1/27. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar.A case of laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar is reported. A 30 year old woman was admitted to our hospital for profuse vaginal bleeding 2 weeks after an abortion had been performed. A urine pregnancy test was positive. Abdominal ultrasound revealed a well-encapsulated bulging mass over the lower anterior uterine wall measuring 7x5 cm. hysteroscopy revealed retained gestational tissue in the lower corpus despite a normal uterine cavity. An incision was made over the most prominent area of the mass by operative laparoscopy. Dark reddish tissue suggestive of the products of conception was removed using grasping forceps. One-layer of continuous endoscopic sutures along the affected uterine wall was made with 1-0 Prolene. laparoscopy enabled the successful treatment of an unruptured ectopic pregnancy in a previous Caesarean scar and made it possible to preserve the patient's reproductive capability.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/27. Circumscribed posterior keratoconus: case report.BACKGROUND: Posterior keratoconus has only a few scattered case reports in the literature. Posterior keratoconus is characterized by a posterior stroma thinning and a depression of the posterior corneal surface. The effect on acuity is variable and may be related to other ocular and systemic conditions. CASE REPORT: An African-American woman came to us with posterior concavity (corneal thinning), with stromal scarring in both eyes and an epithelial iron ring present in the left eye. The endothelia layer appeared intact in both eyes. corneal topography of the right eye demonstrated a central flattened zone with peripheral steepening, while the left eye an inferior nasal steepened zone was present. The patient was also diagnosed with myopic degeneration (O.D. > O.S.) as well as cataracts. CONCLUSIONS: Posterior keratoconus generally has a minimal effect on visual performance and requires no specific treatment. In cases in which visual defect is severe and is attributable to the posterior keratoconus--and not other ocular conditions, such as cataracts--penetrating keratoplasty should be considered.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
3/27. A case of an electrical burn in the oral cavity of an adult.Electrical burns in the oral cavity account for 2.2% of all electrical burns and only 0.12% of all burns; thus, the incidence of electrical burns in the oral cavity is relatively low. As this type of injury occurs in the oral cavity when an individual sucks or chews on a live electrical wire, extension cord, plug, or outlet, most cases occur in toddlers or preschool children, and adult cases are extremely rare. Here we describe a case of an electrical burn in a 56-year-old man who accidentally bit the electric wire of a cleaner while carrying out repairs. Conservative treatment, without surgery, was performed. Two years after the injury, a slight scar and a small tongue deformity remain, but no functional disturbance has been observed.- - - - - - - - - - ranking = 34.1691680133keywords = oral cavity, cavity (Clic here for more details about this article) |
4/27. "Endoview" project of intrapartum endoscopy.INTRODUCTION: The change in obstetrical practices over the last decade in favor of trials of labor in patients with uterine scars has resulted in increased incidences of uterine ruptures. Although neither repeat cesarean delivery nor a trial of labor is risk free, evidence from a large multicenter study shows vaginal birth after the cesarean (VBAC) is associated with shorter hospital stays, fewer postpartum blood transfusions, and a decreased incidence of postpartum maternal fever. The uterine rupture remains the most serious complication associated with VBAC. Factors associated with uterine rupture include excessive exposure to oxytocin, dysfunctional labor, and a history of more than 1 cesarean delivery.2 Because uterine rupture may be a life-threatening event, intrapartum surveillance and the ability to perform an emergency surgery are both necessary when trial of labor is allowed. Until now, no early symptoms pathognomonic to uterine rupture had been described. We share our experiences with the novel approach to the problem - an intrapartum endoscopy. MATERIALS AND methods: Endoscopic examination was accomplished by using the intraoperational fiberscope (Olympus and Endoview system (Costa Mesa, CA, USA). A gas-sterilized 25-cm long fiberscope is introduced into the amniotic cavity through the cervical canal after rupture of the membranes. The distance between the fiberscope and the object varies from 3 to 50 mm. The fiberscope has a separate channel for the fluid infusion (normal saline) throughout the procedure; the surgeon looks through the eyepiece directly and exhibits control over the flexible scope. The duration of endoscopy is less than 15 minutes. The inserting of the endoscopic device is very similar to that of insertion of an intrauterine pressure catheter. The IRB Committees of both participating institutions approved the study protocol. Twenty-eight patients with an unknown or poorly documented site of the uterine scar were included in the study. An ultrasound examination had been performed on all patients prior to endoscopy to assess fetal wellbeing and placental location. The ages of the patients ranged from 21 to 38 years. Eighteen women had 1 previous cesarean delivery, and 10 had 2. The performance of intrapartum endoscopy did not interfere with fetal monitoring; 21 fetuses were monitored externally, 7 internally. Indications for previous cesarean deliveries were as follows: fetal distress in 11 cases, failure to progress in labor in 8, placenta previa in 2, and unknown in 7. Twenty-one patients delivered vaginally; 7 had had repeat cesarean deliveries. All neonates were born in satisfactory condition. The Apgar scores at 1 minute varied from 7 to 9 and at 5 minutes from 8 to 10. The integrity of the uterine wall was assessed by manual postpartum uterine exploration in each case of vaginal delivery and by visualization and palpation of the scar site in each abdominal delivery. RESULTS: The lower uterine segment and contractile portion of the anterior uterine wall were visualized successfully in all patients. In 25 patients, the presumed scar site looked totally indistinguishable from the rest of the lower uterine segment and anterior uterine wall. Two scars were identified as vertical in 2 patients who were delivered by a repeat abdominal operation. A vertical scar appears as a groove running in a cephalad-caudad direction from the lower uterine segment into the contractile portion of the anterior uterine wall. The usefulness of the intrapartum endoscopy is best demonstrated by the following case reports (2 of 28 study cases).- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/27. Distraction of oral scars contractures following caustic ingestion. A form of conservative treatment.The chemical burns in the oral mucosa as consequence of accident of suicide attempt are relatively frequent. The evolution of the repairing process is conditioned by the quality and concentration of the caustic as by the location and time exposure of the affected region. At this report, we document a form of conservative treatment for the limitation of mouth opening, which the patient presented after swallowing a detergent acid. In order to obtain a minimal oral opening, a screwed cone, whose action mechanism was acting as a cradle between both jaws, was used. Once achieved a 10 mm opening, it was possible to use an external distractor to accomplish a continuous traction.- - - - - - - - - - ranking = 2.4383607315674keywords = mouth (Clic here for more details about this article) |
6/27. uterine rupture of cesarean scar related to spontaneous abortion in the first trimester.We report the case of a 31-year-old Japanese female diagnosed by transvaginal ultrasonography to have a spontaneous uterine rupture in the first trimester. Her condition was complicated by diabetes mellitus type 1. Her previous pregnancy had resulted in an emergency cesarean section by transverse incision of the lower uterine segment with single-layer suture at 37( 4) weeks of gestation. Transvaginal ultrasonography displayed both a gestational sac located in the anterior lower uterine segment and a defect in the uterine wall located at the site of the previous cesarean delivery scar. Pelvic magnetic resonance imaging showed that the uterine muscle layer was discontinuous and the gestational sac was almost outside the uterine cavity, accompanied by mild hemorrhaging within the endometrial cavity. The defect in the lower uterine wall was round in shape and was 3 cm in diameter. Since uterine ruptures can occur during all gestational periods, it is important to pay attention to the uterine wall where any cesarean incision was previously made.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
7/27. endometriosis in an episiotomy scar: a case report.endometriosis is defined as the presence of functioning endometrial tissue in an anatomical location other than the uterine cavity. The episiotomy scar is a fairly rare site for endometriosis. The authors present the case of a 42-year-old woman referred 7 years ago for the development of a tender perianal mass at the episiotomy site associated with perianal pain and pruritis which varied in relation to menses, becoming most intense just before and immediately after the onset of menstrual bleeding. Anal endosonography performed with a B&K mechanical probe rotating through 360 degrees with a frequency of 7 and 10 Mhz showed a hypoechoic area with a diameter of 3 cm not involving the external sphincter and extending from the perianal skin to the mid third of the anal canal. Proctosigmoidoscopy findings were normal. A complete local excision was performed. Complete surgical excision of perineal endometriomas should be curative. recurrence, supposedly due to incomplete removal, usually appears within one year.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/27. Caesarean scar pregnancy: a diagnosis to consider carefully in patients with risk factors.INTRODUCTION: Caesarean scar pregnancy is rare. A high index of suspicion is necessary to make the right diagnosis early. CLINICAL PICTURE: Two women, each with a history of 1 previous caesarean delivery, were initially diagnosed with spontaneous abortion in progress when ultrasonography scan revealed the gestational sac to be in the lower uterine cavity. Subsequent ultrasound scans showed that the gestational sac was actually in the anterior uterine wall at the level of the uterine isthmus. TREATMENT: Both women were managed successfully with intrasac methotrexate injection. OUTCOME: We report 2 cases of caesarean scar pregnancies mistaken for spontaneous abortions by experienced ultrasonographers. CONCLUSION: This highlights the difficulty in differentiating between these 2 diagnoses and the importance of having a high index of suspicion in women with risk factors.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/27. Cesarean scar endometriosis--report of two cases.endometriosis is presence of functioning endometrial tissue outside the uterine cavity. endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting two cases of scar endometriosis following cesarean section, which were misdiagnosed as stitch granuloma initially. Medical treatment was not helpful. Both the patients required wide surgical excision of the lesion. The pathogenesis, diagnosis and treatment of this condition are being discussed.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
10/27. The oral implications of caustic soda ingestion in children.The morbidity related to caustic soda (sodium hydroxide) ingestion is well described in the literature. The majority of publications have concentrated on the effects to the trachea and gastrointestinal tract, with little reference to the oral and peri-oral areas. Accidental ingestion of sodium hydroxide-containing substances is fortunately rare; however the consequences can be devastating. Three cases of children who drank caustic substances are described. Treatment included fitting splints, injecting steroids, local surgical procedures, and the use of dynamic appliances to maintain mouth opening. Despite these interventions, all patients developed severe scarring, resulting in stenosis of the oral musculature and extra-articular ankylosis. There is perhaps a role for further investigation of early use of antiproliferative agents to prevent scarring, more aggressive surgery, and long-term physiotherapy appliance use. These patients require lifelong follow-up.- - - - - - - - - - ranking = 2.4383607315674keywords = mouth (Clic here for more details about this article) |
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