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Dermatological emergencies in tropical infections and infestations
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Anup Kumar Tiwary, Niharika Ranjan Lal, Piyush Kumar
Schistosomiasis (bilharziasis) is a serious systemic parasitic infestation by trematodes of the genus Schistosoma (blood flukes) [52]. The three species responsible are Schistosoma mansoni, S. haematobium, and S. japonicum [53]. During exposure to contaminated lakes/rivers in an endemic area, free-swimming cercariae penetrate the human skin and reach the venous circulation within 24 hours and via the portal system are carried to the veins around the rectum, colon (S. mansoni and S. japonicum), and pelvic and vesical veins (S. haematobium) where they lay eggs [54].
The urinary bladder
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The abdomen is opened through a midline incision extending down to the symphysis pubis. The liver and the retro- peritoneum are checked for evidence of metastases, and the operability of the bladder is assessed. A bilateral pelvic lymph- adenectomy is performed, removing external iliac nodes, internal iliac nodes and the nodes in the obturator fossae. Some surgeons will remove lymph nodes up to the aortic bifurcation or higher with some evidence of improved long-term oncological outcomes. The vessels passing to the bladder from the side wall of the pelvis are ligated and divided; these include the obliterated hypogastric vessels, the superior vesical artery, the middle vesical veins, and the inferior vesical arteries and veins. The ureters are then divided. The posterior ligaments extending from the pararectal area to the back of the bladder are ligated and divided, and the layer posterior to Denonvil- liers' fascia is opened up. The endopelvic fascia is then divided on each side and the puboprostatic ligaments are divided. A ligature is passed between the dorsal vein complex and the urethra, and the former is ligated and divided. The urethra is then mobilised and divided. The ligaments lateral to the prostate are divided and the bladder is removed. In women, the uterus and anterior vaginal wall need to be included. Women must be counselled about the loss of ovarian and uterine function.
A Modification of Laparoscopic Type C1 Hysterectomy to Reduce Postoperative Bladder Dysfunction: A Retrospective Study
Published in Journal of Investigative Surgery, 2019
Wei Jiang, Meirong Liang, Douxing Han, Hui Liu, Ling Li, Meiling Zhong, Lin Luo, Siyuan Zeng
Currently, there are two schools of thought regarding NSRHs: One of these favors a traditional approach, and the other favors a modified approach. The traditional school insists on the visualized preservation of the nerve by meticulous separation of the nerve, despite the prolonged and complicated nature of the procedure.6,7,12 To cope with the complex anatomy of the nerve plexus, numerous researchers have invented multiple instruments.6,7,12 In contrast, the modified approach spares the inferior hypogastric plexus as a whole without separating the autonomic nerve by direction of defined anatomical landmarks. The inferior hypogastric plexus is formed by the hypogastric nerve, pelvic splanchnic nerve, innervating bladder, uterus and rectum. A range of anatomical landmarks has been put forward to enable the preservation of the plexus. Fujii5 and Kato13 recommended separation of the inferior vesical vein to identify and preserve the bladder branch from the inferior hypogastric plexus, however, the preservation is difficult due to the rich anatomical variation. Ditto et al.14 and Bin Li et al.15 reported that the middle rectal artery demarcated the boundary between the nervous portion and vesicular portion of the CL. However, the middle rectal artery is subjected to rich anatomical variation and is more commonly single sided than double sided.16