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11/21. Ureteral injuries in gynaecologic oncology surgery procedures.

    This study presents ureteral injuries in gynecologic oncology surgical procedures performed at the Department of obstetrics and gynecology in Novi Sad, in the period from 1991 to 2001. Intraoperative ureteral injuries were recorded in 4 (1%) patients, including: partial ureteral dissection, bilateral ureteral ligation and complete ureteral dissection bellow the lower pole. In 3 (75%) cases, injuries were recognized immediately, and surgical reparation was performed. The patient with bilateral ureteral ligation presented with increased creatinine levels, anuria and development of hydronephrosis detected by ultrasonography 24 h later. Leading reasons for operative ureteral injuries include inadequate experience of surgeons, carelessness during surgery, wrong indication and wrong approach to ureter. Preparation of ureter with minimal trauma, precise localization and visualization of the complete ureteral length, as well as preservation of its vascular network, are of utmost importance in prevention of injuries.
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ranking = 1
keywords = gynecologic
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12/21. myocardial stunning during abdominal hysterectomy in a healthy woman.

    We report a case of myocardial stunning in a healthy patient. During gynecologic surgery, two brief episodes of asystole occurred. Following resuscitation there was a short period of severe hypertension and tachycardia. Electrocardiographic changes and elevations in troponin t and creatine-kinase-MB were observed. angiography revealed normal coronary arteries and multiple areas of hypokinesis. Within 2 weeks, all abnormal values had returned to normal and the patient underwent an uneventful surgery.
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ranking = 1
keywords = gynecologic
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13/21. The control of severe intraoperative bleeding using an overlay autogenous tissue (OAT) patch: case reports.

    BACKGROUND: Severe intraoperative bleeding cannot always be controlled by standard surgical techniques. We recently reported a new technique to repair serious vascular injury using a free graft of omentum or rectus abdominus fascia as an overlay autogenous tissue (OAT) patch in the experimental sheep model. We now describe the successful clinical use of this patch in three patients. case reports: Radical surgery was performed on three patients with pelvic malignancy with resulting uncontrollable bleeding from the internal iliac vein, pelvic side wall and paravaginal venous plexuses, respectively. hemostasis was secured using an OAT patch made of abdominus rectus fascia in two cases and appendix epiploicae as an omental substitute in the other. DISCUSSION: The utility of the OAT patch is described in three different clinical situations. It is suggested that this technique may be especially useful to gynecologic oncologists when standard surgical techniques fail to control bleeding or there is limited access to the site of injury.
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ranking = 1
keywords = gynecologic
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14/21. Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration--a case report and review of the literature.

    This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of gynecology of the Medical University in Gdansk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.
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ranking = 1
keywords = gynecologic
(Clic here for more details about this article)

15/21. Pseudo-renal failure following total abdominal hysterectomy.

    Intraperitoneal urinary bladder perforation should be in the differential diagnosis of acute oliguric renal failure soon after gynecological surgery. We present a case of reversible acute pseudo-renal failure after total abdominal hysterectomy for uterine fibroid. Biochemical features of uremia occur as a result of intraperitoneal extravasation of urine, which is in turn reabsorbed through the peritoneum. Early recognition and surgical repair, as opposed to dialysis therapy, are warranted in such clinical setting. Nephrologists, who are often the first to encounter those patients with presumably acute renal failure, should be aware of this condition. Prompt recovery of the serum biochemistry is to be expected, in contradistinction to genuine renal failure or kidney insults.
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ranking = 1
keywords = gynecologic
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16/21. Transcatheter arterial embolization in the management of gynecological neoplasms.

    Six patients were treated with transcatheter arterial embolization (TAE). Three patients suffered from intractable genital bleeding; the other three patients were preoperative cases of a stage III adenocarcinoma of the uterine cervix and two of these had gestational trophoblastic disease. Bleeding was stopped in all three cases of intractable hemorrhage; one patient rebled after 6 days. In the three preoperative cases, transcatheter arterial embolization was thought to be effective in decreasing intraoperative blood loss. There are no other reports of application of this technique to preoperative cases to decrease intraoperative blood loss in gynecological cases.
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ranking = 5
keywords = gynecologic
(Clic here for more details about this article)

17/21. Pulmonary interstitial edema after probable carbon dioxide embolism during laparoscopy.

    carbon dioxide embolism is a well-known complication of laparoscopy that can be lethal. We describe a patient who showed signs of pulmonary interstitial edema revealing a probable gas embolism. This event occurred during a gynecologic laparoscopy performed for uterine perforation after a curettage.
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ranking = 1
keywords = gynecologic
(Clic here for more details about this article)

18/21. Urinary ascites with pelvic urinoma presenting as ovarian neoplasm: clinical and ultrasonographic features.

    BACKGROUND: The majority of ureteric injuries associated with an operation are the result of gynecologic surgery. Thus, gynecologists must be aware of this risk and appreciate that ureteric injury can present late and in an unusual manner. CASE: A 26-year-old woman presented with gross abdominal distention 4 months after total abdominal hysterectomy. ultrasonography demonstrated a large volume of ascitic fluid and a complex cyst arising from the left ovary. serum blood urea nitrogen and creatinine were normal. laparotomy showed a mass of 1-2-cm cysts (urinomas) on the pelvic peritoneum and tubo-ovarian surfaces and a right hydroureter with a right ureteric fistula at the level of the ureteric tunnel. A ureteroneocystostomy was performed. CONCLUSION: Ureteroperitoneal fistula with urinary ascites is a rare complication of pelvic surgery. Intravenous urography or computed tomography scan would have helped establish the diagnosis.
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ranking = 1
keywords = gynecologic
(Clic here for more details about this article)

19/21. Endoscopic management of incidental cystotomy during operative laparoscopy.

    Operative laparoscopy is rapidly becoming an important technique used by all surgical specialties. More sophisticated and difficult procedures are continually being performed endoscopically. Complications from these procedures are inevitable and are more frequently being managed with the laparoscope. We describe a case of inadvertent cystotomy during a laparoscopic gynecological operation, which was subsequently repaired endoscopically. The technique and patient followup are presented.
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ranking = 1
keywords = gynecologic
(Clic here for more details about this article)

20/21. Use of endoscopy in the management of postoperative ureterovaginal fistula.

    The aim of the study was to evaluate endourological techniques in the management of iatrogenic ureterovaginal fistula. Seventeen patients referred to us after gynecologic surgery were diagnosed as having iatrogenic ureterovaginal fistula. First, retrograde double-J stenting was tried. If this failed, percutaneous nephrostomy using an antegrade double-J stent was performed. If this also failed, open surgical repair was performed. The retrograde double-J stent bypassed the fistula in 2 patients (11.8%). Percutaneous nephrostomy was performed in the remaining 15. The antegrade double-J stent bypassed the fistula in another 2 of these patients (11.8%). Open surgical repair was performed in the remaining 13 patients (67.5%) (direct ureteroneocystostomy) with nipple valve in 11 patients and Boari flap with psoas hitch in 2 patients). Of all patients, 2 had ureteral stricture, one after antegrade double-J stenting and the other after open repair. It was concluded that early intervention is recommended in the treatment of iatrogenic uretrovaginal fistula, causing minimal morbidity and discomfort, and being less expensive.
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ranking = 1
keywords = gynecologic
(Clic here for more details about this article)
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