- Email: [email protected]
Controlling tenaculum: Instrument for uterine mobilization during tubal sterilization
Volume Number
Communications
112 6
in brief
865
a change in our philosophy of management of this particular problem. A case report of a patient who developed a small bowel obstruction following operative removal of an intraperitoneal intrauterine device is presented. This study illustrates some of the perplexing aspects of management of the patient with uterine perforation with an open end intral uterine device. On the basis of clinical data presently available, a plan for management is suggested. REFERENCES
1. Ledger, W. J., and Willson, J. R.: Obstet. Gynecol. 28: 806, 1966. 2. Shimkin, P. M., Seigel, H. A., and Seaman, W. B.: Radiology 92: 353, 1969. 3. Report on Intrauterine Contraceptive Devices: Advisory Committee on Obstetrics and Gynecology, Food and Drug Administration, 1968. 4. Hall, R. E.: AM. J. OBSTET. GYNECOL. 99: 808, 1967. 5. Haspelas, A. A.. J. Obstet. Gynaecol. Br. Commonw. 76: 178, 1969. 6. Price, C. W. R.: Med. J. Aust. 1: 106, 1955. 7. Rutherford, A. M.: N. 2. Med. J. 60: 413-415, 1961. 8. Schwartz, G. F., and Markowitz, A. M.: J. A. M. A. 211: 959, 1970. 9. Echenberg, R., and Ledger, W. J.: Obstet. Gynecol. 31: 795, 1968.
Controlling tenaculum: Instrument for uterine mobilization during tubal sterilization J. F. HULKA,
M.D.
Department of Obstetrics and Gynecology and The Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
M o B I L I z A T I o N of the uterus during laparoscopy for tubal cauterization and division has proved to be extremely useful in positive identification of the Fallopian tubes and isolating them from adjacent structures such as bowel and pelvic side wall. Instruments currently available for this on the market include both spring loaded cannulas (through which dye to test tubal patency can be injected) and vacuum attachments which require additional tubing and pumps. In the course of developing laparoscopy tubal sterilization methods at the University of North Carolina, Partially Foundation
supported by and U.S.A.I.D.
funds
from
‘l-he
Rockefeller
Fig. 1. Controlling tenaculum and uterine sound. Although the distal portion of this instrument is malleable, a sharp right angle has been found to be most useful in moving the uterus so as to stretch the adnexal structures to maximize identification of the Fallopian tubes for cautery sterilization. The patient remains in the lithotomy position during the procedure. it was found that ordinary uterine sounds could be used to advantage if bent at a fairly sharp angle at the tip, but the sound would become easily dislodged if it were not held in place. Holding the tenaculum and sound together with tape sometimes allowed the sound to dislodge with subsequent uterine perforation.
866
Communications
March Am. J. Obstet.
in brief
It was therefore decided to create a hybrid instrument (controlling tenaculum) consisting of a uterine sound with a single tooth tenaculum attached to it in a fixed position (Fig. 1) . This instrument is inserted into the uterus at the beginning of the operation and is held firmly in place by grasping the cervix with the tenaculum. Retroverted uteri are easily moved to the anterior position by rotation of the instrument and clamping on the anterior lip of the cervix. The proportions of the instrument are such as to fully control most multigravid and postabortal uteri. An occasional patient who has been taking oral contraception for a number of years will have a small uterus for which this sound may be too long; in this situation we have held the instrument taped to an ordinary single toothed tenaculum placed on the cervix. The advantage of this instrument is that it is all in one piece, is autoclavable, requires no additional attachments, is easily removable after tubal division, and has even survived several falls to the floor in over 100 cases in which it has been used to date. It has recently been accepted for manufacture by the Week Instrument Company.” “Edward Long Island
Week & Company, City, New York 11101.
Extragenital infection
49-33
31st
Place,
type 2 herpesvirus
RAYMOND WILLIAM
Inc.,
H. H.
KAUFMAN, RAWLS,
M.D. M.D.
Departments of Obstetrics and Gynecology, Virology, and Epidemiology, Baylor College Medicine, Houston, Texas
of
THE TYPE 2 herpesvirus which is isolated predominantly from genital lesions is very likely venereally transmitted.‘, a This virus can easily be distinguished antigenically and biologically from the type 1 herpesvirus which is usually isolated from nongenital sites. The following case report clearly demonstrates the occurrence of an extragenital type 2 herpesvirus infection and further confirms the venereal transmission of this disease.
This seen on throat, perature patient
patient was a ZO-year-old woman first June 14, 197 1, complaining of a sore headache and generalized aching, temelevation, and burning on urination. The gave a history of having sexual contact
15, 1972 Gynecol.
with only one individual for the past year. Her consort left town the early part of June and returned to Houston on June 7, 1971. At that time he noted a bump on his penis. The patient and consort had intercourse on that day as well as oral-genital contact. On June 10 the patient noted an aching under her ears and on June 11 she began to feel pain in her throat. On June 12 she developed vulva soreness. Examination of the patient on June 14, 1971, revealed a hyperemia of the pharynx. There was cervical lymphadenopathy; inguinal lymphadenopathy was also present. Multiple shallow ulcers were present on the lower aspect of both labia majora and labia minora as well as on the perineum and forchette. Multiple ulcers up to 5 mm. in diameter covered with a shaggy exudate were present on the portio of the cervix. It was felt that the patient had a primary genital herpesvirus infection. Examination of her consort at that time revealed a 5 mm. crusted lesion present on the dorsum of the shaft of the penis. The patient was again seen on June 19, 1971, complaining of increased pain in her throat. Examination of the pharynx revealed multiple shallow shaggy ulcers with one small 3 mm. vesicle noted. The patient was next seen on June 28. She was feeling much better at that time and had no discomfort. Examination revealed the pharynx to be normal in appearance. Several healing ulcers were present on the lower aspect of the vulva. Swabs of cervical and vulvar lesions taken on June 14 were found to contain herpesvirus type 2. Frozen sections of biopsy specimens of the cervix were stained by direct immunofluorescence using antiserum prepared in rabbits and specific intranuclear and intracytoplasmic staining was observed. On June 19, a swab of the pharyngeal lesions was obtained and herpesvirus type 2 was isolated. No antibodies to either type of herpesvirus were found in serum obtained on June 14; however, neutralizing antibodies were detected in serum sample obtained on June 28 and August 12. The antibody titers to herpesvirus type 2 increased from less than 1:lO to 1: 100 and was characteristic of a primary infection with herpesvirus type 2.2 The herpesvirus was not recovered from the crusted lesion of the male consort; however, paired sera, obtained on June 14 and August 5, revealed an antibody response indicating a recent herpesvirus type 2 infection. The isolation of type 2 herpesvirus from the cultures of the pharynx in this patient after oralgenital contact with her consort, who revealed serologic evidence of a type 2 herpesvirus infection at this time, demonstrates the venereal transmission of this infection to an extragenital site. This case is unique in that it has been found that the type 2 herpesvirus does not commonly produce lesions in extragenital locations. However, the sequence of events and the laboratory findings confirmed the presence of a type 2 herpesvirus infection of the pharynx.
Communications
112 6
in brief
865
a change in our philosophy of management of this particular problem. A case report of a patient who developed a small bowel obstruction following operative removal of an intraperitoneal intrauterine device is presented. This study illustrates some of the perplexing aspects of management of the patient with uterine perforation with an open end intral uterine device. On the basis of clinical data presently available, a plan for management is suggested. REFERENCES
1. Ledger, W. J., and Willson, J. R.: Obstet. Gynecol. 28: 806, 1966. 2. Shimkin, P. M., Seigel, H. A., and Seaman, W. B.: Radiology 92: 353, 1969. 3. Report on Intrauterine Contraceptive Devices: Advisory Committee on Obstetrics and Gynecology, Food and Drug Administration, 1968. 4. Hall, R. E.: AM. J. OBSTET. GYNECOL. 99: 808, 1967. 5. Haspelas, A. A.. J. Obstet. Gynaecol. Br. Commonw. 76: 178, 1969. 6. Price, C. W. R.: Med. J. Aust. 1: 106, 1955. 7. Rutherford, A. M.: N. 2. Med. J. 60: 413-415, 1961. 8. Schwartz, G. F., and Markowitz, A. M.: J. A. M. A. 211: 959, 1970. 9. Echenberg, R., and Ledger, W. J.: Obstet. Gynecol. 31: 795, 1968.
Controlling tenaculum: Instrument for uterine mobilization during tubal sterilization J. F. HULKA,
M.D.
Department of Obstetrics and Gynecology and The Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
M o B I L I z A T I o N of the uterus during laparoscopy for tubal cauterization and division has proved to be extremely useful in positive identification of the Fallopian tubes and isolating them from adjacent structures such as bowel and pelvic side wall. Instruments currently available for this on the market include both spring loaded cannulas (through which dye to test tubal patency can be injected) and vacuum attachments which require additional tubing and pumps. In the course of developing laparoscopy tubal sterilization methods at the University of North Carolina, Partially Foundation
supported by and U.S.A.I.D.
funds
from
‘l-he
Rockefeller
Fig. 1. Controlling tenaculum and uterine sound. Although the distal portion of this instrument is malleable, a sharp right angle has been found to be most useful in moving the uterus so as to stretch the adnexal structures to maximize identification of the Fallopian tubes for cautery sterilization. The patient remains in the lithotomy position during the procedure. it was found that ordinary uterine sounds could be used to advantage if bent at a fairly sharp angle at the tip, but the sound would become easily dislodged if it were not held in place. Holding the tenaculum and sound together with tape sometimes allowed the sound to dislodge with subsequent uterine perforation.
866
Communications
March Am. J. Obstet.
in brief
It was therefore decided to create a hybrid instrument (controlling tenaculum) consisting of a uterine sound with a single tooth tenaculum attached to it in a fixed position (Fig. 1) . This instrument is inserted into the uterus at the beginning of the operation and is held firmly in place by grasping the cervix with the tenaculum. Retroverted uteri are easily moved to the anterior position by rotation of the instrument and clamping on the anterior lip of the cervix. The proportions of the instrument are such as to fully control most multigravid and postabortal uteri. An occasional patient who has been taking oral contraception for a number of years will have a small uterus for which this sound may be too long; in this situation we have held the instrument taped to an ordinary single toothed tenaculum placed on the cervix. The advantage of this instrument is that it is all in one piece, is autoclavable, requires no additional attachments, is easily removable after tubal division, and has even survived several falls to the floor in over 100 cases in which it has been used to date. It has recently been accepted for manufacture by the Week Instrument Company.” “Edward Long Island
Week & Company, City, New York 11101.
Extragenital infection
49-33
31st
Place,
type 2 herpesvirus
RAYMOND WILLIAM
Inc.,
H. H.
KAUFMAN, RAWLS,
M.D. M.D.
Departments of Obstetrics and Gynecology, Virology, and Epidemiology, Baylor College Medicine, Houston, Texas
of
THE TYPE 2 herpesvirus which is isolated predominantly from genital lesions is very likely venereally transmitted.‘, a This virus can easily be distinguished antigenically and biologically from the type 1 herpesvirus which is usually isolated from nongenital sites. The following case report clearly demonstrates the occurrence of an extragenital type 2 herpesvirus infection and further confirms the venereal transmission of this disease.
This seen on throat, perature patient
patient was a ZO-year-old woman first June 14, 197 1, complaining of a sore headache and generalized aching, temelevation, and burning on urination. The gave a history of having sexual contact
15, 1972 Gynecol.
with only one individual for the past year. Her consort left town the early part of June and returned to Houston on June 7, 1971. At that time he noted a bump on his penis. The patient and consort had intercourse on that day as well as oral-genital contact. On June 10 the patient noted an aching under her ears and on June 11 she began to feel pain in her throat. On June 12 she developed vulva soreness. Examination of the patient on June 14, 1971, revealed a hyperemia of the pharynx. There was cervical lymphadenopathy; inguinal lymphadenopathy was also present. Multiple shallow ulcers were present on the lower aspect of both labia majora and labia minora as well as on the perineum and forchette. Multiple ulcers up to 5 mm. in diameter covered with a shaggy exudate were present on the portio of the cervix. It was felt that the patient had a primary genital herpesvirus infection. Examination of her consort at that time revealed a 5 mm. crusted lesion present on the dorsum of the shaft of the penis. The patient was again seen on June 19, 1971, complaining of increased pain in her throat. Examination of the pharynx revealed multiple shallow shaggy ulcers with one small 3 mm. vesicle noted. The patient was next seen on June 28. She was feeling much better at that time and had no discomfort. Examination revealed the pharynx to be normal in appearance. Several healing ulcers were present on the lower aspect of the vulva. Swabs of cervical and vulvar lesions taken on June 14 were found to contain herpesvirus type 2. Frozen sections of biopsy specimens of the cervix were stained by direct immunofluorescence using antiserum prepared in rabbits and specific intranuclear and intracytoplasmic staining was observed. On June 19, a swab of the pharyngeal lesions was obtained and herpesvirus type 2 was isolated. No antibodies to either type of herpesvirus were found in serum obtained on June 14; however, neutralizing antibodies were detected in serum sample obtained on June 28 and August 12. The antibody titers to herpesvirus type 2 increased from less than 1:lO to 1: 100 and was characteristic of a primary infection with herpesvirus type 2.2 The herpesvirus was not recovered from the crusted lesion of the male consort; however, paired sera, obtained on June 14 and August 5, revealed an antibody response indicating a recent herpesvirus type 2 infection. The isolation of type 2 herpesvirus from the cultures of the pharynx in this patient after oralgenital contact with her consort, who revealed serologic evidence of a type 2 herpesvirus infection at this time, demonstrates the venereal transmission of this infection to an extragenital site. This case is unique in that it has been found that the type 2 herpesvirus does not commonly produce lesions in extragenital locations. However, the sequence of events and the laboratory findings confirmed the presence of a type 2 herpesvirus infection of the pharynx.