Biomedical subjects
Publications and source records attributed to A Lalonde.
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Canadian obstetricians, gynecologists and family practitioners are not allowed to perform female genital mutilation (FGM), but because of immigration patterns it is still a reality for them. Dr. André Lalonde, an Ottawa obstetrician-gynecologist who serves as executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, offers some practical suggestions from his own experience for physicians unaccustomed to seeing patients who have experienced FGM.
The chronic constriction injury (CCI) model of neuropathy in the rat produces hyperalgesia and allodynia in the sciatic distribution of one hindlimb. We previously described the pathology of the affected nerves at the light microscopic and electron microscopic levels and in this report quantify the morphological changes of the nerves. This analysis gives new insights into the pathophysiology and pain-related mechanisms in this model of human neuropathy. We observed that total fascicular area increased up to fourfold due to an initial massive increase in edema and, later, endoneurial cells. Intact myelinated nerve fibers were reduced from 75% of fascicular area to 29.7% on day 1 and to a minimum of less than 0.5% on day 14 when edema had resolved. The few surviving myelinated fibers were in the small to medium size range. Fiber size histograms revealed an increase in fiber size early on, corresponding to fiber swelling, and the later loss of large as well as small myelinated fibers. Unmyelinated nerve fibers dropped from 19.36/1,000 microns 2 to 6.08/1,000 microns 2 on day 5, and increased from there on. Sprouts were first visible on light micrographs on day 7, occupying 6.8% of fascicular area, while regenerating fibers that were undergoing myelination reached 42.6% of fascicular area by day 42. Macrophage numbers were maximal on day 14 and were still increased on day 42. These data support the hypothesis that the pathogenesis of the extended hyperalgesia following chronic constrictive nerve injury is temporally linked with Wallerian-like degeneration and macrophage activation.(ABSTRACT TRUNCATED AT 250 WORDS)
Total abdominal and vaginal hysterectomy has been the standard treatment for intractable and unmanageable menorrhagia for many years. However, in the last few years, hysteroscopic treatment of menorrhagia through surgical resection and/or ablation of the endometrial cavity has gained success. Over 625,000 hysterectomies are performed each year in the USA alone. More than 30% are done for menorrhagia as a primary diagnosis. Three times more hysterectomies are performed using the abdominal route than the vaginal approach. Morbidity is higher using the abdominal route alone. Complications of abdominal and vaginal hysterectomies will be briefly discussed. Menorrhagia caused by submucous fibroids can be treated hysteroscopically. A review of methods, complications, advantages and long-term follow up will be presented. Laparoscopically-assisted vaginal hysterectomy (LAVH) is the latest surgical option offered for menorrhagia. The advent of a hysteroscopic approach to the treatment of menorrhagia and careful analysis of the advantages and disadvantages of LAVH will be discussed.
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Five obstetrician-gynecologists experienced in fetal monitoring assessed 150 intrapartum cardiotocograms obtained with an external transducer. There were three successive blind readings, the first two without any clinical data apart from gestational age. The reviewers indicated whether the tracings showed definite, possible or no abnormalities. The interpretations given by each reviewer for any one tracing were fairly consistent, but they varied markedly from one reviewer to another. The proportion of tracings interpreted as normal ranged from 39% to 74%, and the proportion assessed as abnormal ranged from 3% to 43%. All five observers agreed on the interpretation of 29% of the tracings. Inter-reviewer reproducibility scarcely changed when clinical data were provided. These findings emphasize the need to evaluate all methods of fetal monitoring before they become widespread.
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Six Canadian medical students record their experience at a summer school of tropical medicine in Haiti, sponsored by the Canadian Association of Medical Students and Internes. The social, economic and medical background is described, including "Voodoo" practices, language and Haitian art. Attention is directed to the occurrence of umbilical tetanus, diarrhea and malnutrition. From even a brief stay in a country such as Haiti one comes to appreciate that a public health program in an underdeveloped nation is not strictly a medical undertaking but must be seen in its social and economic contexts.