Detorsion of an ischemic adnexal mass has recently been advocated for most cases of twisted adnexa. Usually, the affected ovary regains some or all of its vitality and function. However, when the ovary is completely necrotic, it may form an abscess if it contains tissue components that cannot be eliminated by the peritoneal immune system. We report a case of pelvic abscess formation in a detorsed ovary that previously contained an unsuspected dermoid cyst. We call for an extensive inspection of the detorsed ovary before ending the laparoscopic operation, and if it remains necrotic and is suspected of containing a dermoid cyst, it should be removed promptly.

Objective. The purpose of this series is to present deciduosis (the formation of extrauterine decidua) as one of the differential diagnoses of a malignant tumor during pregnancy. Methods. Two cases are described in which pregnant patients had a pelvic tumor. The lesions, which were diagnosed in the early second trimester, consisted of complex masses with an extensive blood supply and had a sonographic appearance of a malignant tumor The high suspicion for malignancy necessitated surgical intervention. Results. During surgery, the lesions were observed to be of an ovarian origin with papillary excrescences covering their exterior The lesions were excised and sent for histologic examination. The results showed a markedly decidualized endometriotic cyst in both cases. Conclusions. This phenomenon is a diagnostic challenge and should be considered in the differential diagnosis of a malignant mass during pregnancy.

Objective. To describe the sonographic signs of uterine venous plexus thrombosis. Methods. Four pregnant patients had a diagnosis of uterine venous plexus thrombosis in the first half of gestation. The diagnosis was based on transvaginal sonography only in 3 cases, and the fourth had magnetic resonance imaging corroboration. Results. All 4 patients had similar sonographic features of uterine venous plexus thrombosis on transvaginal sonographic examination. The thrombi within the dilated veins were shown as elongated echogenic structures along the lumen that appeared round on transverse views of the affected veins. They showed swinging movements provoked by gentle transducer pressure. Power and color Doppler sonography enhanced the uterine venous plexus thrombosis diagnosis by showing blood flow around the thrombi. There were no signs of thromboembolic disease. Sonographic findings in deep leg veins and iliac veins were normal in all cases. Complete thrombophilia studies did not reveal any abnormalities. The uterine venous plexus thrombosis could not be detected on transabdominal sonography and was shown better by transvaginal sonography compared with magnetic resonance imaging. During 3 months of anticoagulation therapy, the thrombi gradually disappeared in all cases. Conclusions. Focusing on the pelvic veins while performing a transvaginal sonographic study during pregnancy may reveal important findings, which may have clinical implications. The therapeutic treatment of uterine venous plexus thrombosis is controversial and still empirical.

Intra-amniotic injection, as well as intravaginal application of prostaglandins, have been used to terminate second trimester pregnancies. There is as yet no consensus as to the most efficient protocol of such late abortions. Our goal was to compare the efficacy of intra-amniotic injection of prostaglandin F2 alpha (PGF2) and intravaginal application of misoprostol in terminating second trimester pregnancies after pretreatment with intracervical laminaria. Women with live fetuses and requesting second trimester abortions were randomized into two groups. Eighteen hours following the insertion of intracervical laminaria, women were treated with either intra-amniotic injection of 40 mg PGF2, or 12 hourly doses (to a maximum of 4 doses) of 200 mcg misoprostol. Fifty women were randomly assigned to each group. Failure to abort within 24 h of initiation of treatment occurred in 6 patients (12%) in the misoprostol group and 14 (28%) of the PGF2 group (p 0.04). Mean time of induction of pharmacologic treatment to abortion was 13.6 h in the misoprostol group and 10.7 h in the PGF2 group (p 0.03). The mean number of analgesic injections given were 0.8 in the misoprostol group and 1.6 in the PGF2 group (p 0.0001). Only the method of abortion was predictive of abortion success and not other variables such as patient age, gestational age, gravidity, or parity. Following intracervical laminaria, vaginal misoprostol has been found to be more effective and less painful, compared with intraamniotic PGF2, for the termination of second trimester pregnancies with live fetuses. © 2002 Elsevier Science Inc. All rights reserved.

Intra-amniotic injection. as well as intravaginal application of prostaglandins, have been used to terminate second trimester pregnancies. There is as yet no consensus as to the most efficient protocol of such late abortions. Our goal was to compare the efficacy of intra-amniotic injection of prostaglandin F2 alpha (PGF2alpha) and intravaginal application of misoprostol in terminating second trimester pregnancies after pretreatment with intracervical laminaria.Women with live fetuses and requesting second trimester abortions were randomized into two groups. Eighteen hours following the insertion of intracervical laminaria, women were treated with either intra-amniotic injection of 40 mg PGF2alpha, or 12 hourly doses (to a maximum of 4 doses) of 200 mcg misoprostol. Fifty women were randomly assigned to each group.Failure to abort within 24 It of initiation of treatment occurred in 6 patients (12%) in the misoprostol group and 14 (28%) of the PGF2alpha group (p = 0.04). Mean time of induction of pharmacologic treatment to abortion was 13.6 h in the misoprostol group and 10.7 h in the PGF2alpha group (p = 0.03). The mean number of analgesic injections given were 0.8 in the misoprostol group and 1.6 in the PGF2alpha group (p = 0.0001). Only the method of abortion was predictive of abortion success and not other variables such as patient age, gestational age, gravidity, or parity.Following intracervical laminaria, vaginal misoprostol has been found to be more effective and less painful, compared with intra-amniotic PGF2a, for the termination of second trimester pregnancies with live fetuses. (C) 2002 Elsevier Science Inc. All rights reserved.

BackgroundTransvaginal sonography (TVS) enables a close imaging of the pelvic organs providing a clear imaging of the pelvic vessels. To the best of our knowledge – this is the first report of the diagnosis of uterine venous plexus thrombosis using this technique.Case reports 1st case: 38‐year‐old patient diagnosed as having a left tubal ectopic pregnancy in the 7th week of gestation. On TVS examination the ipsilateral uterine plexus thrombosis was found. The blood clots were demonstrated as elongated echogenic structures within the dilated veins. The thrombi showed swinging movements caused by the surrounding blood flow. This effect could also be provoked by gentle transducer pressure. On the transverse view of the affected veins the thrombi appeared as free round structures in the lumen. The blood flow around the thrombi was seen on color Doppler. 2nd case: 36‐year‐old patient with fetal death in the 19th week of gestation. Two days after the induced labor the patient experienced excessive vaginal bleeding. A placental residue was confirmed by TVS. Upon examination the engorged uterine venous plexuses were seen with a thrombus on the right side. The sonographic description of the clot was as in the first case.There were no signs of thromboembolic disease in both cases. The deep leg veins and iliac veins were studied and found to be normal. The uterine plexus thrombi could not be detected by transabdominal sonography and were only seen by TVS. Over 3 months of anticoagulation therapy the clots gradually disappeared in both cases.ConclusionsIn both patients the transvaginal sonographic diagnosis of uterine venous plexus thrombosis was accidental. There is not enough data in the medical literature to determine the evidence based approach to such cases. Nevertheless, focusing on the pelvic veins may reveal important findings with significant clinical implications.

Objective To assess the efficacy of deferred surgery on fertility preservation in women with early ovarian malignancy discovered at laparoscopy.Methods Over a 3-year period, patients who had laparoscopic surgery for ovarian cysts underwent a defined protocol that included preoperative malignancy assessment, non-spillage laparoscopic technique and frozen-section histological determination. In a retrospective analysis, four cases of ovarian malignancy were found in reproductive age patients. Their staging laparotomy was deferred until after the final histological results were obtained. The avoidance of extensive surgery and achievement of pregnancy was considered to be a successful outcome.Results Deferring the staging laparotomy until after the final histological results informed us of the grading of the tumour and allowed us to avoid hysterectomy or removal of the contralateral ovary in cases of stage I, grade I tumours. Only one patient underwent hysterectomy. Two patients had wedge resection from the contralateral ovary, and one had bilateral ovariectomy. The latter three have already achieved pregnancy, including the patient with bilateral ovariectomy who had a successful IVF treatment with donor ova.Conclusion In cases of ovarian malignancy discovered at laparoscopy, deferring the staging laparotomy till after the final histological results may give the opportunity of preserving fertility as well as that of scheduling a gynaecological oncologist for the operation.

OBJECTIVE:To compare an operative and postoperative course of open vaginal cuff hysterectomy and closed vaginal cuff hysterectomy, and to correlate the length of stay, febrile morbidity and the incidence of pelvic fluid collections to the type of surgery.PARTICIPANTS:One-hundred women scheduled for hysterectomy were prospectively randomized into two groups that underwent either a closed or an open vaginal cuff technique.RESULTS:The open vaginal cuff technique took on average 19% more time than the closed vaginal cuff operation (P < 0.05, t-test). The incidence and size of pelvic fluid collections was significantly higher after the closed vaginal cuff hysterectomy than after the open technique (P < 0.01, t-test). However, the postoperative length of stay, febrile morbidity and the rate of complications were similar.CONCLUSIONS:Both techniques of hysterectomy produced a similar postoperative course despite the fact that the closed vaginal cuff technique resulted in a higher incidence of pelvic fluid collections. Therefore considering a shorter operation time for the closed vaginal cuff hysterectomy, this technique seems slightly preferable.

Abdominal wall vessel injury occurs with increasing frequency as the practice of laparoscopic surgery becomes wider and trocars become sharper. Precautions for avoiding vessels have been advocated and should be implemented at every laparoscopy. Nevertheless, injury of abdominal wall blood vessels occurs in approximately 2% of cases. Several methods of treatment have been advocated. We compared the efficacy and outcome of suturing and Foley catheter insertion for managing bleeding trocar sites. Both methods controlled haemorrhage effectively, but suturing took 11 min and involved two to four insertions of the needle, whereas the catheter was inserted and set to compress the trocar site in 30 s. Removal of the Foley catheter, 20–24 h later, did not renew the bleeding in any of the patients, and was not associated with aggravation of pain. We recommend that in most cases a Foley catheter should be used to stop bleeding of the abdominal wall.

This retrospective study represents our experience with cervical cerclage (suture) in pregnancies with uterine malformation. Seventeen patients with uterine malformations were involved. In these patients, the outcome of 31 gestations with cervical cerclage was evaluated. Uterine malformation was associated with cervical incompetence in 41% of the patients. Term delivery rate and fetal loss were observed in 56% and 26% of pregnancies, respectively. Infant salvage was not significantly different regardless of whether cervical incompetence was present or absent. A prolonged hospital stay and frequent use of tocolysis were noted during gestations with cerclage. Our data suggest that the outcome of pregnancies with uterine malformation was not improved by cervical cerclage when the indication for cerclage was the malformation itself.

Verrucous carcinoma of the vulva, a rare variant of squamous cell carcinoma, is a locally destructive, nonmetastasizing tumor. While controversy surrounds the choice of treatment for this lesion, which frequently recurs, it is generally accepted that a recurrence is almost always local, with histologic characteristics and biologic behavior the same as those of the primary tumor. A case of squamous cell carcinoma of the vulva with involvement of the regional lymph nodes after treatment of verrucous carcinoma is reported to increase awareness of the potential biologic behavior of this uncommon tumor.

Malignant pericardial effusion and tamponade are rarely seen complications of epithelial ovarian cancer. With the use of multiagent chemotherapy these complications may be seen more frequently in the future. Therapy should be individualized, as long-term survival may be possible if the systemic manifestations of the cancer can be controlled.

Maternal group B streptococcal (GBS) meningitis is rare, with only four cases previously reported in the literature. In this review a fifth case of postpartum GBS meningitis is presented. The five cases are compared with 34 cases of GBS meningitis in nonparturient adults. All cases of maternal GBS meningitis followed a vaginal delivery. The mean age of patients who had GBS meningitis outside the perinatal setting was 55 years, and most of these individuals had associated illnesses or frank immunosuppression; the mortality rate in this group was 23%. In contrast, all five patients with maternal GBS meningitis recovered. The case presented herein, like the four previous cases, illustrates the point that when patients with maternal GBS meningitis are treated immediately and have been healthy before the infection, the prognosis is good.

International Journal of Gynecology & ObstetricsVolume 30, Issue 3 p. 288-288 Citations from the literature oncology Primary malignant melanoma of the vagina; Report of four cases and review of the literature Z Levitan, Z LevitanSearch for more papers by this authorAN Gordon, AN GordonSearch for more papers by this authorAL Kaplan, AL KaplanSearch for more papers by this authorRH Kaufman, RH KaufmanSearch for more papers by this author Z Levitan, Z LevitanSearch for more papers by this authorAN Gordon, AN GordonSearch for more papers by this authorAL Kaplan, AL KaplanSearch for more papers by this authorRH Kaufman, RH KaufmanSearch for more papers by this author First published: November 1989 https://doi.org/10.1016/0020-7292(89)90426-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume30, Issue3November 1989Pages 288-288 RelatedInformation

Four cases of malignant melanoma arising in the vagina are described, and the literature related to this unusual tumor is reviewed. The 2-year survival rate is better following radical surgery than after other treatment modalities; however, the 5-year survival rate is unrelated to type of therapy. Radical surgery appears to control local disease, but fails to address systemic spread of the tumor. Therefore, improvement in survival will require effective systemic therapy.

A prospective randomized placebo controlled double-blind study was conducted in order to evaluate the effect of short term perioperative antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy. Fifty-two patients received 3 doses of 0.5 g cefazolin, 54 patients received 3 doses of 1 g mezlocillin and 53 patients received placebo. Postoperative infectious morbidity and the rate of pelvic cellulitis were significantly lower in either antibiotic group in comparison to the placebo group, but neither drug proved to be superior in this respect. The fever index was significantly lower in the mezlocillin group in comparison to both cefazolin and placebo groups. It was thus concluded that antibiotic prophylaxis has a beneficial effect on patients undergoing abdominal hysterectomy and both drugs--cefazolin and mezlocillin--seem to be equally effective.

The efficacy of intraoperative irrigation with cefamandole nafate at cesarean section was evaluated in a prospective, randomized double-blind study. Two hundred and eight patients were treated with antibiotic irrigation and intravenous placebo or with perioperative intravenous cefamandole and irrigated with normal saline. The rate of endometritis was 10.9% in the irrigation group and 14% in the intravenous group, but the difference was not statistically significant. The rate of any infection, the number of days with fever, additional hospitalization days, and number of antibiotics used for treatment were similar in the two groups. It thus was concluded that irrigation with antibiotic is equal but not superior to perioperative intravenous antibiotics.

During the period from February 1980 until November 1982 (32 months), Haifa City Medical Center (Rothschild) served as the sole treatment center for all cases of alleged sexual assault in the Haifa area (350,000 inhabitants). Sixty-seven cases were seen, of them 63 females and 4 males. The four males were adolescents, all with alleged rectal sodomy. In the female group, two out of every three alleged victims were adolescent or younger girls, with diagnoses varying from child molestation to rape. The approach to the alleged victims was multidisciplinary, with gynecologists being called to the emergency room in each case. In addition, social workers and police officers were present in most cases to help the victims. Pediatricians, general and orthopedic surgeons were called when necessary. Since the gynecologist in our hospital was the only physician who attended all cases of alleged sexual assault, he had to be familiar with the different aspects of the problem like diagnosis of different kinds of sexual assault, emotional shortand long-term disturbances in the victim, medicolegal implications, postcoital pregnancy interception and prevention of sexually transmitted diseases. It is our impression, that a team approach involving at least a gynecologist, pediatrician and social worker should be used on during the acute crisis. This is especially important when dealing with adolescents in the young age group.