Treatments of unscheduled vaginal bleeding due to progestin-only contraception.

OBJECTIVES: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effectiveness, safety, and side effects associated with the usage of different treatments for unscheduled vaginal bleeding in premenopausal women using progestin-only pills.

Development of a Neurosurgical Cadaver Laboratory despite Limited Resources.

OBJECTIVE: Our neurosurgical program did not have a cadaver laboratory. The need to create one arose following a decrease in elective cranial cases at our institution after Hurricane Maria. Many neurosurgical programs are in countries where financial support for projects such as developing a cadaver research laboratory cannot be expected from their parent institutions. This article describes how, despite limited resources, a neurosurgical cadaver dissection laboratory can be created and maintained to promote resident education and stimulate future research. MATERIALS AND METHODS: The University of Puerto Rico Institutional Review Board evaluated and approved the proposal for creating a neurosurgical cadaver laboratory. The process to establish the laboratory was broken into steps. After obtaining the basic materials, the laboratory was created. RESULTS: The creation of our neurosurgical cadaver laboratory was divided into discrete steps that can be undertaken by any institution with a similar goal. First, a suitable workspace was identified. Second, the surgical instruments and equipment required to perform dissections were obtained. Third, cadaveric specimens for dissection and for practicing surgical approaches were acquired. Last, documentation regarding the laboratory's development was maintained, and an expansion plan was created. We created a dissection laboratory by gathering decommissioned or donated operating room equipment, seeking out contributions from other institutions, and, sometimes, by monetary contribution from the faculty or residents. CONCLUSION: Clear goals, interdepartmental collaboration, and a high degree of motivation were essential in creating, despite limited resources, a working neurosurgical cadaver laboratory to improve resident education.

Neurosurgery Technical Procedure: Surgeon's Position during Microscopic Transsphenoidal Surgery.

The surgeon's position in relation to the patient has been modified throughout the years for transsphenoidal surgery (TSS). Nowadays, if a microscopic approach is used, most centers place the surgeon at the side of the patient's head with the patient facing him. In this paper, we propose a more ergonomic and time-proven setup for this type of surgery. Since the early 1980s, our neurosurgical section has been using an approach where the surgeon stands behind the patient's head with the microscope tower on the surgeon's back. This position is rarely mentioned in the literature. We want to refresh this position for those who still use the microscope and those young neurosurgeons and residents who do most of their work endoscopically. We consider that when the surgeon is standing behind the patient's head, it is more comfortable for the surgeon. Also, it allows for the assistant to be close enough to help during the surgery. This technical note may bring new ideas for those using the microscopic TSS.