RESUMEN
BACKGROUND: Expanded polytetrafluoroethylene (ePTFE) membranes have been used successfully as permanent implants to prevent adhesions after gynecologic surgery. Fistulization involving such an implant has not been reported previously. CASE: A 27-year-old woman had micturition problems and pain four years after a myomectomy and implantation of an ePTFE membrane. Laparotomy revealed that the membrane was partly inserted into a hole in the anterior bladder wall, close to the vesicouterine pouch. The membrane was removed and the fistula repaired. Pathologic studies of the specimen showed multispecies bacterial contamination. CONCLUSION: The fistula may have originated with ischemia at the vesicouterine fold caused by the suture in the corner of the ePTFE membrane. This led to intussusception of the prosthesis. The hole that was created expanded, and pelvic inflammatory disease probably produced the local sepsis. In patients with posterior or fundal uterine incisions for myomectomy, the ePTFE membrane is a useful permanent adhesion barrier in an area at substantial risk of adhesion formation. In cases using anterior incisions, however, in which the membrane may be fixed close to the vesicouterine fold, surgeons should consider removing the prosthesis after peritoneal healing has occurred.
Asunto(s)
Leiomioma/cirugía , Membranas Artificiales , Politetrafluoroetileno , Prótesis e Implantes/efectos adversos , Fístula de la Vejiga Urinaria/etiología , Neoplasias Uterinas/cirugía , Adulto , Femenino , Humanos , Dolor , Fístula de la Vejiga Urinaria/cirugía , Trastornos Urinarios/etiologíaRESUMEN
The authors, after general consideration of family planning programs, present a study of 22714 women, who, in the decade 1983-1993, required contraceptive protection from the Family Planning Centers in the region of Vigevano (Italy). The authors underline the importance of a protocol used before beginning treatment to help prevent women receiving methods carrying too great a health risk. The results show a very high prevalence of oral contraception, increasing in recent years with the introduction of triphasic pills, while use of intrauterine contraception seems to be declining. Other conventional methods, such as barrier (diaphragm and condom) and 'natural' methods, had a low incidence in the sample studied. The reasons for these behaviors are analyzed and the relative trends discussed.
Asunto(s)
Comportamiento del Consumidor , Anticoncepción , Adolescente , Adulto , Dispositivos Anticonceptivos , Anticonceptivos Orales , Femenino , Humanos , Dispositivos Intrauterinos , Italia , Estado Civil , Persona de Mediana Edad , Métodos Naturales de Planificación Familiar , ParidadRESUMEN
PIP: 380 patients, aged 19-41, 60% of whom were wearers of Gravigard, and 40% wearers of Copper T, were observed for a total of 5000 woman cycles. Uterine cramps were reported in 40% of cases, but they receded spontaneously; 12.8% of patients complained of menorrhagia, and 1.84% of disappearance of the IUD strings. There were no cases of uterine perforation and only 3 cases of infection. There were 5 partial expulsions with gravigard, and 1 total expulsion with Copper T. Of the 6 cases of pregnancy with IUD in situ 3 terminated in spontaneous abortion, 2 in induced abortion, and 1 was carried to term. There were 2 cases of ectopic pregnancy. These results coincide with others published in the literature on the subject.^ieng