Puerperal tubal sterilization: report of 1,830 cases.
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The efficacy of prehysterectomy curettage in ruling out an endometrial cancer was evaluated in three ways. First, by an evaluation of the extent of routine prehysterectomy curettage; second, by the assessment of the clinicians' ability to recognize endometrial cancer on the basis of curettings; and third, by evaluating the presence of a gross endometrial lesion in those uteri removed without a preoperative diagnosis of an endometrial malignancy. It was concluded that the examination of the opened excised uterus was more valuable than prehysterectomy curettage for the operative diagnosis of an endometrial malignancy.
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Evidence-based medicine is a concept developed by David Sackett and colleagues since 1980 at the Medical University center MacMaster, Hamilton city, Ontario. The main idea was to propose an evaluating tool of medical practice allowing a structured way of reasoning and the elimination of self-made opinion. We present a short explanation of evidence-based medicine and compare our daily practice in obstetrics and gynecologic surgery with this new practice paradigm.
We evaluated 50 women who had had a previous laparotomy to determine the extent of adhesion formation. Patients were grouped according to previous obstetric and gynecologic surgery. The reason for laparoscopy was generally pelvic pain or infertility, and in some women with no complaint, for evaluation. Women with several incisions did not have more adhesions than those with a single one. Those with midline incisions had more adhesions than those with Pfannenstiel incisions. Women with midline or Pfannenstiel incisions for gynecologic surgery had more adhesions than those with incisions for obstetric surgery.
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OBJECTIVES: Our purpose was to determine whether the sequence of rotation disciplines taken can effect medical student examination scores on the National Board of Medical Examiners Subject Exam score for obstetrics and gynecology. STUDY DESIGN: A retrospective study was conducted of 439 student files for the academic years 1987 through 1991. The final clerkship grades and subject examination scores for internal medicine, pediatrics, psychiatry, surgery, and obstetrics and gynecology were reviewed. RESULTS: It was determined that completion of internal medicine or surgery before obstetrics and gynecology yielded higher scores in obstetrics and gynecology (p < 0.00001), with the largest improvement (from 533 to 586) observed when obstetrics and gynecology followed the internal medicine rotation. CONCLUSION: The sequence of rotation can affect scores on the National Board of Medical Examiners subject examination in obstetrics and gynecology. The largest improvement in student scores was observed when obstetrics and gynecology followed the internal medicine or surgery clerkships.
Different reconstructive operations were performed in 20 patients for intraoperative traumas of the urinary tract. 4 patients had injured ureter and urinary bladder. The damage was done in the course of obstetric operations (cesarean section, uterine extirpation). In 12 cases the ureter was injured in uterine extirpation for cancer (n = 4), myoma (n = 4), prolapse of the uterus, (n = 1), extirpation of uterine cervix stump (n = 1), ureteral electrocoagulation (n = 1) and adnexectomy (n = 1). In 4 cases ligation of the ureter complicated surgical interventions for cancer of the sigmoid colon (n = 1) and rectum (n = 1), diverticulosis of the colon (n = 1) and portal cirrhosis of the liver with evident cirrhosis (n = 1). Surgical policy in the treatment of intraoperative urinary tract injuries was organ-saving. Only in 3 patients with severe acute pyelonephritis surgery was two-staged with prior nephrostomy. In the rest cases primary reconstructive operations were made. Two patients with bilateral injury of the ureters after uterine extirpation have undergone transabdominal bilateral reimplantation of the ureters by Boari in Gregoir's modification. Reconstruction of pelvic ureter was often made by using a urinary bladder graft (Boari's technique). In 1 female patient with extensive vesicovaginal fistula resultant in detruzor corrugation sigmocystoplasty was made with a good result. Serious complications after the reconstruction were absent. Urinary fistulas formed in 4 cases. In 3 of them they closed without surgical intervention. In 1 patient, to close urinary fistula complicating ureterocystoanastomosis Boari's operation was conducted with a favourable outcome. Reconstructive operations saved the kidney function.
As part of an institution-wide program to enhance the education of physicians in diagnosing and treating alcohol dependence and abuse, a comprehensive survey was conducted in which all new admissions to the adult inpatient services of The Johns Hopkins Hospital were screened for alcoholism. The prevalence of screen-positive alcoholism, by department, was as follows: medicine (25%), psychiatry (30%), neurology (19%), obstetrics-gynecology (12.5%), and surgery (23%). Detection rates by the house staff and faculty physicians caring for those patients who screened positively were less than 25% in surgery and obstetrics-gynecology, between 25% and 50% in neurology and medicine, and greater than 50% in psychiatry. However, physicians were less likely to identify as alcoholic those patients with higher incomes, higher education, or private medical insurance; women; and those who denied heavy alcohol intake. Physician-instituted treatment rates for those patients diagnosed by the physician as having nonrecovered alcoholism were less than 50% in surgery and obstetrics-gynecology, between 50% and 75% in medicine and neurology, and 100% in psychiatry. The extent to which the physicians intervened while the patient was hospitalized correlated with the patient's reported change in alcohol use after discharge. Recommendations based on these data are being incorporated into the medical education curriculum.
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We have previously discussed the general principles of antibacterial prophylaxis in surgery, and its use in orthopaedic surgery, gastrointestinal and biliary surgery and urogenital, obstetric and gynaecological surgery. Here we consider the role of prophylaxis in reconstructive surgery involving the arteries of the abdomen, pelvis and legs.
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