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Podcast: What Should You Tell Your Patients About Bioidentical Hormones?Menopausal women often present with a list of complaints, questions and worries. While they seek effective treatment to alleviate their symptoms, they express their concerns regarding the potential adverse effects associated with conventional hormone treatment-namely, coronary heart disease, stroke and breast cancer. As a result, many women ask their clinicians about alternative options. They come armed with anecdotal stories, advice from friends, and information from television and internet sources.
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Strategies for Enhanced Physician Targeting and SegmentationOBGYN.net Conference Coverage from the recent Technology Supported Physician Detailing conference in Philadelphia, PA in September 2004
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Requiring Pharma to Disclose Payments Paints Doctors as VillainsObGyn.net blogger Richard Chudacoff, MD, FACOG, responds to the news that new health care laws will require pharmaceutical companies to disclose all payments to doctors.
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Don't Wait for a Fracture Identifying OsteoporosisLike the proverbial elephant, osteoporosis has been described in ways that vary according to the scientific orientation of the describer. It has been defined clinically as the presence of fracture; biomechanically as decreased bone strength; radiographically as osteopenia; histomorphometrically as reduced bone matrix per unit of bone volume; and epidemiologically as increased fracture risk.
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Hysteroscopy in the office settingOBGYN.net Conference CoverageFrom the 32nd Annual Meeting of the American Association of Gynecological Laparoscopists (AAGL)
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New Techniques in UrogynecologyOBGYN.net Conference CoverageFIGO 2000 INTERNATIONAL FEDERATION of GYNECOLOGY & OBSTETRICS: Washington DC, USA
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Difference in Obstetric Care between U.S. and Eastern European CountriesOBGYN.net Conference CoverageFrom American/Austrian Conference, Salzburg Austria March 4-10, 2000
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Pros and Cons of C-Section on Demand in Low Risk PatientsI think the problem was mainly put on the physicians because it was perceived that in the private sector the cesarean sections were done for monetary reasons. Currently, the issue is becoming a broader one because the women themselves want a cesarean section on request.
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Preventing Infection in NewbornsOBGYN.net Conference CoverageFrom American/Austrian Conference, Salzburg Austria March 4-10, 2000
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Disseminated Intravascular CoagulationDisseminated Intravascular Coagulation (DIC) By Prof. Rifaat Al-Shimmy, Al-azhar U.Definition of DIC A pathological condition associated with activation of both: • Coagulation system and • Fibrinolytic one It should be considered as a secondary phenomena of an underlying disease as...Common Obstetric ConditionsAssociated with: • Inadequate replacement of blood loss • Pre-eclampsia-Eclampsia…HELP syndrome • Ante partum hge (abruption placenta and P.P.) • I U F D when prolonged more than 4 weeks • Blood transfusion when massive or incompatible • Septic abortion or massive tissue injury • Amniotic fluid embolism • Saline I U infusionMassive Transfusion Is defined as the replacement of a patient's total blood volume in less than 24 hours,or as the acute administration of more than half the patient's estimated blood volume per hour. DIC is commonly a consequence of delayed or inadequate resuscitation page_break@DIC: Is it Predictable? • It can probably be predicted in all the previously mentioned high risk groups, except amniotic fluid embolism, as it is an unpredictable condition. • However, in AFE, DIC it always occurs only after resuscitation from the primary shocked state. page_break@Is it Preventable? • It can be avoided in most cases by proper ‘in time’ resuscitation and management of the underlying disease in proper time, e.g. Pre-eclampsiaPathogenesis • The most accepted theory is the Cascade theory in which there is activation of both Extrinsic and Intrinsic pathways leading to activation of factor xa leading to formation of thrombin from prothrombin to form fibrin from fibrinogen • With associated activation of fibrinolytic system as a protective mechanism.Pathophysiology, continued Pregnancy is considered as a hypercoagulable state by: • An increase in all coagulation factors except FXI/FXIII. Fibrinogen which increases to 400-650mg/dl in late pregnancy. • The fibrinolytic system is depressed during normal pregnancy and labor but returns to normal one hour after delivery of the placenta.Pathophysiology, continued Decrease in platelets count is a result of: 1. Consumption 2. Aggregation of plateletsPathophysiology, continued • So DIC is a state of increase thrombin activity at first, followed by increased fibrinolytic activity, leading to… • consumption of coagulation factor (source of old name consumptive coagulopathy) and the formation of FDP impairing homeostasis.Pathophysiology, continued • Deposition of fibrin in organs and tissues may lead to ischemic tissue damage. • The decreased number of platelets and elevated FDP increase the problem of homeostasis.Symptoms of DIC It is variable according to the cause, the presentation of the primary cause with: • Generalized or localized hemorrhage • Peticheae • Thromboembolc manifestation, organ failure as: liver, lung, kidneys, brain and frank gangrene have been described. • Chronic DIC, (that occurs with IUFD) may be asymptomatic.Diagnosis Although the definite diagnosis is only by histological finding of fibrin deposits, there are many indirect tests as: • Bedside clot retraction test • Skin puncture test, measure clotting time (fibrinogen) • D. Diamer (90%) • Platelets count (90%) • FDP (90%) • Thrombin time (80%) • PTT and PT (60%)Bedside Clot Retraction Tes(CT) • It simply tests the clotting time - a test of decreased fibrinogen • 2 ml blood in test tube - no clot formed but if occurs it is prolonged, soft and not retracted after half an hour, leaving a clot volume more than serum volume. (the clot doesn't retract)Skin Puncture Test (bleeding time) • Prolonged skin puncture ooze is observed when the platelets count is less than 100,000/ul • Continuous bleeding at puncture site occurs when pl count is less than 30,000 /ulOther laboratory tests • Platelets count decreases in 90% of cases (count less than 100,000/dl) • PT, which measures the time required by extrinsic pathway, elevated in 80% of DIC • PPT which measure the time required by intrinsic pathway - not helpful. • Thrombin time elevated in 80% of casesOther laboratory tests • Fibrinogen level/ less than150mg. This is present in 70% of cases. • Fibrin split product >40ug/dl, 90% of cases • D-Diamer - an antigen formed as a result of plasmin digestion, elevated in 90%of cases.Treatment of DIC • Essentially treat the underlying cause. In most cases prompt termination of pregnancy is required. • Supportive therapy should be directed to the correction of shock, acidosis and tissue ischemia. • Cardiopulmonary support including inotropic therapy, blood transfusion and assisted ventilationGuidelines by the Scottish Executive Committee of the RCOG
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Rob Newman from InSightec talks about a new method for treating fibroidsFrom the 34th Annual Meeting - Chicago, Illinois - November 2005
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Transobturator Approach For Cystocele Repair With Anterior Wall MeshAnterior vaginal wall relaxation (cystocele) is one of the most commonly diagnosed forms of pelvic organ prolapse in women.
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ContraceptionEntering the word ‘contraception’ into a search engine will result in over one million hits, from commercial sites to personal homepages and scientific sites. How can the physician find the information s/he is seeking in this overwhelming labyrinth? This review presents a guideline for quick access to practical professional information in the field of contraception and reproductive health care.
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Research Information Every Woman Should Know AboutOne of the most effective treatments for bleeding is to stop the blood supply to the area that is bleeding by blocking the vessels from the inside, this is known as “embolization”. Embolization of the arteries to the uterus has been used as a treatment for severe uterine bleeding after surgery or childbirth since at least the late 1970s, and is used as a treatment for uterine fibroids.
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Prevent Osteoporosis Before It's Too LateOsteoporosis is an enormous public health problem. Twenty-eight million Americans suffer from this disease, a condition which can cause crippling fractures. It is the major cause of disability among American women. However, while there is no cure for osteoporosis, it is important to remember that proper treatment can help stop further bone loss and prevent fractures.
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Chronic Pelvic Pain in the Adolescent Differential Diagnosis and EvaluationChronic pelvic pain, a common complaint in female adolescents, is defined as cyclic or noncyclic, intermittent or constant discomfort in the pelvic region for at least 6 months. It often frustrates the patient, her parents, and her physician, and it can lead to major functional problems such as changes in family dynamics or school absenteeism.
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Controversies in Obstetrics, Gynecology, and InfertilityOBGYN.net Conference CoverageFrom the ESHRE 2001 Conference - Lausanne, Switzerland
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New Biomarkers in Preeclampsia; Diagnosis is now possible where does that take us?Coverage of the 2009 World Congress of Perinatal Medicine
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ISGE 2006, Buenos Aires VideoFrom the 34th Annual Meeting - Chicago, Illinois - November 2005
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The Role of Cytoplasmic TransferThe First World Congress On: Controversies in Obstetrics, Gynecology & InfertilityPrague, Czech Republic - 1999
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Establishing a Continence CenterA continence center represents a center of excellence concept. A specific commitment to making a unique entity is required to fulfill this goal. This commitment should represent a high degree of motivation to provide unique and progressive care for patients afflicted with voiding dysfunction.
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Educational Tutorial: GDM & DM in PregnancyGestational diabetes is a serious concern in pregnancy for both the fetus and mother. In this educational tutorial, review the epidemiology, classification, pathogenesis of glucose intolerance, consequences for mother and fetus, fetal evaluation, screening and more.
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Like Mother, Like DaughterDuring a gynecologic consultation my patient, Mrs. Andersen age 48 years was distraught and asked me for advice. She was worried about her mother, but also about herself. She was very concerned and proceeded to explain in detail the current situation.
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Elective Egg Freezing: 10 Thoughts From an REIDon't overpromise when it comes to elective egg freezing. It doesn't protect against infertility nor does it guarantee a future pregnancy.
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International Members of AAGLOBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsOrlando, Florida, November 2000
