Pregnancy and Birth

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Advances in technologies have allowed conduct of many procedures by laparoscopy and hysteroscopy. These are the essence of our specialty. Most new technologies foster improved performance. In business term, they are called sustaining technologies. In fact, most technological advances in an industry are sustaining in nature.

ISGE July 2005 Volume 13

We are in the cyber-era. Many conventional “snail” mails have been replaced with emails. Electronic mails allow easy, fast and economical communication. It is ideal for short messages, and quick questions and replies. For ISGE with members from around the world, it is a convenient way to communicate; time-zone is not a factor anymore. You send your e-mail and the receiver replies at his or her convenience. It helps us stay connected.

Suppose for instance, that last year, the chair of an organizing committee invites you to lecture at a meeting. You accept. You then assist this chair in organizing the program by inviting other speakers to the meeting. Two months before the meeting, the invitation for you to speak is withdrawn.

In minimally invasive surgery (MIS), complications can occur due to faulty instruments, surgical technique, or inadequate patient election. Surgeons who routinely perform MIS rarely encounter complications. Conversely, practicing gynecologists at large often find that certain procedures or techniques are not as safe as previously reported in the literature by the "experts." One of the reasons is that complications tend to be underreported.

The tragic events of September 11 have, to put it mildly, thrown many people off balance. On a somewhat secondary scale, our Society was affected. The 5th Regional Meeting of ISGE in conjunction with the 2nd Brazilian Congress of Gynecologic Endoscopy took place on September 12-15, 2001.

We are entering a time in the development of the discipline of gynecologic endoscopy where there is an opportunity to build bridges, both ideologically and functionally. The science and practice of endoscopy have progressed to the point where core groups of advanced endoscopic surgeons have organized themselves in every corner of the world, not only to exchange knowledge, but also to set goals and plan for the future of the field.

Uterine prolapse or dropped womb is a condition in which the uterus drops downward in the pelvis below its normal position. The uterus may drop slightly and remain above the introitus (vaginal opening, grade 1). It may drop further so that the cervix or lower portion of the uterus reach the region of the introitus (grade 2). In the most severe form, the cervix or even the entire uterus bulges out of the introitus (grade 3). Uterine prolapse is the indication for hysterectomy in 16% of cases in the U.S.

The first laparoscopic hysterectomy was performed in 1989 by Henry Reich. Nowadays the laparoscopic hysterectomy for a uterus up to 300 grams, without other pathologies that could limit its mobility or without a poor vaginal access, has to be considered a basic well standardized procedure.

What are Uterine Fibroids?The walls of the uterus are made of smooth muscle called myometrium, and the inside lining, with glandular tissue, is called endometrium. “Uterine fibroid” is a slang term for leiomyoma, or often simply myoma. Fibroids are benign tumors made of smooth muscle cells.

New research sheds light on vulvodynia, showing that the disorder is under-diagnosed and inadequately treated. Since the chronic pain associated with vulvodynia can make it difficult to sit or participate in sexual activity, the disorder greatly impacts quality of life for women afflicted with it. The research is published online as part of the American Journal of Obstetrics and Gynecology.

Hysterectomy is the most frequently performed operation in women, with a life time risk varying from country to country from less than 20% to more than 40%. Overall these differences reflect more medical practice than differences in pathology between countries.

Menopause and Hormones

Steroid hormones have a typical chemical structure. Their mechanism of action is through binding to a specific receptor which in the nucleus of the cell will induce effects at the genomic level.

Hormonal changes associated with menopause do not increase a woman’s risk for heart disease and heart disease mortality, according to new research published in BMJ. The work of Dr Dhananjay Vaidya, assistant professor of medicine at John Hopkins School of Medicine, and colleagues contradict the previously hypothesis that heart disease and heart attacks rise dramatically after menopause.

This is a term that includes several conditions that are associated with the results of a pregnancy. The conditions are molar pregnancy, invasive mole, metastatic mole and gestational choriocarcinoma(korio carcinoma). These are cancers and cancer like conditions of placental elements. The concept is so far beyond most people's experience, that unless they have been to medical school they will never have heard of it. It is not uncommon.

Cancer of the vagina is rare. It is almost always a squamous cell cancer. The exception is an adenocarcinoma that occurs in women who were exposed to DES (diethylstilbestrol) in-utero. One of the reasons that it is rare is that cancers of the vagina that also involve the vulva are considered to be vulvar cancers; if it involves the cervix it is considered to be a cervical cancer. Vaginal cancer may cause symptoms of abnormal bleeding and foul discharge. Bleeding after intercourse is a symptom of cancer of the vagina as well as cancer of the cervix.

The cervix is the part of the uterus connected to the upper vagina. It is the structure that dilates during childbirth to allow the baby to traverse the birth canal. There are two major types of cancer that develop from the cervix. Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Adenocarcinomas arise from the glandular lining of the endocervical canal.

The uterus is the pelvic organ that holds the pregnancy and that bleeds each menstrual period. The cervix is that part of the uterus fixed at the top of the vagina. The normal size of the uterus is about that of a lemon. The uterus is divided into three parts. The great bulk of the uterus is composed of smooth muscle and forms a thick uterine wall.

The Pap test is a screening test for malignant and premalignant changes of the cervix. A positive result indicates that there may be a problem and that further diagnostic procedures must be done. The Pap test is not a diagnostic test. It cannot be used to exclude a cancer of the cervix for a person who has symptoms that could be due to a cervical cancer.

Ovarian cancer, long considered a silent killer because of the lack of warning signs, may not be so silent. A new consensus statement released by the Gynecological Cancer Foundation reveals that women who have developed ovarian cancer may have had common disease symptoms.

The challenge we face in interpreting Pap smears is to facilitate the assignment of smears into either a low-risk category (including "within normal limits" and "benign cellular changes") or a high-risk category (including "squamous intraepithelial lesion" and higher-grade categories).