Gynecological fistulae are a rare but severe complication of radiation therapy, pelvic surgery, prolonged labor, cesarean deliveries, or inflammatory bowel diseases. A gynecological fistula is an abnormal pathway formed between the urinary and gynecological tract, most commonly located between the urinary bladder and vagina. Vesico-uterine and vesicovaginal fistulae are an important health issue, common in women of reproductive age in developing countries with limited access to obstetrical care. Various surgical techniques have been described for VVF repair, depending on the location, severity, and cause of the fistula and the surgeon’s experience. The purpose of our review was to evaluate the present state of knowledge about the prevalence and treatment of gynecological fistulae. The PubMed scientific database was searched for original articles on the subject of gynecological fistulae that had been published between 2013 and 2023.
Background and Goal of Study: Percutaneous Dilational Tracheostomy (PDT) facilitates the bedside insertion of a tracheostomy tube in the Intensive Care Unit. Accidental puncture of endotracheal tube (ETT) cuff and unintended tracheal extubation are the potential complications during (PDT) our purpose was to evaluate the safety and efficiency of the use of the laryngeal mask airway (LMA) during percutaneous dilatational tracheostomy under bronchoscopic guidance comparing with the ventilation via (ETT). Materials and Methods: The bedside PDT was performed in 30 critically ill patients-15 in each group: LMA group and ETT group-that fulfilled the criteria for this study: PaO 2 Ͼ 100 mmHg, PaCO 2 Ͻ 45 mmHg under intermittent positive pressure ventilation (IPPV) with a mean ventilation pressure of Ͻ25 mmHg.The positioning of the LMA was done at least 30 min before the tracheostomy was performed.Blood samples for arterial blood gas analyses were taken 5 min before the procedure (first value) and just after (1 min) the insertion of tracheostomy tube (second value). Mean arterial pressure (MAP), heart frequency (HF) and peripheral oxygen saturation (SpO 2 ), endexpiratory CO 2 and minute ventilation volume (MVV) were registered every 60 seconds.
Results and Discussions:There was no significant difference in MAP, HF, SpO 2 , pH, PaO 2 , or PaCO 2 between groups before the procedure. The operating time was significantly shorter in LMA group (5.5 Ϯ 0.8 min versus 7.9 Ϯ 1.4 min, P Ͻ 0.05.). Hypercarbia was noted in 33.3% in the LMA group and 26.7% in the ETT group.
Conclusion(s):The LMA provides a safe and effective alternative to an endotracheal tube for airway management during guidewire dilatating forceps tracheostomies in selected patients and prevents the difficulties associated with the use of ET such as cuff puncture, tube transection by the needle, and accidental extubation.
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