLUSION: CMV infection can lead, exceptionally. to a hypoxic pneumonia in the immunocompetent host. Antiviral therapy should not be prescribed systematically.
Assuntos
Infecções por Citomegalovirus/complicações , Pneumonia Viral/etiologia , Adulto , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/imunologia , Feminino , Seguimentos , Humanos , Imunocompetência , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Pneumonia Viral/diagnóstico por imagem , Reação em Cadeia da Polimerase , Radiografia Torácica , Fatores de TempoRESUMO
An 81-year-old man was admitted for generalized weakness, erythrodermia and eosinophilia. His chest CT showed nodules related to lung adenocarcinoma. Chemotherapy induced a tumour response with the disappearance of the erythrodermia and eosinophilia. A tumour relapse indicating the recurrence of the erythrodermia and eosinophilia was confirmed 2 months after completion of the chemotherapy. The outcome was rapidly fatal. The evolution of the symptoms suggests that eosinophilic erythrodermia is a paraneoplastic syndrome. Cutaneous paraneoplastic syndromes are rare but may be associated with lung cancer.
Assuntos
Adenocarcinoma/complicações , Dermatite Esfoliativa/etiologia , Eosinofilia/etiologia , Neoplasias Pulmonares/complicações , Síndromes Paraneoplásicas/etiologia , Idoso de 80 Anos ou mais , Humanos , MasculinoRESUMO
Cervical cerclage is a common surgical technique that has been used for more than 50 years to prevent preterm deliveries and in the management of a threatened second trimester loss. However, it remains one of the most controversial interventions in obstetrics and this is probably due to difficulties in diagnosing cervical insufficiency, which is based on a history of recurrent second trimester loss or early preterm delivery following painless cervical dilatation in the absence of contractions or bleeding. This article reviews in 2008 the current literature regarding the efficacy of elective cerclage, ultrasound-indicated cerclage, emergency cerclage, and cervico-isthmic cerclage for singletons and multiple pregnancies.
Assuntos
Cerclagem Cervical , Aborto Espontâneo/prevenção & controle , Cerclagem Cervical/efeitos adversos , Cerclagem Cervical/métodos , Emergências , Feminino , França , Humanos , Gravidez , Segundo Trimestre da Gravidez , Gravidez Múltipla , Resultado do TratamentoRESUMO
A strategy to establish the diagnosis and the etiology of menorrhagia is necessary for an adaptated therapeutic care. The cross-examination must endeavour to assess bleedings and their clinical impact, and concentrate on specific pathology (such as hemostasis disorders). Clinical examination may eliminate cervical vaginal pathologies and estimate uterine volume. The diagnosis of pregnancy should always be considered and eliminated and that of iron deficiency anemia will be helpful. Explorations of hemostasis balance will be recommended according to clinical and biological features. Hormonal measurement are not contributive, except in diagnosis of SOPK. Endometrium biopsy with the Pipelle will be systematically performed after 40 years of age or in case of risk factors of endometrial cancer. Transvaginal ultrasonography is the first line exam to recommend in case of proved menorrhagia. Hysteroscopy and hysterosonography will be recommended if ultrasonography is not informative enough, or in case of medical treatment failure. MRI is recommended in an second intention (in case of multiple uterine fibroids, or suspected adenomyosis, and if an arterial embolization is required).
Assuntos
Metrorragia/diagnóstico , Metrorragia/etiologia , Adulto , Anemia Ferropriva/diagnóstico , Biópsia , Gonadotropina Coriônica/sangue , Endométrio/patologia , Feminino , Hemostasia , Humanos , Histeroscopia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Gravidez , UltrassonografiaRESUMO
OBJECTIVE: To evaluate the feasibility and the outcome of Essure sterilization associated with different techniques of endometrial ablation. METHOD: Retrospective study conducted among 23 women with confirmed menometrorrhagia and with the desire for or the medical need for permanent tubal sterilization. Patients underwent combined hysteroscopic placement of Essure and hysteroscopic endometrial resection procedures: ThermaChoice (n=14), NovaSure (n=4), Hydrothermablator (n=2) and endometrial resection using monopolar energy (n=1), or bipolar energy (n=2). RESULTS: Fallopian tubes were successfully cannulated bilaterally in 87% of the cases (20/23). No adverse event was reported. Adequate bilateral occlusion was confirmed for all patients (20/20) by 3D ultrasound and pelvic X-ray at a 3-month follow-up. Furthermore, 85% of these patients were satisfied with the results of the procedure, all experiencing a significant reduction in menstrual blood loss (Higham blood loss score). CONCLUSION: Combining EA and hysteroscopic sterilization seems to be feasible and efficient in patients with menometrorrhagia.
Assuntos
Eletrocoagulação/métodos , Endométrio/cirurgia , Histeroscopia/métodos , Menorragia/cirurgia , Esterilização Tubária/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Esterilização Tubária/instrumentação , Resultado do TratamentoRESUMO
Dysfunctionnal uterine bleeding (DUB) is a significant health problem in premenopausal women. First line therapy is traditionally medical therapy but often ineffective. Hysterectomy is obviously effective in stopping bleeding but is associated with morbidity and is most costly. Endometrial ablation technique is becoming the first conservative line in the management of DUB. In 2007, the Cochrane Data Base, and the NICE published the new guidelines for DUB treatment. Pharmaceutical treatments should be considered in the following order: levonorgestrel-releasing intra uterine system and if hormonal treatment is not acceptable, tranexamic acid can be used. This is the exclusive line of treatment for women who desire to be pregnant, and the first step for the others one. The rapid development of second generation technique of endometrial destruction suggests that these techniques are becoming "the gold standart" for the patients without desire of future pregnancy. These techniques are easier that endometrial resection/ablation by hysteroscopy without major complications. In France, the National Health Insurance must find a codification CCAM for giving an exact price to the procedure. This new tarification could include the device cost and could avoid either inefficient procedure like datation and curetage or morbide procedure like hysterectomy.
Assuntos
Hemorragia Uterina/terapia , Endométrio/cirurgia , Feminino , Humanos , Histeroscopia , Levanogestrel/administração & dosagem , Gravidez , Pré-Menopausa , Ácido Tranexâmico/administração & dosagem , Hemorragia Uterina/tratamento farmacológico , Hemorragia Uterina/cirurgiaRESUMO
INTRODUCTION: Septate uterus is the principal müllerian anomaly, but complete septate uterus is uncommon and often associated with frequent obstetrical complications. Surgical section of the septum is however possible. MATERIAL AND METHOD: We report patients with a complete septum uterus operated in our department between 2002 and 2006. We performed a hysteroscopic section of the cervical, uterine and vaginal septum at discovery of the anomaly. The accuracy of imaging exams, frequency of associated malformations, past obstetrical events and reproductive outcome post surgery were analyzed. RESULTS: The surgical technique was based on section of the cervical part with scissors and hysteroscopic section of the uterine septum; no perforation was noted. Four patients required a second procedure to achieve complete uterine section. Five patients became pregnant after surgery, 8 pregnancies are reported: 2 term delivery, 1 preterm delivery, 4 miscarriages and 1 ectopic pregnancy. CONCLUSION: Complete surgical section of the cervical and uterine septum in case of complete septum uterus is safe. However, we cannot conclude about the obstetrical benefit of this surgical technique. A longer follow-up is needed.
Assuntos
Colo do Útero/anormalidades , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Taxa de Gravidez , Útero/anormalidades , Vagina/anormalidades , Adulto , Colo do Útero/cirurgia , Feminino , Humanos , Histeroscopia , Laparoscopia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Útero/cirurgia , Vagina/cirurgiaRESUMO
OBJECTIVES: We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. MATERIAL AND METHODS: Retrospective study concerning 20 women under age 50 who underwent between July 2000 and December 2003 surgical insertion of an anterior (n=14), posterior (n=3) or double (anterior and posterior) (n=3) polypropylene mesh via the vaginal route. A minimum follow-up of 6 months was required for inclusion in the study. Anatomical results were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) according to ICS (International Continence Society) recommendations. To document the functional results, the patients answered 3 validated self-assessment questionnaires related to pelvic symptoms, sexual behaviors and quality of life. RESULTS: Mean follow-up was 21 months (6 to 52 months). A vaginal erosion of the mesh occurred in 2 women (10%). Cystocele recurred in one woman among the 17 patients who had an anterior polypropylene mesh (Gynemesh, Gynecare, Ethicon). Seventeen women were sexually active before the surgical procedure and 19 post-operatively. Among these women, 5 (26%) reported alteration of sexual activity after surgery (with dyspareunia in 4 cases (21%)), and 14 women (74%) reported no changes or improvement in sexual activity. CONCLUSION: Surgical management of genital prolapse using a polypropylene mesh inserted via the vaginal route has proven its anatomical efficacy in young women. The potential adverse consequences on sexual life would require clinical research concerning the surgical approach (abdominal or vaginal route) and synthetic materials used in prolapse surgery for young women.
Assuntos
Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Comportamento Sexual/fisiologia , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Polipropilenos , Qualidade de Vida , Estudos Retrospectivos , Comportamento Sexual/psicologia , Telas Cirúrgicas/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Doenças da Bexiga Urinária/epidemiologiaRESUMO
OBJECTIVE: To describe management of vaginal mesh erosion following transvaginal repair of acystocele by placement of a polypropylene mesh. MATERIALS AND METHOD: Retrospective analysis of 34 consecutive cases of vaginal mesh erosion following transvaginal repair of cystocele using synthetic mesh (Gynemesh or Gynemesh-Soft). We have analyzed the results of both medical and surgical management of this complication. Furthermore, we also assessed sexual and urinary morbidity in women with mesh erosion (n = 34) and in women who had undergone the same procedure but without mesh erosion (n = 111). RESULTS: Among the 34 patients with vaginal mesh erosion, 23 (68%) have undergone local therapy using Colposeptine (Chlorquinaldol + Promestriène). In 12 (52%) cases no modification of the surface of the erosion was observed. In 6 (26%) cases, a decrease of the surface of the mesh erosion was observed. In 5 (22%) cases the mesh erosion had completely disappeared, with a follow-up of 2 to 9 months. Nineteen symptomatic patients (19/32, 59%) required partial (n = 18) or complete (n = 1) excision of the mesh, associated with vaginal mucosal closure, under general anaesthesia. Duration of operation ranged from 15 to 40 minutes for partial excision of the mesh. This procedure was successful in 14 cases (77%). Four women required repeated resection of the mesh because of recurrence. The incidence of de novo dyspareunia was 12% in patients with vaginal mesh erosion, and 11% in patients without mesh erosion (p = 0.81). The incidence of urge urinary symptoms and voiding dysfunction symptoms was respectively 8% versus 9% (p = 0.95), and 8% versus 10% (p = 0.81) in the 2 groups. CONCLUSION: Management of vaginal mesh erosion is simple and is associated with a low rate of morbidity. However, patients should be informed that vaginal erosion of the mesh can occur.
Assuntos
Cistocele/cirurgia , Migração de Corpo Estranho/etiologia , Telas Cirúrgicas/efeitos adversos , Falha de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos , VaginaRESUMO
OBJECTIVE: To assess the efficacy of performing transvaginal cervico-isthmic cerclage using synthetic tape in prevention of preterm labor in high-risk women. PATIENTS AND METHODS: A retrospective analysis of 24 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of pregnancy losses in the second trimester, prior failure of Mac Donald's cerclage and/or absent portio vaginalis of the cervix. Cerclage was performed between 12 and 16 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. RESULTS: The median age of the patients in this series was 32.1 years (range 22-39 years). No intra-operative complication occurred. The median operating time was 34.9 minutes (+/-5.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Mean gestational age and birth weight at delivery were respectively 37.1 weeks (+/-1.8) and 2850 g (+/-745). Preterm birth rate was 19% (4/21). Birth at less than 32 weeks occurred in only one patient (4%). In one case, the tape has been removed later because symptomatic vaginal erosion was noted. One neonatal death occurred following amniotic fluid infection at 34 weeks. At the present time, 3 women are at 22, 26 and 26 weeks of gestation with no preterm labor. CONCLUSION: Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.
Assuntos
Cerclagem Cervical/métodos , Resultado da Gravidez , Nascimento Prematuro/prevenção & controle , Adulto , Cerclagem Cervical/instrumentação , Feminino , Idade Gestacional , Humanos , Polipropilenos , Gravidez , Estudos RetrospectivosRESUMO
Computed tomography (CT) has become the reference technique in medical imaging for renal colic, to diagnose, plan treatment and explore differential diagnosis. Its main limitation is the radiation dose, especially as urinary stone disease tends to relapse and mainly affects young people. It is therefore essential to reduce the CT radiation dose when renal colic is suspected. The goal of this review was twofold. First, we wanted to show how to use low-dose CT in patients with suspected renal colic in current clinical practice. Second, we wished to discuss the different ways of reducing CT radiation dose by considering both behavioral and technological factors. Among the behavioral factors, limiting the scan coverage area is a straightforward and effective way to reduce the dose. Improvement of technological factors relies mainly on using automatic tube current modulation, lowering the tube voltage and current as well using iterative reconstruction.
Assuntos
Doses de Radiação , Cólica Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Protocolos Clínicos , HumanosRESUMO
The first line treatment of the polycystic ovary syndrome is a medical one. It begins with dietary-induced weight loss, dyslipidemy treatment or insulin-sensitising agents. In the case of infertility, as primary intention, the patients are treated by citrate of clomiphene. In case of failure, the indications of laparoscopy have to be set up as an alternative to utilization of gonadotrophin and recombinant FSH associated to intra-uterine insemination. According to the results of the meta-analysis of Campo, medical and surgical approaches give an identical rate of pregnancy (40%) but can reach 48-50% in the surgical group after one year because the pregnancy rate continues to grow, when the women treated medically do not have a pregnancy in the absence of treatment. Furthermore, ovarian drilling by fertiloscopy is less minimally invasive compared to laparotomy.
Assuntos
Ovário/cirurgia , Síndrome do Ovário Policístico/cirurgia , Clomifeno/uso terapêutico , Feminino , Humanos , Laparoscopia/efeitos adversos , Síndrome do Ovário Policístico/tratamento farmacológico , GravidezRESUMO
INTRODUCTION: Urinary complications following sub urethral sling procedures are common, and management of these complications continue to be discussed. METHODS: The literature available on Medline/PubMed, relating to urinary complications associated with suburethral sling procedures, was reviewed. RESULTS: Bladder perforation, which occurs with an incidence of 5.7% in tension-free vaginal tape procedure, requires repositioning of the sling, but does not cause any increase in postoperative morbidity. The trans-obturator approach appears to decrease this risk. Urethral perforation, which is uncommon (0.4-1%), is a contraindication to maintenance of the sling. Bladder erosion is rare, requiring resection of the mesh with a combined abdominal and cystoscopic approach. Urethral mesh erosion (0.07% to 1.5%) also requires surgical sling removal, but few patients remain continent because this removal requires a large urethrolysis (recurrence rate of incontinence is 66% following removal of the sling). Bladder outlet obstruction occurs frequently after sub-urethral procedures. When complete obstruction is clinically evident 2 days after a sub-urethral sling procedure, immediate reintervention is performed with a rapid return to normal voiding. Recurrence rate of stress incontinence is less than 30% following reintervention.
Assuntos
Uretra , Incontinência Urinária/cirurgia , Doenças Urológicas/epidemiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Falha de Equipamento , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , MEDLINE , Complicações Pós-Operatórias/epidemiologia , Recidiva , Telas Cirúrgicas , Bexiga Urinária/lesões , Doenças da Bexiga Urinária/epidemiologia , Doenças da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/epidemiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Doenças Urológicas/etiologia , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
PURPOSE: To prospectively assess how to address requests for ultrasonographic examinations when setting up an on-call teleradiology service. MATERIALS AND METHODS: An analytical prospective study was performed from January 2012 to December 2012 inclusively. All requests received for after-hours ultrasonographic examinations during this period were analyzed. Ultrasound requests were classified as being postponable until working hours, replaceable by an alternate cross-sectional imaging modality, or urgent and needing to be performed after hours. RESULTS: A total of 176 requests for ultrasonographic examinations were analyzed. They predominantly included requests for abdominal and pelvic ultrasonographic examinations (63%). Thirty-nine requests (22.2%) were considered as postponable, 49 (27.8%) as replaceable and 64 (36.4%) as both postponable and replaceable. Twenty-four requests (13.6%) were considered as urgent; they consisted of 10 requests for venous duplex Doppler ultrasonographic examinations of the lower limbs, eight requests for testicular ultrasonographic examinations, five for pelvic ultrasonographic examinations and one for soft-tissue ultrasonographic examination. In these urgent cases, realistic options were either to transfer the patient to another institution or to train emergency department physicians in ultrasonography for local handling. CONCLUSION: Although the need for addressing requests for ultrasonographic examinations should be taken into account when setting up an on-call teleradiology service, it should not impede such plans.
Assuntos
Telerradiologia , Ultrassonografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Telerradiologia/organização & administração , Adulto JovemRESUMO
BACKGROUND: Emergency cerclage can be used in cases of cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure we used a balloon device to replace the fetal membranes. TECHNIQUE: With the patient in a steep Trendelenburg position, after epidural anesthesia, the fetal membranes were replaced into the uterine cavity with an inflated balloon of the type used for endoscopic preperitoneal dissection. Cervical cerclage was done by the McDonald technique. EXPERIENCE: We have done 25 emergency cerclages with this technique. The following maternal and perinatal outcomes were assessed retrospectively: age, medical history, gestational age at inclusion and delivery, cervical dilatation at admission, preterm rupture of membranes, clinical or histologic chorioamnionitis, birth weight, admission to the neonatal intensive care unit, neonatal death, and postnatal course. CONCLUSION: Replacing prolapsed fetal membranes with an inflated balloon is a convenient technique that allows gestation to be prolonged for an average of 31 days. Cerclage was feasible when the cervix was widely dilated (more than 4 cm); it was associated with prolongation of gestation by a median of 9 days.
Assuntos
Incompetência do Colo do Útero/cirurgia , Emergências , Membranas Extraembrionárias/patologia , Feminino , Humanos , Trabalho de Parto Prematuro/prevenção & controle , Procedimentos Cirúrgicos Obstétricos/instrumentação , Procedimentos Cirúrgicos Obstétricos/métodos , Gravidez , Segundo Trimestre da Gravidez , ProlapsoRESUMO
OBJECTIVE: To evaluate a new minimally invasive surgery for treatment of the polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. DESIGN: Prospective study. SETTING: University teaching hospital. PATIENT(S): Thirteen clomiphene citrate-resistant anovulatory women with PCOS. INTERVENTION(S): Operative transvaginal hydrolaparoscopy (THL) using a coaxial bipolar electrode. MAIN OUTCOME MEASURE(S): Feasability, ovulation rate, and pregnancy rate. RESULT(S): Ovarian drilling was performed by THL in all patients; no surgical complications occurred. Mean (+/-SD) duration of follow-up time was 6.3 +/- 3.3 months. Six patients recovered to have regular ovulatory cycles. Six pregnancies occurred; three were spontaneous, two occurred after stimulation and intrauterine insemination, and one occurred after IVF. The cumulative pregnancy rate was 33% at 3 months after THL and 71% at 6 months after THL. No miscarriages occurred. CONCLUSION(S): Transvaginal hydrolaparoscopy with ovarian drilling using bipolar electrosurgery appears to be an alternative minimally invasive in patients with PCOS who are resistant to clomiphene therapy.