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Sunday, January 2, 2011
Minimally Invasive Robotic Surgery for Hysterectomy
Robotic surgery enables physicians to perform minimally invasive surgery that was not possible with simple laparoscopic instruments. Its one of the greatest advancements in surgery during our lifetime. With the robots high definition camera, 10 times magnification and 540 degrees of movement we are able to perform surgery that could not be accomplished with traditional methods.
Carolina Robotic center is a division of WHA Midcarolina obstetrics and Gynecology P.A.
Estrogen as an initial treatment for symptomatic labial adhesions
The initial treatment of choice for symptomatic labial adhesions is :
A) testosterone cream
B) estrogen cream
C) GnRH antagonist
D) hydrocortisone cream
E) surgical separation
Answer and Discussion
The answer is: ( B ).
Labial adhesions are common in prepubertal females. The cause is thought related to low levels of circulating estrogen. Most women with small areas of labial adhesions are asymptomatic. However, interference with urination or accumulation of urine behind the adhesion can lead to discomfort and symptoms. Dysuria and recurrent vulvar and vaginal infections are associated symptoms. In rare situations urinary retention may occur. Asymptomatic labial fusion usually does not require treatment. Symptomatic adhesions may be treated with a short course of estrogen cream applied twice daily for 7 to 10 days; this may separate the labia.
A new alternative treatment is to use estrogen transdermal patches in close proximity to the labia. When medical treatment fails or if severe urinary symptoms exist, surgical separation of the labia is indicated. This can be done as an office procedure using 1% to 2% topical xylocaine gel. Because of inadequate levels of estrogen, recurrences of labial adhesion are common until puberty. Following puberty, the condition usually resolves spontaneously. Improved hygiene and removal of vulvar irritants may help prevent recurrences.
A 30 year old pregnant lady in her 20th week of gestation. She is asking you about routine vaccinations during pregnancy and you told her that routine immunizations during pregnancy is best avoided because of theoretical risks to the fetus, however many vaccines are safe and can be given during pregnancy period and in special conditions . Which one of the following vaccines is contraindicated in this lady :
a) Tetanus toxoid. b) Influenza vaccine. c) Pneumococcal vaccine. d) Rubella. e) Diphtheria toxoid.
The correct answer is D Explanation
Because of the theoretical risks to the fetus and real litigation to the practitioner, routine immunization of pregnant women is best avoided. However, wherever hygienic conditions during delivery can not be guaranteed, it is essential to ensure that pregnant women are immune to tetanus: the transfer of maternal anti-toxin is an important means of preventing neonatal tetanus, and pregnant women can safely receive tetanus as well as diphtheria toxoids.
Although live-virus vaccines in general should withheld during pregnancy, polio and yellow fever vaccines are exceptions and may be administered if the risk of exposure to disease is great. If indicated, some inactivated vaccines (HBV, influenza and pneumococcal vaccines) are safe for pregnant women. Known pregnancy is considered a contraindication to the receipt of rubella, measles, mumps and varicella vaccines. Although of theoretical concern, no cases of congenital rubella syndrome or abnormalities attributable to rubella vaccine virus have been observed in infants born to susceptible mothers who received rubella vaccine during pregnancy.
Obstetric Evidence-Based Guidelines, Second Edition
This book reviews the evidence for best practice in obstetrics and maternal-fetal medicine. It presents readers with the right information, in the right format, by summarizing evidence in easy-to-use tables and algorithms. Recommendations have linkage to supporting evidence, and quality of evidence and strength of recommendation is stressed. Areas of uncertainty are recognized, and ‘individualized’ care suggested. Recommendations based on randomized trials and meta-analyses are highlighted so that clinical outcomes can be improved. The proper use of each guideline is aimed at “make it easy to do itright ”, so there is appropriate use of proven interventions and no use of harmful interventions. Plenty of evidence is available so that well-informed clinicians can reduce errors (primum non nocere), so the first aim is ultimately to improve the health of mother and fetus by providing quality care.
Some contraindication to Exercise during pregnancy
Which of the following is not a contraindication to exercise during pregnancy?
A) Pregnancy induced hypertension (PIH)
B) Incompetent cervix
C) Preterm labor during a prior pregnancy
D) Placenta previa
E) All are contraindications
The answer is :( E ).
Although supportive data is limited, there appears to be no reason why women who are in good health should not be permitted to engage in exercise while pregnant. However, women with medical or obstetric complications should be encouraged to avoid vigorous physical activity. Given the current lack of data, a conservative approach is warranted when doubt exists.
Contraindications to exercise during pregnancy include PIH, preterm rupture of membranes, preterm labor during the prior or current pregnancy, incompetent cervix or cerclage placement, persistent second- or third-trimester bleeding, placenta previa, and intrauterine growth retardation.
The ten years since the first edition of Operative Obstetrics have witnessed considerable changes in obstetric practice. There has been a continued increase in the rate of cesarean delivery, and the use of minimally-invasive surgery has rapidly gained popularity. Social changes affecting practice have also been significant, prompting a reevaluation of the appropriateness of certain types of operations during pregnancy. This fully-updated edition includes chapters on cesarean delivery, birth injury, ectopic pregnancy, and common surgical complications. It features a new discussion of surgical procedures performed by non-physicians and an updated treatment of fetal surgery. The text also considers complicated and controversial subjects such as cervical insufficiency,pregnancy termination, instrumental delivery, and shoulder dystocia. Each of the four sections includes an in-depth analysis of the important ethical and legal issues underlying practice for the area in question. An expanded appendix reviews legal concepts pertinent to practitioners in the field of obstetrics.
A 64 y old woman presents with vaginal bleeding similar to “spotting” that has occurred daily for 1 mo. Her last menses was at age 50 and she has been healthy her entire life. She denies fever,weight loss, or abdominal pain.Physical examination is normal.
the most likely diagnosis is?
a.Atrophic vaginitis
b.Endometriosis
c.Uterine leiomyoma
d.Endometrial carcinoma
e.Polycystic ovarian syndrome
The answer is ( a ).
The most commoncause of postmenopausal vaginal bleeding is atrophic vaginitis (with or without trauma).
Endometriosis is the most common cause of infertility;patients present with dyspareunia (painful intercourse), abnormal vaginal bleeding, and pelvic pain. Uterine leiomyomas (uterine fibroids) change in size with the menstrual cycle but regress in size during menopause. Often the fibroid is palpable on pelvic examination. Polycystic ovarian syndrome (Stein-Leventhal syndrome) affects younger women (15–30). The etiology of polycystic ovary syndrome is unknown; patients present with amenorrhea, obesity, hirsutism, and infertility. All postmenopausal women with vaginal bleeding require a biopsy to rule out endometrial carcinoma.
Donald School Textbook of Ultrasound in Obstetrics & Gynecology
Featuring more than 650 color illustrations, this definitive volume provides comprehensive and expert coverage on the practical applications of ultrasound. The text is divided into three parts: general aspects, obstetrics, and gynecology. It includes recent technological breakthroughs in diagnostic ultrasound, including the advent of color Doppler, power Doppler, and three-dimensional and four-dimensional imaging. All contributors are either present or former teachers at the 8 branches of the Ian Donald school. A comprehensive text with state-of-the-art images, the book is of value to obstetricians, gynecologist, and medical ultrasonographers.
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Laparoscopic hysterectomy is a surgical removal of the uterus,Laparoscopic hysterectomy is alternative to abdominal hysterectomy.Hysterectomy is the second most common major operation performed in the United States today, second only to cesarian section.The first laparoscopic hysterectomy (LH) was performed in January 1988 by Harry Reich in Pennsylvania.The indications for laparoscopic hysterectomy are similar to the generally accepted indications for hysterectomy.
The contraindications for laparoscopic hysterectomy include postpartum hysterectomy and adnexal masses which cannot be removed with an endobag. The size of the uterus and access to it also limit the scope of the procedure depending on the experience of the surgeon.Hysterectomy is usually performed for problems with the uterus itself or problems with the entire female reproductive complex. Some of the conditions treated by hysterectomy include uterine fibroids (myomas), endometriosis (growth of menstrual tissue outside of the uterine cavity), adenomyosis (a more severe form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall), several forms of vaginal prolapse, heavy or abnormal menstrual bleeding, and at least three forms of cancer (uterine, advanced cervical, ovarian). Hysterectomy is also a surgical last resort in uncontrollable postpartum obstetrical haemorrhage.Tags,laparoscopic hysterectomy recovery,laparoscopic vaginal hysterectomy
Hormonal and Other Changes in Patients with Hypothalamic Amenorrhea.
In patients with hypothalamic amenorrhea, there are alterations of hormones and other factors that affect the secretion of gonadotropin-releasing hormone (GnRH), including : #low levels of leptin and #high levels of both ghrelin and neuropeptide Y (NPY). β-endorphin, corticotropin-releasing hormone (CRH), dopamine, and γ-aminobutyric acid (GABA) are factors that negatively influence GnRH secretion. Some of these factors may also serve as hunger signals from the peripheral to the central nervous system and as links between nutrition and reproduction. Hallmark findings in adolescents and young women with hypothalamic amenorrhea include overactivity of the hypothalamic–pituitary–adrenal axis, suppression of the hypothalamic–pituitary–ovarian axis, and alterations in thyroid hormone regulation. FSH denotes follicle-stimulating hormone, LH luteinizing hormone, TSH thyrotropin, and T3 triiodothyronine.
Location: Amman-Jordan Osama Badran,M.D.,FACOG , american board certified gynecologist performing laparoscopy for resection of a 4-5 cm omental -metastatic- nodule in the infracoloic omentum . The omentum and nodule are resected. The patient has endometrial adenocarcinoma , status post hysterectomy, radiation therapy, and chemotherapy. CT scan and PET scan showed a singleton metastatic lesion in the omentum.
The ten years since the first edition of Operative Obstetrics have witnessed considerable changes in obstetric practice. There has been a continued increase in the rate of cesarean delivery, and the use of minimally-invasive surgery has rapidly gained popularity. Social changes affecting practice have also been significant, prompting a reevaluation of the appropriateness of certain types of operations during pregnancy. This fully-updated edition includes chapters on cesarean delivery, birth injury, ectopic pregnancy, and common surgical complications. It features a new discussion of surgical procedures performed by non-physicians and an updated treatment of fetal surgery. The text also considers complicated and controversial subjects such as cervical insufficiency,pregnancy termination, instrumental delivery, and shoulder dystocia. Each of the four sections includes an in-depth analysis of the important ethical and legal issues underlying practice for the area in question. An expanded appendix reviews legal concepts pertinent to practitioners in the field of obstetrics.
