Manual of Diagnostic Ultrasound Iagnostic U Vol
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
A Case of Non-Communicating Uterine Horn Containing Functional Endometrium
logy & Ob o st ec e tr n i y c s G Rani et al., Gynecol Obstet (Sunnyvale) 2015, 5:9 Gynecology & Obstetrics DOI: 10.4172/2161-0932.1000320 ISSN: 2161-0932 Case Report Open Access A Case of Non-Communicating Uterine Horn Containing Functional Endometrium Anjali Rani*, Madhu Kumari and Shipra Department of Obstetrics and Gynaecology, Institute Of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India Abstract Uterine anoamalies are very rare. They can present with complains of amebnorrhoea, dysmenorrhoea, bad obstetrical outcome and infertility etc. Unicornuate uterus with rudimentary horn is very rare. The incidence of this is 1/100,000. Normally rudimentary horns are non- functional and non-communicating. But if they have functional endometrium they can develop hematometra. We are presenting a case of hematometra and pain in a patient with rudimentary non communicating horn with functional endometrium. Rudimentary horn should be kept as a differential diagnosis in pelvic pain. Keywords: Unicornuate uterus; Rudimentary horn; Dysmenorrhea were found in the pelvis. Exploratory laparotomy was decided and the rudimentary horn was excised by applying clamps (Figure 2). Histo- Introduction pathological examination of the specimen was reported as uterine Uterine anomalies are very rarely seen. Unicornuate uterus is a very udimentary horn with functional endometrium with haematometra. rare uterine anomaly. The incidence of congenital uterine anomalies The patient was discharged on the fifth postoperative day. She came in in fertile population is 1/200 to 1/600. The incidence of rudimentary follow up her nomal menses after 6 weeks. horn is very very rare (1:100,000). -
Sexual Assault Cover
Sexual Assault Victimization Across the Life Span A Clinical Guide G.W. Medical Publishing, Inc. St. Louis Sexual Assault Victimization Across the Life Span A Clinical Guide Angelo P. Giardino, MD, PhD Associate Chair – Pediatrics Associate Physician-in-Chief St. Christopher’s Hospital for Children Associate Professor in Pediatrics Drexel University College of Medicine Philadelphia, Pennsylvania Elizabeth M. Datner, MD Assistant Professor University of Pennsylvania School of Medicine Department of Emergency Medicine Assistant Professor of Emergency Medicine in Pediatrics Children’s Hospital of Philadelphia Philadelphia, Pennsylvania Janice B. Asher, MD Assistant Clinical Professor Obstetrics and Gynecology University of Pennsylvania Medical Center Director Women’s Health Division of Student Health Service University of Pennsylvania Philadelphia, Pennsylvania G.W. Medical Publishing, Inc. St. Louis FOREWORD Sexual assault is broadly defined as unwanted sexual contact of any kind. Among the acts included are rape, incest, molestation, fondling or grabbing, and forced viewing of or involvement in pornography. Drug-facilitated behavior was recently added in response to the recognition that pharmacologic agents can be used to make the victim more malleable. When sexual activity occurs between a significantly older person and a child, it is referred to as molestation or child sexual abuse rather than sexual assault. In children, there is often a "grooming" period where the perpetrator gradually escalates the type of sexual contact with the child and often does not use the force implied in the term sexual assault. But it is assault, both physically and emotionally, whether the victim is a child, an adolescent, or an adult. The reported statistics are only an estimate of the problem’s scope, with the actual reporting rate a mere fraction of the true incidence. -
The Reproductive System
27 The Reproductive System PowerPoint® Lecture Presentations prepared by Steven Bassett Southeast Community College Lincoln, Nebraska © 2012 Pearson Education, Inc. Introduction • The reproductive system is designed to perpetuate the species • The male produces gametes called sperm cells • The female produces gametes called ova • The joining of a sperm cell and an ovum is fertilization • Fertilization results in the formation of a zygote © 2012 Pearson Education, Inc. Anatomy of the Male Reproductive System • Overview of the Male Reproductive System • Testis • Epididymis • Ductus deferens • Ejaculatory duct • Spongy urethra (penile urethra) • Seminal gland • Prostate gland • Bulbo-urethral gland © 2012 Pearson Education, Inc. Figure 27.1 The Male Reproductive System, Part I Pubic symphysis Ureter Urinary bladder Prostatic urethra Seminal gland Membranous urethra Rectum Corpus cavernosum Prostate gland Corpus spongiosum Spongy urethra Ejaculatory duct Ductus deferens Penis Bulbo-urethral gland Epididymis Anus Testis External urethral orifice Scrotum Sigmoid colon (cut) Rectum Internal urethral orifice Rectus abdominis Prostatic urethra Urinary bladder Prostate gland Pubic symphysis Bristle within ejaculatory duct Membranous urethra Penis Spongy urethra Spongy urethra within corpus spongiosum Bulbospongiosus muscle Corpus cavernosum Ductus deferens Epididymis Scrotum Testis © 2012 Pearson Education, Inc. Anatomy of the Male Reproductive System • The Testes • Testes hang inside a pouch called the scrotum, which is on the outside of the body -
Multidetector CT of Expected Findings and Complications After Hysterectomy
Insights into Imaging (2018) 9:369–383 https://doi.org/10.1007/s13244-018-0610-9 PICTORIAL REVIEW Multidetector CT of expected findings and complications after hysterectomy Massimo Tonolini1 Received: 19 December 2017 /Revised: 12 February 2018 /Accepted: 12 February 2018 /Published online: 6 April 2018 # The Author(s) 2018. This article is an open access publication Abstract Indicated to manage a variety of disorders affecting the female genital tract, hysterectomy represents the second most common gynaecological operation after caesarean section. Performed via an open, laparoscopic or vaginal approach, hysterectomy is associated with non-negligible morbidity and occasional mortality. Iatrogenic complications represent a growing concern for gynaecologists and may result in prolonged hospitalisation, need for interventional procedures or repeated surgery, renal im- pairment and malpractice claims. As a result, radiologists are increasingly requested to investigate patients with suspected complications after hysterectomy. In the vast majority of early postoperative situations, multidetector CT represents the ideal modality to comprehensively visualise the surgically altered pelvic anatomy and to consistently triage the varied spectrum of possible injuries. This pictorial review provides an overview of current indications and surgical techniques, illustrates the expected CT appearances after recent hysterectomy, the clinical and imaging features of specific complications such as lymphoceles, surgical site infections, haemorrhages, urinary tract lesions and fistulas, bowel injury and obstruction. Our aim is to increase radiologists’ familiarity with normal post-hysterectomy findings and with post-surgical complications, which is crucial for an appropriate choice between conservative, interventional and surgical management. Teaching points • Hysterectomy via open, laparoscopic or vaginal route is associated with non-negligible morbidity. -
Surgical Techniques
SURGICAL TECHNIQUES ■ BY MARCO A. PELOSI II, MD, and MARCO A. PELOSI III, MD Pelosi minilaparotomy hysterectomy: Effective alternative to laparoscopy and laparotomy This new modality—useful for normal, large, and fibroid-ridden uteri—combines the technical benefits of standard laparotomy with the convalescent advantages of laparoscopic surgery. lthough laparoscopic hysterectomy Position, incision, and retraction offers a minimally invasive alternative are crucial to success Ato laparotomy when vaginal hysterec- ur minilaparotomy hysterectomy is a sys- tomy is contraindicated, it has its drawbacks. Otemized approach with elements derived Among them: the cost of expensive equip- from both open and laparoscopic surgery. ment, the long learning curve, and prolonged Three preparatory components are involved: operating time. • position We describe another alternative to open • incision surgery that is comparable to laparoscopic • retraction hysterectomy in postoperative pain, cosmetic All are critical to a successful hysterectomy, results, and time to return to normal activi- ensuring that the procedure never becomes a ties. Our procedure—a redesigned minila- haphazard struggle through an improvised, parotomy hysterectomy—relies on tradition- scaled-down, conventional Pfannenstiel or al open techniques and inexpensive novel vertical incision. Our approach also avoids instrumentation, making it significantly cumbersome traditional laparotomy exposure faster than laparoscopy and easy to perform maneuvers and positioning. and teach. Position: Modified lithotomy. After For patients who cannot undergo vaginal regional or general anesthesia is given, posi- hysterectomy, this new modality offers tion the patient in a modified lithotomy with an expeditious, minimal-access option. both arms tucked as for laparoscopic surgery. Gynecologists reluctant to relinquish the rou- Place the legs in boot-type stirrups, with no tine use of standard laparotomy may hip flexion and sufficient thigh abduction to find this approach an appealing, less-invasive expose the vagina. -
Normal Imaging Findings of the Uterus 3
Normal Image Findings of the Uterus 37 Normal Imaging Findings of the Uterus 3 Claudia Klüner and Bernd Hamm CONTENTS the strong muscle coat forming the mass of the organ. The myometrium is mostly comprised of spindle- 3.1 Embryonic Development and shaped smooth muscle cells and additionally con- Normal Anatomy of the Uterus 37 tains reserve connective tissue cells, which give rise 3.2 Imaging Findings: Uterine Corpus 40 to additional myometrial cells in pregnancy through 3.3 Imaging Findings: Uterine Cervix 44 hyperplasia. The uterine cavity is only a thin cleft and References 47 is lined by endometrium (Fig. 3.2). Functionally, the endometrium consists of basal and functional layers. The isthmus of uterus (lower uterine segment), 3.1 together with the internal os, forms the junction be- Embryonic Development and tween the corpus and cervix. In nonpregnant wom- Normal Anatomy of the Uterus en the isthmus is only about 5 mm high and is less muscular than the corpus. Unlike the uterine cervix, During embryonal life, fusion of the two Müllerian the isthmus becomes overproportionally large in the ducts gives rise to the uterine corpus, isthmus, cervix, course of pregnancy and serves as a kind of reserve and the upper third of the vagina. The Müllerian ducts for fetal development in addition to the uterine cor- are of mesodermal origin and arise in the 4th week pus. The endometrium of the isthmus consists of a of gestation. They course on both sides lateral to the single layer of columnar epithelium and only under- ducts of the mesonephros (Wolffi an ducts). -
Clinical Pelvic Anatomy
SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig. -
Left Vaginal Obstruction and Complex Left Uterine Horn Communication in a 12 Year Old Female Barry E
Perlman et al. Obstet Gynecol cases Rev 2015, 2:7 ISSN: 2377-9004 Obstetrics and Gynaecology Cases - Reviews Case Report: Open Access Left Vaginal Obstruction and Complex Left Uterine Horn Communication in a 12 Year Old Female Barry E. Perlman*, Amy S. Dhesi and Gerson Weiss Department of Obstetrics, Gynecology and Women’s Health, Rutgers - New Jersey Medical School, Newark, USA *Corresponding author: Barry E. Perlman DO, Department of Obstetrics, Gynecology and Women’s Health, Rutgers - New Jersey Medical School, MSB E-506, 185 South Orange Avenue, Newark, NJ 07101-1709, USA, Tel: 732 233 0997, E-mail: [email protected] Transabdominal pelvic sonogram revealed two prominent uterine Abstract cornua with an endometrial thickness of 3 mm in each horn. The Obstructive Müllerian duct anomalies are an infrequently right cornu measured 11.4 x 2.0 x 3.6 cm and the left cornu measured encountered clinical problem. The use of imaging and surgical 10.4 x 2.8 x 4.1 cm. A 7 cm mass in the endocervical canal, concerning exploration allowed for diagnosis and treatment of symptoms of a for hematocolpos, represented an occlusion extending to the left complex obstructive müllerian anomaly. We present a case of a 12 vagina (Figure 1). year old female with a history of intermittent lower abdominal pain and absent left kidney who was found to have an obstructed left She underwent further imaging with two MRI studies that were vagina and complex left uterine horn communications resulting in mutually inconclusive and inconsistent in regards to her pelvic hematocolpos, hematometra, and endometriosis. -
REPRODUCTIVE SYSTEM Vasco Dominic
REPRODUCTIVE SYSTEM Vasco Dominic ORGANISATION Reproductive organs which produce gametes and hormones. Reproductive tract consisting of ducts, store and transport gametes. Accessory glands and organs that secrete fluids into the ducts of the reproductive system or into other secretory ducts. Perineal structures associated with the reproductive system, collectively known as external genitalia. The male and female systems are functionally different. In the male the gonads are the testes that secrete androgens, principally testosterone and produce a half billion sperms per day. After storage the sperm travel along a lengthy duct and mixed with secretions of the glands to form semen. In the female the gonads are the ovaries which produce only one mature gamete per month. The oocyte travels via a short duct into the muscular uterus. THE MALE REPRODUCTIVE SYSTEM TESTES Each has the shape of a flattened egg rougly 5cm long, 3cm wide and 2.5 cms thick and weighs 10-15 gms. They hang within the scrotum. During development the testes form inside the body cavity adjacent to the kidneys. As the foetus grows they move inferiorly and anteriorly towards the anterior abdominal wall. The gubernaculum testis is a cord of connective tissue and muscle fibers that extend from the inferior part of each testis to the posterior wall of a small, inferior pocket of the peritoneum. As growth proceeds the gubernacula do not elongate and the testes are held in position. During the seventh developmental month: growth continues at a rapid pace, circulating hormones stimulate contraction of the gubernaculum testis. Over this period the testes move through the abdominal musculature accompanied by small pockets of the peritoneal cavity. -
Imperforate Anus and Cloacal Malformations Marc A
C H A P T E R 3 5 Imperforate Anus and Cloacal Malformations Marc A. Levitt • Alberto Peña ‘Imperforate anus’ has been a well-known condition since component but were left with a persistent urogenital antiquity.1–3 For many centuries, physicians, as well as sinus.21,23 Additionally, most rectovestibular fistulas were individuals who practiced medicine, have tried to help erroneously called ‘rectovaginal fistula’.21 A rectoblad- these children by creating an orifice in the perineum. derneck fistula in males is the only true supralevator Many patients survived, most likely because they suffered malformation and occurs in about 10%.18 As it is the only from a type of defect that is now recognized as ‘low.’ malformation in males in which the rectum is unreach- Those with a ‘high’ defect did not survive. In 1835, able through a posterior sagittal incision, it requires an Amussat was the first to suture the rectal wall to the skin abdominal approach (via laparoscopy or a laparotomy) in edges which was the first actual anoplasty.2 Stephens addition to the perineal approach. made a significant contribution by performing the first Anorectal malformations represent a wide spectrum of anatomic studies in human specimens. In 1953, he pro- defects. The terms ‘low,’ ‘intermediate,’ and ‘high’ are arbi- posed an initial sacral approach followed by an abdomi- trary and not useful in current therapeutic or prognostic noperineal operation, if needed.4 The purpose of the terminology. A therapeutic and prognostically oriented sacral stage of this procedure was to preserve the pub- classification is depicted in Box 35-1.24 orectalis sling, considered a key factor in maintaining fecal incontinence. -
Outcome of Abdominal Sacrocolpopexy for Post Hysterectomy Vaginal Vault Prolapse BRIG
Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2): 90-93 Outcome of Abdominal Sacrocolpopexy for Post Hysterectomy Vaginal Vault Prolapse BRIG. GEN. LIZA CHOWDHURY1, NURUN NAHAR KHANAM2, MAJ. JUNNU RAYEN JANNA3 Abstract: Objective (s): The aim of this study was to explore the outcome of abdominal sacrocolpopexy for the correction of post hysterectomy vaginal vault prolapse. Materials and Methods: This prospective study was done over the period of five years from 2011 to 2015 where twenty patients of vault prolapse were subjected to abdominal sacrocolpopexy. Procedure was completed by securing the vaginal apex to the anterior longitudinal ligament of sacrum using synthetic mesh. Intra and postoperative complications and patients’ satisfaction was assessed. Results: No post-operative serious complications were reported during follow up period. The vaginal vault was well supported in all patients with no recurrent vault prolapse. One patient had mild asymptomatic rectocele. No mesh complication was found during the follow up period. Conclusion: The abdominal sacrocolpopexy achieves excellent correction of post hysterectomy vaginal vault prolapse with minimal morbidity. Keywords: Abdominal sacrocolpopexy, vaginal vault prolapse, anterior longitudinal ligament. Introduction: and something coming down. There may be vaginal Where the top of the vagina gradually falls toward the discomfort, dyspareunia and impaired vaginal vaginal opening and eventually may protrude out of intercourse because of something is in the way. The the body through vaginal opening is known as vaginal patient’s sexual partner may also complain that the vault prolapse. The vaginal vault prolapse can be vagina is too large. If the vaginal skin is ulcerated, there 4,5 encountered in patients who had abdominal or vaginal may be troublesome discharge and bleeding. -
The Uterus and the Endometrium Common and Unusual Pathologies
The uterus and the endometrium Common and unusual pathologies Dr Anne Marie Coady Consultant Radiologist Head of Obstetric and Gynaecological Ultrasound HEY WACH Lecture outline Normal • Unusual Pathologies • Definitions – Asherman’s – Flexion – Osseous metaplasia – Version – Post ablation syndrome • Normal appearances – Uterus • Not covering congenital uterine – Cervix malformations • Dimensions Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer To be avoided at all costs • Do not describe every uterus with two endometrial cavities as a bicornuate uterus • Do not use “malignancy cannot be excluded” as a blanket term to describe a mass that you cannot categorize • Do not use “ectopic cannot be excluded” just because you cannot determine the site of the pregnancy 2 Endometrial cavities Lecture outline • Definitions • Unusual Pathologies – Flexion – Asherman’s – Version – Osseous metaplasia • Normal appearances – Post ablation syndrome – Uterus – Cervix • Not covering congenital uterine • Dimensions malformations • Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer Anteflexed Definitions 2 terms are described to the orientation of the uterus in the pelvis Flexion Version Flexion is the bending of the uterus on itself and the angle that the uterus makes in the mid sagittal plane with the cervix i.e. the angle between the isthmus: cervix/lower segment and the fundus Anteflexed < 180 degrees Retroflexed > 180 degrees Retroflexed Definitions 2 terms are described