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Excision of Transverse Vaginal Septum Transverse vaginal septum usually occurs between the upper one-third and lower two-thirds of the vaginal canal. This is additional evidence that the upper one-third of the vagina is Mellerian origin and that the lower two-thirds of the vagina is embryologically developed via the urogenital sinus. The septum can be either complete or partial. If it is complete, the symptoms of vaginal obstruction occur at the time of mensarche, since menstrual blood is entrapped above the septum and has no egress from the vagina. If the septum is partial, it may be discovered on a routine gynecologic examination, or the patient may present with dyspareunia. The operation is performed to remove the transverse vaginal septum without significantly shortening the vaginal canal. Physiologic Changes. The physiologic changes desired are (1) the egress of menstrual blood from the vaginal canal without obstruction and (2) the normal functioning of the vagina. Points of Caution. If the septum is complete and hematometra or hematocolpos is present, it is unwise to attempt surgical correction of the septum at the time the obstruction is relieved. The procedure of choice is incision and drainage of the hematometry or hematocolpos, with reconstruction delayed 6-8 weeks until the tissues have completely healed. To avoid unduly shortening the vagina, excessive vaginal mucosa should not be removed. Technique The typical position of most transverse vaginal septa at the junction of the upper one-third and the lower two-thirds of the vagina is shown. B, bladder. With the patient in the dorsal lithotomy position, the perineum is prepped and draped, and adequate vaginal retraction is applied to allow exposure of the septum, which is incomplete here. Initially, the septum is grasped with Allis clamps, and the vertical incision is made through the septum to divide it in half. The septum is picked up with tissue forceps, traction is applied, and with a scalpel the septum is separated from the vaginal mucosa. The vaginal mucosa is then approximated with 3-0 synthetic absorbable suture throughout its circumference. The sagittal view illustrates closure of the defect in the vaginal mucosa.

Type Fight: Lucha de Letras | AIGA Austin

2017 Menu # 15

Susurrando Letras: Juvenile and romantic literature

Published: Fri, May 19, 2017
World | By Tasha Manning

Cutting seton without preliminary internal sphincterotomy in management of complex high fistula-in-ano | SpringerLink

Cutting seton without preliminary internal sphincterotomy in management of complex high fistula-in-ano | SpringerLink

PURPOSE: The traditional treatment of a complex high fistula-in-year by internal sphincterotomy and insertion of a seton carries a risk of fecal incontinence. We have evaluated the functional impact of treating patients with a fistula-in-year complex by a seton fistulotomy technique that preserves the internal sphincter. METHODS: The operative steps consisted of initial eradication of sepsis, identification of the internal and external openings of the fistula tract, excision of the fistula tract with anal canal mucosa, and insertion of a cutting silk seton around both the internal and external sphincters. In this way open drainage of the intersphincteric space was avoided, and integrity of the internal sphincter was maintained. Functional outcome following treatment with this technique, with regard to fistula eradication and effect on fecal continence was assessed in 27 patients (15 males) who were treated during a six-year period. Twenty-three patients (85 percent) had a history of previous fistula surgery. RESULTS: The fistula was cured in 26 patients (96 percent) with no reports of altered continence at the time of discharge from outpatient review. Recurrence developed in one patient (4 percent) in whom hidradenitis suppurativa was subsequently diagnosed. All four patients with Crohn's disease had their fistulas eradicated; Three (75 percent) have subsequently undergone proctectomy for severe perianal and rectal Crohn's involvement. Long-term follow-up revealed three patients (19 percent, all rectovaginal fistulas) who experienced deterioration in continence after discharge. CONCLUSIONS: Although this procedure may not be appropriate for rectovaginal fistulas, the data suggest that setons are effective in treating complex fistula-in-year, including those that have failed to respond to other forms of surgery. Avoidance of preliminary internal sphincterotomy may prevent deterioration in continence.

Baptist Health Systems in Jackson, MS | Health Library
The most effective treatment is to keep your fever as low as possible and to maintain good fluid-based hydration. It is believed that the virus is spread by contact with infected saliva and that adults form the main reservoir.

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