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El prolapso genital es una afección frecuente en la postmenopausia y junto con el cáncer de cuello uterino son causa frecuente de histerectomía. Pero la asociación de estas dos entidades nosológicas es muy rara. Se presenta un caso de 63 años de edad que es portadora de estas dos enfermedades, la cual se ilustra con fotos. Valorada en la consulta central de oncoginecología del Hospital Abel Santamaría de Pinar del Río en el mes de mayo del 2002, donde le fue indicado tratamiento quirúrgico (histerectomía vaginal), efectuado sin dificultades con tratamiento complementario de radioterapia y una evolución satisfactoria en cuatro meses(AU)

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El prolapso de la cúpula vaginal es una complicación tardía de la histerectomía, su frecuencia es baja, su momento de aparición estuvo entre los tres y los cinco años de la operación. En su etiología influye insuficiente fijación de las fascias pelvianas de sotén a la cúpula vaginal. Así mismo puede influenciar la alteración de la estática pelviana debida a incipientes prolapsos genitales no corregidos durante la histerectomía. En la selección de una técnica se estudian en primer término los procedimientos que suspenden la cúpula tomando un apoyo en el sacro, en el promontorio e el hueso coaxal. Se exponen losinconvenientes técnicos que se derivan de la preencia del uréter, de los elementos nerviosos(plexo sarco e hipogástrico) y de la vascularizaación de la parte posterior de la pared lateral de la pelvis dependiente de la arteria ilíaca interna, causas de accidentes inmediatos o de secuelas tardías de tipo urológico o neuralgias de difícil tratamiento. Seguidamente son expuestos los procedimientos que consideramos de elección, los cuales son de tipo anterior con suspensión de lacúpula por dos cintas de aponeurosis movilizadas desde la parte medial y anterior de la vaina del recto del abdomen y llevadas através de la pared abdominal hasta la cúpula vaginal. Asímismo se expone la otra técnica fijando la cúpula vaginal con malla de marlex mediante dos cintas delgadas del mismo material que son fijadas al pecten , quedando la vagina de ambas técnicas en posición antómica. Sedebe tomar especial cuidado en el tratamiento del enterolece que eventualmente puede estar presente, así como también la debida correción de los prolapsos genitales que existan, los cuales son causa de futuras recidivas. Los resultados obtenidos por los autores son sastifactorios con controles de los pacientes durantes dos a doce años de edad

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I didactically compared the breast as a glandular cone with an envelope of skin and subcutaneous tissue. The aesthetic alterations of the breast are classified in four groups related to form, to volume, to grams, and to ptosis in centimeters. An imaginary plane that passes by the mammary sulcus (plane A) will determine the area of the breast that is ptotic. The projection of this plane in the anterior part of the breast is called point A. The distance between point A and the nipple will give in centimeters the amount of ptosis. I use this distance to draw geometrically in the breast the amount of excess of skin to be removed to correct the ptosis. In group I, the volume is normal and part of the mammary gland is under plane A. In this type of breast, the skin is resected, and since there is no excess of breast tissue, the breast that is under plane A is used as an inferior pedicle flap to give a better volume to the new breast. In group II, the base of the breast is large, the height is normal, and the volume is increased by the enlargement of the base. In this type of breast, the excess of breast under plane A and a wedge under the nipple are resected to reach the normal volume at the end of the surgery. In group III, the base is normal and the volume of the breast is increased by the height. For treatment, I resect the excess of breast under plane A as well as a segment at the base to reduce its height. In group IV, the volume of the breast is increased by the size of the base and the height of the cone, and I treat by resection of the excess of tissue under the ptotic area, a wedge under the areola, and a transversal segment in the base to reduce all the dimensions. In the final result of this technique in the majority of patients I will obtain a short scar. This technique was used in 1083 patients from January of 1979 to May of 1988.

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A simple and reliable technique of capsulopexy is presented. A total of six inferiorly displaced inframammary folds were thus corrected during the past 8 years with good results and with an average of 3.2 years of follow-up. It is felt that this method is simple, reliable, and easier than other techniques previously reported in the literature.

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A case of postoperative haemorrhage into the basal ganglia following decompression of the craniovertebral junction in a 35-year-old patient is presented. Similar cases in the literature of intracerebral bleeding remote from the site of surgery are reviewed and the possible pathogenesis of this unusual complication discussed.

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Bologna's procedure allows the curative or preventive treatment for urinary stress incontinence during surgical cure of prolapse with large cystocele (2nd or 3rd degree). An infra-cervical sling is created with 2 vaginal bands dissected from the anterior colpocele, passed through the retropubic space on either side of the bladder neck and fixed to the abdominal wall, after making a suprapubic approach to the aponeurosis of the rectus abdominis muscle. This colposuspension technique, performed via a mixed approach, is generally accompanied by vaginal hysterectomy and colpectomy designed to treat the various elements of the prolapse. This operation is easily reproducible and the postoperative course is generally uneventful. The intermediate term anatomical and functional results are very satisfactory in women over the age of 60 years. There is not sufficient follow-up at the present time to consider this procedure for young women.

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A patent omphalomesenteric duct is an uncommon condition. These lesions are prone to give a small bowel prolapse, which complicates the situation. We report 1 such patient. Early surgical management is necessary to prevent complications.

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Mesenteric mesh-pexy is indicated for permanent and quick-clean fixation of the intestine. It is applicable to the treatment of recurrent stomal prolapse and intestinal volvulus when the intestine is viable, but resection, less definitive treatment or an additional operation would pose increased risks to the patient. Mesenteric mesh-pexy may also be considered prophylactically for floppy cecum and severely redundant loops of sigmoid colon.

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The authors describe this operation, which is carried out as a single procedure which they have been doing since 1982. Then the results in 90 patients are studied. The post-operative controls carried out on the clinical state of the patient and on the urodynamic tests show that this operation is very successful, both in curing stress incontinence and in giving a good anatomical result for correcting prolapse of the anterior wall of the vagina. In over one-third of the cases the post-operative follow-up has been carried out for 2 years or more. This follow-up has shown that the relapse rate over a period of time, both for the stress incontinence and the prolapse, is nil. The principal snags that still remain are: post-operative infection in about a third of cases; the rare but possible development of an enterocele and of dyspareunia (2%).

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A simple method for the correction of severely leaking or prolapsing gastrostomies, or both, is presented. The stoma is relocated using a new catheter in a manner similar to our previously described percutaneous endoscopic gastrostomy. The old stoma is closed extraperitoneally. The procedure is simple, fast and safe and has proved to be effective in seven high risk patients.

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Excess skin and insufficient gland are two problems posed by the correction of the small ptotic breast. A single-stage operation can resolve these problems. Our technique used for 20 patients proved satisfactory with a low rate of complications.

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