Complex uterine surgery: a cooperative role for interventional radiology with hysteroscopic surgery.

OBJECTIVE: To describe the value of concurrent interventional radiology with hysteroscopy for the management of complex intrauterine abnormalities. DESIGN: A new descriptive technique. SETTING: Tertiary care center. PATIENT(S): Three case reports. INTERVENTION(S): Interventional radiology with the placement of guidewires and/or dilatation of resistant structures may assist with hysteroscopic management of complex intrauterine abnormalities or may be a primary therapeutic option. MAIN OUTCOME MEASURE(S): Resolution of dysmenorrhea and restoration of fertility. RESULT(S): The placement of a guidewire into an occluded portion of the intrauterine cavity provides direction and safety for hysteroscopic resolution of the underlying problem. In the last case, placement of the guidewire and passing dilators over the guidewire provided complete treatment. CONCLUSION(S): The uterine cavity or a smaller segment of it may be blocked by occlusive fibrous tissue that is not amenable to standard hysteroscopic dissection. Combining radiologic imaging with hysteroscopic surgery allows visual access to instrumentation and the hidden structures or organs throughout the entire procedure. It adds complexity to the surgery but may allow restoration of function to an organ or structure that is otherwise inaccessible.

The unit nurse executive: a changing perspective.

A study describes the perception of unit nurse managers (head nurses/nurse executives) as to what constituted their role functions, activities and responsibilities. Four major components were used to clarify this description: administration, clinical practice, education and research.

Endometrial Ablation for Menorrhagia: Will this procedure become a mainstay of treatment?

Endometrial ablation is a relatively new treatment for patients with persistent menorrhagia. The procedure can be performed by either laser photocoagulation or electrocoagulation; both have a very low risk of complication. Generally, less than 24 hours of hospitalization is required and return to normal activities, including work, is almost immediate. Endometrial ablation is likely to become a mainstay of treatment for menorrhagia as the technology and training become more readily available.

Carcinoma in situ of the vagina.

A review was made of 136 cases of carcinoma in situ of the vagina seen over a 30-year period, 1953 to 1982. The patients ranged in age from 17 to 77 years, with a mean age of 55 years. One hundred sixteen patients (85%) presented with an abnormal Papanicolaou smear. Colposcopically directed biopsies were used for diagnosis in 62% of the patients. The upper one third of the vagina was the most common site of disease, with 54% of patients having unifocal lesions. A previous hysterectomy had been performed in 71% of patients, 35% of whom had undergone operation for benign disease. A concomitant, subsequent, or prior neoplasm of the lower genital tract or pelvis was noted in 109 patients. Surgical intervention in the form of either wide local excision or partial or total vaginectomy was the most frequently used method of treatment. Radiotherapy, usually in the form of a vaginal mold, was the second most commonly used method of treatment, and it was used in 27 patients. Radiotherapy and more extensive surgical treatment methods gave the best results. Four patients subsequently developed invasive carcinoma of the vagina.