Obstetrics and Gynaecology Forum - Volume 12, Issue 2, 2002
Volume 12, Issue 2, 2002
Author G. DreyerSource: Obstetrics and Gynaecology Forum 12, pp 2 –7 (2002)More Less
Many aspects of the surgical treatment of gynaecologic cancers are currently undergoing reassessment. Some issues that hold most potential to drastically influence future health, future treatment or future reproductive potential of the individual patient will be reviewed here in an effort to provide guidelines and practical strategies for some of the controversial issues, based on an interpretation of the current literature. It has become clear that the preservation of ovarian or even reproductive function is feasible, safe and therefore desirable in some patients with gynaecological cancer. The place for conservative strategies in cervical and ovarian cancer will be discussed. The role of lymphadenectomy and lymph node sampling in gynaecologic surgery is a hotly debated issue. While the indications will undoubtedly change even in the near future, an attempt will be made to provide current indications and to describe the emerging consensus.
Author L. SnymanSource: Obstetrics and Gynaecology Forum 12, pp 8 –13 (2002)More Less
The caesarean section rate has increased over recent years throughout the world. No acceptable ideal caesarean section rate has been agreed upon, and values in the developed world vary from 10% in Sweden to 38% in Chile. Some areas of Brazil have a rate of 75%! Is the high caesarean section rate a cause for concern? The answer is obviously "yes". The more important question might be : for whom? Who might be concerned, or who should be concerned? Are academics concerned about the high caesarean section rate (what should the "normal" rate be?). Should the obstetricians in private practice be concerned, or perhaps the medical fund providers? Maybe the patients should be concerned as they are on the receiving end, or perhaps the paediatricians should be concerned on behalf of the neonate. And don't forget about the ethicists among us - they might also be concerned about this issue. It is obvious that there are many role players in this debate, and this review will attempt to look at all the different issues regarding caesarean sections, hopefully in such a way that it will allow everybody to decide for him / herself whether there are reasons for concern or not.
Source: Obstetrics and Gynaecology Forum 12, pp 14 –17 (2002)More Less
It may be speculated that having a chaperone present during the intimate clinical examination was originally instituted to protect women from inappropriate advances by the doctor. In the current medico legal climate the rationale has probably been reversed, and the presence of a chaperone is felt to minimize the risk of the patient accusing the doctor of taking unnecessary liberties. Medical indemnity organizations consider the presence of a chaperone helpful in the defence of a doctor against an allegation of sexual misconduct during an intimate examination, however realize that presence of a third party does not necessarily protect either the patient or the doctor and may be counterproductive in some situations.
Author V. EeckhoutSource: Obstetrics and Gynaecology Forum 12, pp 18 –25 (2002)More Less
Congenital adrenal hyperplasia develops secondary to inherited enzyme defects in adrenal steroidogenesis. Feedback from deficient cortisol production causes the pituitary gland to secrete increased ACTH (adrenocorticotropin), with consequent enhanced adrenal stimulation and development of hyperplasia of the adrenal glands. The syndrome occurs in 1 / 5 000 to 1 / 10 000 births and early diagnosis is important, as severe metabolic disturbances in some forms of the condition may lead to demise of the newborn infant. Early treatment is also important to prevent developmental abnormalities. Incomplete enzyme defects may present postnatally or at puberty when increased adrenal activity reveals the enzyme abnormalities.
Author H. De MuelenaereSource: Obstetrics and Gynaecology Forum 12, pp 26 –31 (2002)More Less
As an endoscopic procedure, hysteroscopy is still neglected when compared to the widely practiced laparoscopic procedures. Despite having all the advantages of laparoscopy, namely direct optical judgement of body cavities, the possibility of surgical treatment during the same procedure, less trauma, reduced post-op pain and shorter hospital stay, hysteroscopy developed with greater difficulty. Reasons for this are the fragile endometrium, the virtual cavity and problems with the distention media, which all require special instrumentation and techniques. In addition, operative procedures require a complicated instrumentation set-up, special surgical training and knowledge of complications and their appropriate management. Modern women are increasingly demanding conservation of their uterus and hysteroscopy as a procedure has documented success in correcting problems with abnormal bleeding, infertility and pregnancy wastage.