Untreated endocervical gonorrhea and endometritis following elective abortion

A matched-pair analysis of 228 cases of endometritis occurring over a two-year period in 4,823 elective abortion patients was carried out. Patients with postabortal endometritis were matched with control subjects for age, parity, race, pay status, time of abortion, and type of abortion procedure. The prevalence of endocervical gonorrhea was 2.7% in the entire group seeking abortion, with 14.7% of patients with gonorrhea subsequently developing endometritis. The matched-pair analysis detected a threefold increased risk for endometritis in patients with untreated gonoccocal endocervicitis when compared with control subjects (p less than 0.05). The significance of these findings to centers performing abortions is discussed.     

Endoscopic management of uterine perforation with the ENDO-UNIVERSAL surgical stapler

The management of an uterine perforation occurring during a D & C, in which a bleeding could not be stopped by coagulation per laparoscopiam is described. The closing of the bleeding injury in the uterus wall was performed by ENDO-UNIVERSAL-clip-instrument. The wound was closed and the bleeding stopped. The possibility to manage an uterine perforation with this simple method is reported and discussed.     

Esophageal perforation following use of esophageal airway

The esophageal airway has gained increasing acceptance in airway management during cardiopulmonary resuscitation, and its enthusiastic advocates are urging expansion of its use. A fatal case of esophageal perforation following the use of an esophageal airway is presented. Possible contributing factors are discussed. A modified esophageal airway which seems safer and more versatile, effective, and economic is described.     

Intrauterine adhesions secondary to elective abortion. Hysteroscopic diagnosis and management

Ten patients who developed Asherman's syndrome following elective first trimester abortion underwent outpatient hysteroscopy under local anesthesia. Six of the 10 patients had hysterosalpingograms prior to surgery. Correlation between the radiographic findings and those at hysteroscopy was poor. Treatment consisted of hysteroscopic lysis of adhesions, placement of an IUD or Foley catheter, and sequential estrogen-progestin administration. Normal menses were resumed in all women. Hysteroscopy was also used for followup in 4 patients. Outpatient hysteroscopy under local anesthesia is safe and is the method of choice for diagnosing, treating, and following patients with Asherman's syndrome.     

Jejunum perforation following blunt abdominal trauma--a case report

We describe an intestinal perforation in a football player who had been hit with the knee in the abdomen. Perforation of the small bowel, following blunt abdominal trauma, is relatively rare. Its most frequent cause is a deceleration trauma, usually from a traffic accident. Clinical signs are frequently discrete and nonspecific. The most frequent symptom is abdominal pain. Lack of bowel sounds is reported in 64% oft the cases. Enteric lesions should be suspected in the presence of a corresponding history (deceleration trauma) and of other pathologies (fractures of vertebrae and/or pelvis). Sonography and computed tomography are rarely helpful. Delayed perforations have been described, necessitating prolonged observation for 48 to 72 h. after painful abdominal trauma. Repeated examinations are essential to rule out enteric perforation. Initially, less than 50% of the cases show free air, thus limiting the usefulness of thoracic and abdominal radiography. Mortality reaches 30%. This rate is adversely affected by concomitant lesions in other organs and by delay (more than 10 h.) in diagnosis. When laparotomy has been delayed and peritonitis is present, antibiotic treatment should be started immediately during surgical intervention (cephalosporin, aminoglycoside, metronidazole). Postoperative complications include septicaemia, wound infection and, rarely, enterocutaneous fistulae.     

Case reports: unrecognized oviduct pregnancy and therapeutic abortion by uterine aspiration

2 cases of unrecognized oviduct pregnancy receiving therapeutic abortion by uterine aspiration are reported. A 29-year-old white female, gravida 4, para 2 with a Dalkon Shield in place for 2 1/2 years and with 6 weeks amenorrhea received a therapeutic abortion. 3 days later the patient complained of fever and severe suprapubic cramps. Minocycline was given in the belief that the patient was suffering from endometritis. 17 days after uterine aspiration the pain increased. At laparoscopy a corpus luteum was seen in the left ovary and blood was present in the pelvis. Histological examination of the oviducts revealed signs of an aborted oviduct pregnant. A 2nd case concerned a 26-year-old white female, gravida 2, para 2, using the Ogino-Knaus method of contraception and who had a normal menses 7 weeks previously. 12 days after uterine aspiration the patient complained of continued vaginal bleeding, lower abdominal cramps, and chills. After uterine aspiration was repeated minocycline therapy was initated. 20 days after the initial aspiration the patient reported a return of vaginal bleeding and lower abdominal pain. Laparotomy revealed a ruptured oviduct. Histology showed salpingitis and fusion of the right fimbria and a large blood clot and trophoblastic villi in the lumen of the right ampulla. In the future it is suggested that histological examination of the aspiration should be performed to aid in finding oviductal or ovarian pregnancies.     

Pseudoaneurysm of the left ventricle following repair for ventricular septal perforation

The patient was a 64-year-old man who was treated surgically for an infarct-related ventricular septal perforation. Pseudoaneurysm of the left ventricle was recognized on the 38th postoperative day. Emergency surgery was performed. It seemed that insufficient resection of the infarcted myocardium was performed during the initial surgery to avoid narrowing the ventricular dimension by direct closure of the left ventricle, but this resulted in pseudoaneurysm of the left ventricle. Left ventricular free wall plasty with a patch should be performed during the initial surgery.     

Management of spontaneous abortion in family practices and hospitals

The results of a greenhouse experiment on the translocation rate of 134Cs from potato leaves to tubers were compared with calculations of the radioecological model ECOSYS-87 and other literature values. The 134Cs activities applied at three development stages (three pinnate leaves fully developed, onset of flowering, onset of yellowing) to leaves of the plant were taken as starting points for the model to calculate the activity in the tubers at harvest. The default yield in the model was replaced by the experimentally obtained values. The translocation rate measured in the greenhouse experiment was 4 to 14 times higher than the calculations of the model. Some possible reasons for such a high translocation rate, compared with the literature data, are discussed. Based on these comparisons, it is concluded that maximal translocation occurs at the growth stage of flowering of a crop and that the development stage of a crop might be a stronger parameter to describe the time dependency of translocation than the usually applied parameter 'days before harvest'.     

Management of multiple intestinal atresias and perforation with intraluminal stenting

Intraluminal stenting of the gastrointestinal (GI) tract in both multiple intestinal atresias and perforations was used in three patients. In the atresia patients (2), a piercing trocar was used to create continuity of the GI tract and as a guide to thread the intestine over the stent. All patients currently demonstrate normal growth and development on routine enteral feeds. None developed anastomotic leaks or strictures.     

Management of mucosal perforation during pyloromyotomy for infantile pyloric stenosis

Mucosal perforation during Fredet-Ramstedt pyloromyotomy is the cause of unnecessary morbidity and death if unrecognized. Previously, a variety of closure have been advocated. In 1,777 cases there has been 42 (2.3%) intraoperative perforations. One unrecognized perforation led to a postoperative death. Closure of a mucosal tear is accomplished safely by a simplified suture technique without prolonged convalescence or death.     

Prevention of accidental intraocular injection following inadvertent needle perforation of the eyeball

To prevent accidental intraocular injection after inadvertent single needle perforation of the eyeball, the authors recommend moving the needle and watching for corresponding movement of the globe following peribulbar or retrobulbar placement of the needle and prior to injecting. The authors have found this technique to be safe and reliable, with negligible morbidity.     

Coronary artery perforation and delayed cardiac tamponade following balloon coronary angioplasty

A 62-year-old woman who had coronary artery disease and hypertrophic cardiomyopathy received percutaneous transluminal coronary angioplasty and endomyocardial biopsy. She withstood the procedure well. However, delayed pericardial tamponade occurred 2 hours after discharge from the cardiac catheterization laboratory. Despite pericardial drainage with a pigtail catheter and blood transfusion, the patient required emergency surgery. An oozing diagonal branch of the left anterior descending coronary artery was found. Ligation of this small branch stabilized the hemodynamics. Avoidance of improper positioning of the guide wire in the small coronary artery branch is important in preventing arterial wall trauma and subsequent perforation.     

Induced regeneration of endometrium following curettage for abortion: a comparative study

A significant increase in endometrial thickness and volume was observed in 30 patients given oestrogen and progestin supplementation following curettage for first trimester abortions, compared with 30 women who received no treatment. This indicates an enhanced regeneration of the endometrium following treatment. The ability to induce this response, creating a space between the intra-cavity surface area a short time after abortion, may theoretically be suggested as preventative treatment to reduce the risk of intrauterine adhesions.