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.
Principles and Practically
Both types of surgery are complimentary. Each has specific advantages and indications. It is an advantage to have and to be able to use both.
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.
The female reproductive function depends on the healthy ovaries (primary reproductive organ) and genital tract organs. Infertility is one of the main gynecological problems which affect between 10-15% of females in the reproductive age.
Recently a letter was sent to the Women's Health Forum by a patient who had undergone numerous surgeries in an effort to alleviate her pain due to surgical adhesions. Additionally, I recently had a patient whose case demonstrates a rather typical story for post-surgical adhesions, and her management. These two patient cases I hope you will find informative and "food for thought".
Myomectomy is becoming a much more frequently performed procedure certainly it is one that is sought out much more frequently by our patients. Probably the most intimidating form of fibroids is that which occurs in the broad ligament, and particularly one which occurs in the cervical region.
Chronic pelvic pain affects a large number of women, and is not often optimally treated within a single specialty. It is responsible for approximately 40% of laparoscopies and 10-15% of hysterectomies in this country. In one survey of 5300 women, more than 16% noted chronic pelvic pain.
Of the 600,000 hysterectomies performed yearly in the U.S., approximately 300,000 are accompanied by prophylactic bilateral oophorectomy, traditionally suggested as the best strategy to decrease the rate of ovarian cancer.
To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models.
Cancer of the vulva is not a common disease. There are about 4,000 new cases each year in the United States. Although it can occur in women in the third and fourth decade it is usually diagnosed in older women. Over 95% of vulvar cancers arise from the squamous epithelium. The remainder are mostly melanomas. The cause of squamous cancer of the vulva is unknown but there is a weak association with Human Papilloma Virus (HPV). The most important feature about vulvar cancers is the premalignant phase.
Many medical conditions, including all cases of cancer, must be diagnosed by removing a sample of tissue from the patient and sending it to a pathologist for examination. This procedure is called a biopsy, a Greek-derived word that may be loosely translated as "view of the living."
The Society of Gynecologic Oncologists (SGO) has endorsed the American Cancer Society's (ACS) new guidelines, "Early Detection of Cervical Neoplasia and Cancer," released in the Nov./Dec. issue of CA: A Cancer Journal for Clinicians. The new guidelines represent a significant step forward in advising the health care community and the public on the importance of cervical cancer screening and the relationship between the Human Papillomavirus (HPV) virus and cervical cancer.
Depression and incontinence appear to be associated in women, but the statistical strength of that association depends on the instrument used to classify depression, according to this population-based, cross-sectional study. Investigators used data on 5,701 women aged 50 to 69 years collected during interviews conducted for the Health and Retirement Study.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
A 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.
On October 6, 2000 the Health Care Financing Administration (HCFA) announced that it was initiating a national policy for coverage of biofeedback treatments of urinary incontinence (UI). This is a significant development both for physicians already using biofeedback and for those contemplating adding conservative therapies to their practice.
Pantaleoni first performed hysteroscopy in 1869, but it was not until the early 1970s that hysteroscopy became part of the gynecologist's armamentarium. The need for visual appraisal of the endocervix and endometrial cavity and technical advances in instrumentation increased the awareness of, and interest in, the advantages of hysteroscopic sterilization techniques.
The National HPV & Cervical Cancer Campaign is a public education campaign whose goal is to reduce the number of preventable deaths each year by cervical cancer through increased education, outreach and communication between women and their health care providers.
Our hospital is installing an electronic medical record system (EMR). It has added a minimum of 15 minutes to the time it takes to process each patient, without a perceptible increase in quality of care. And trying to make sense of meaingful use? It's like "Catch 22."
Are you using Electronic Health Records? What do you think about them? Share your gripes or sing the praises of EHRs.
A list of key terms for gynecologists and patients dealing with cancer.
Following two days of hearings, the US Food and Drug Administration has declared that silicone breast implants are safe for use and will remain available. However, the FDA will encourage manufacturers to conduct post-approval studies.
New research shows that the SIRT3 gene may contribute to obesity as well as a variety of chronic diseases including diabetes, heart disease, and high blood pressure. The study was published in the August 18th issue of Molecular Cell.
Patient safety is finally being institutionalized due to growing concern over the terrible cost of inadvertent human error. Medicine's punitive perfectibility model in dealing with unintended injury is slowly evolving to accept error during surgery, as an inevitable yet manageable reality of operations (Leap, 1994).
Women with cervical intraepithelial neoplasia now have a number of treatment options including cold-knife conization, laser ablation, and loop electrosurgery but, all too often, the physician s preference is the determining factor in selection of therapy. This detailed presentation of the advantages and disadvantages of electrosurgery will help the physician to decide whether this procedure truly fits the needs of a given patient.
We are coming out of a dust bowl. When I was asked to write an article on the recent history of biofeedback for treating incontinence and the reimbursement associated with it, my first thought was that it's been a dust bowl. For the last five years we have been working with OB/GYNs, urogynecologists, and urologists from across the country who provide biofeedback.
The first carefully described abdominal supracervical hysterectomy was performed by Wilhelm Alexander Freund in 1878 and it was the leading technique for over 80 years (1). Tervilä (2) described the danger of cervical cancer to be 0.3-1.9% following supracervical hysterectomy.
Vitamin E (alpha-tocopherol) is thought to play a role in several stages of carcinogenesis through its contribution to immunocomptence, inhibition of mutation formation and repair of membranes and DNA.
A number of case-control and cohort studies have demonstrated a relationship between high intake of foods rich in carotenoids, Tocopherols, and vitamin C with a reduced risk of certain human malignancies.