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1.
Isr Med Assoc J ; 22(1): 13-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927799

RESUMO

BACKGROUND: During Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) the surgeon operates exclusively through a single vaginal entry point, leaving no external scarring. OBJECTIVES: To evaluate the learning curve of vNOTES hysterectomy by experienced gynecologists based on surgical times and short-term outcomes. METHODS: A retrospective study was conducted of the first 25 vNOTES hysterectomy surgeries performed from July to December 2018 at Rambam Health Care Campus by a single surgeon. The primary outcome was hysterectomy time. Secondary outcomes included intra-operative bleeding, length of hospitalization, postoperative pain, and need for analgesia. Socio-demographic and clinical data were retrieved from patient electronic medical charts. RESULTS: Median age was 64.5 years (range 40-79). Median hysterectomy time was 38 minutes (range 30-49) from the first cut until completion. Comparisons between median hysterectomy time in the first 10 hysterectomies and in the 15 subsequent procedures demonstrated a significant decrease in median total time: 45 minutes (range 41-49) vs. 32 minutes (range 30-38), respectively (P = 0.024). The median estimated intraoperative blood loss decreased from 100 ml (range 70-200) in the first 10 hysterectomies to 40 ml (range 20-100) in the subsequent procedures (P = 0.011). CONCLUSIONS: vNOTES hysterectomy is feasible by an experienced gynecologist, with an exponential improvement in surgical performance in a short period as expressed by the improvement in hysterectomy time, low complication rates, negligible blood loss, minimal post-surgical pain, fast recovery, and short hospitalization. vNOTES allows easier and safer access to adnexal removal compared to conventional vaginal surgery.


Assuntos
Ginecologia/educação , Histerectomia Vaginal/educação , Curva de Aprendizado , Cirurgia Endoscópica por Orifício Natural/educação , Adulto , Idoso , Feminino , Humanos , Histerectomia Vaginal/métodos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
4.
Ceska Gynekol ; 84(5): 341-344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826630

RESUMO

OBJECTIVE: This article stresses an impact of appropriate management work up in the diagnosis of acute apendicitis in puerperium. Atypical clinical symptoms may cause doubts in diagnosis and may delay necessary surgical intervention. DESIGN: Case report. SETTINGS: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, and Hospital Na Bulovce, Prague. METHODS: We present a case report describing an atypical presentation of acute apendicitis in early puerperium. Due to atypical course of the disease and atypical imaging locality and morphology, there were doubts about the diagnosis of acute apendicitis, patient was treated conservativelly and the disease later resulted in extensive surgical intervention. CONCLUSION: Acute appendicitis is the most common cause of non-urogenital morbidity in puerperium. Management of work up and timing of surgical intervention have key impact on maternal mortality and morbidity.


Assuntos
Apendicite/diagnóstico , Período Pós-Parto , Doença Aguda , Feminino , Ginecologia , Humanos , Morbidade , Gravidez
5.
Ceska Gynekol ; 84(5): 376-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826636

RESUMO

OBJECTIVE: To summarize current knowledge of the ERAS protocol in gynecologic oncology surgery. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Department of Obstetrics and Gynecology, University of Ostrava, Ostrava. METHODS: Literature review, PubMed and Medline databases were used to search relevant literature from 1995 to 2019. CONCLUSION: ERAS (Enhanced Recovery after Surgery) is a perioperative treatment program based on evidence-based medicine. Guidelines consist of pre-operative, perioperative and post-operative care items. Implementation of the ERAS protocol leads to a decrease in complications up to 40% and a reduction in hospitalization by up to 30%, thereby reducing overall costs without increasing the number of rehospitalizations. Multidisciplinary cooperation not only with anesthesiologists and consultant surgeons, but also with nutritional specialists and nurses is crucial.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/normas , Assistência Perioperatória/normas , Cuidados Pós-Operatórios/normas , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Medicina Baseada em Evidências , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Ginecologia , Humanos , Complicações Pós-Operatórias
8.
Presse Med ; 48(11 Pt 1): 1288-1294, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31727484

RESUMO

Menopause is associated with a significant increase in arterial and metabolic risk. Systolic hypertension is common in post-menopausal women. Measurement of blood pressure should be repeated systematically at each visit. Ambulatory blood pressure measurements should be encouraged, especially to detect nocturnal hypertension and to prevent more efficiently women at risk. Self-testing of hypertension by home blood pressure should be encouraged at menopause. Antihypertensive treatment should be initiated after ambulatory blood pressure monitoring in association with reinforced lifestyle. Furthermore, global level of cardiovascular risk should take into account before starting antihypertensive treatment. There are no women specificities in the choice of the initial treatment except thiazide diuretics which should be preferred in osteoporotic women. In hypertensive women and with disabling climacteric symptoms under 60 and within 10 years after the onset of menopause, post-menopausal hormone therapy can be offered in absence of arterial or venous contraindications. A preliminary discussion between gynecologist, cardiologist and general practionner is necessary before deciding to treat a post-menopausal women for her climacteric symptoms. A clear information on the benefit-risk balance of post-menopausal hormone therapy should be given to the women. The information should be recorded in the medical file. Cooperation between cardiologists, gynecologists and general practionners should be promoted in France, to optimize the care pathways in these women at risk and to improve medical practices.


Assuntos
Hipertensão , Pós-Menopausa , Fatores Etários , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/métodos , Cardiologia , Feminino , Ginecologia , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Hipertensão/terapia , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Medicina de Precisão , Autocuidado , Fatores de Tempo
10.
Presse Med ; 48(11 Pt 1): 1301-1305, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31727486

RESUMO

Menopause requires the implementation of organized screening and dedicated care pathways in collaboration with the attending physician, the gynaecologist-obstetrician and the cardiovascular physician. It will be necessary to take into account the hormonal specificities of the cardiovascular risk, in order to know-how to properly prescribe hormonal treatments.


Assuntos
Procedimentos Clínicos/organização & administração , Hipertensão/terapia , Menopausa , Cardiologia , Feminino , França , Ginecologia , Humanos , Hipertensão/diagnóstico , Pessoa de Meia-Idade , Obstetrícia , Equipe de Assistência ao Paciente/organização & administração
11.
Presse Med ; 48(11 Pt 1): 1249-1256, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31727491

RESUMO

Cardiovascular diseases are become the primary cause of death in women. The cardiovascular risk of the woman has unknown specificities and remains underestimated. At equal age, women have more cardio vascular risk factors than men. All these specificities must be taken into account for an optimized evaluation of cardiovascular risk and for improvement of CV management in women. Some traditional risk factors are more deleterious in women such as hypertension, tobacco, diabetes or psycho-social stress and they are less well controlled compared to men. Women are also exposed to hormonal risk factors (contraception, pregnancy and menopause) or to emergent risk situations (migraine with aura, endometriosis, polycystic ovary syndrome, auto-immune diseases…). Conversely, lifestyle measures (regular physical activity, no smoking, healthy diet, stress management) are extremely effective in primary and secondary prevention in women. Predicting the risk of cardiovascular events in women is difficult because the classic risk scores (SCORE, Framingham…) do not take into account hormonal CV specificities and underestimate the women CV risk. Until then, only the specific women AHA stratification of CVR allowed for appropriate care for them. Recently, at the initiative of the French Society of hypertension, a consensus of experts proposed a stratification of CVR adapted to French women, to help practitioners in their care, especially for the two hormonal periods as contraception and menopause.


Assuntos
Doenças Cardiovasculares/etiologia , Cardiologia , Doenças Cardiovasculares/prevenção & controle , Anticoncepção/efeitos adversos , Angiopatias Diabéticas/etiologia , Endometriose/complicações , Feminino , França , Ginecologia , Humanos , Hipertensão/complicações , Menopausa , Equipe de Assistência ao Paciente , Síndrome do Ovário Policístico/complicações , Gravidez , Prevenção Primária , Medição de Risco , Fatores de Risco , Prevenção Secundária , Fatores Sexuais , Fumar/efeitos adversos , Sociedades Médicas , Estresse Psicológico/complicações
15.
Rev Prat ; 69(4): 417-422, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626499

RESUMO

Menometrorrhagia is a frequent bleeding symptom in young women, and may be related to an inherited bleeding disorder. If there is no gynecological etiology, hemostasis tests are required. The early medical management of these teenage girls is important, especially when a bleeding disorder is known. The bleeding risk of the first periods may then be anticipated. Afterwards, the objective of the treatment is to keep the bleeding symptoms under control: anti-fibrinolytic treatment, specific replacement therapy for bleeding disorder and hormonal treatment. This management requires a multidisciplinary medical team, mainly hematologist and gynecologist, all along the genital lifespan, from the first periods to the desire for pregnancy.


Assuntos
Transtornos Herdados da Coagulação Sanguínea , Menorragia , Adolescente , Transtornos Herdados da Coagulação Sanguínea/terapia , Feminino , Ginecologia/normas , Hematologia/normas , Humanos , Menorragia/terapia , Menstruação/fisiologia , Obstetrícia/normas , Gravidez
16.
BMC Surg ; 19(1): 146, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619236

RESUMO

BACKGROUND: Simulation in laparoscopic surgery is nowadays recognized as a valid instrument for learning and training surgeons in different procedures. However, its role as evaluation test and self-assessment tool to verify basic surgical skills is still under discussion. METHODS: Thirty-three residents in obstetrics and gynecology at University of Pisa, Italy were recruited, and they received a simulation program consisting of 5 tasks. They had to perform basic laparoscopic surgery maneuvers as creating pneumoperitoneum, positioning trocars under vision, demonstrating the appropriate use of dominant and non-dominant hand and making single stitch and knot. They were evaluated with a modified OSATs scale. RESULTS: Senior trainees had better score than junior trainees (p value< 0,005) and after different sessions of simulation scores of both groups significantly improved (p < 0,001), especially for the junior group. All the trainees reported self-assessments that matched with the evaluation of external observers demonstrating the importance of simulation also as auto-evaluation test. CONCLUSIONS: In this study, we demonstrated the role of simulation as powerful tool to evaluate and to self-assess surgical technical skills and to improve own capacities, with the use of a modified OSATs scale adapted to specific exercises.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Internato e Residência , Laparoscopia/educação , Treinamento por Simulação , Competência Clínica , Ginecologia/educação , Humanos , Itália , Cirurgiões/educação
17.
J Pediatr Adolesc Gynecol ; 32(5S): S30-S35, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31585616

RESUMO

Adolescents are at high risk for unintended pregnancy and rapid repeat pregnancy, both of which can be associated with negative health and social outcomes. Intrauterine device (IUD) use has been shown to decrease unintended pregnancy and rapid repeat pregnancy. Evidence supports IUD insertion postabortion and postpartum as safe and practical for nearly all women, including adolescent and young adult women. Providers of adolescent gynecology can play an important role in decreasing repeat and unintended pregnancy among adolescents by increasing access to IUDs, reducing barriers to care, and providing IUDs immediately postabortion and postpartum.


Assuntos
Assistência ao Convalescente/métodos , Anticoncepção/métodos , Ginecologia/métodos , Acesso aos Serviços de Saúde , Dispositivos Intrauterinos , Aborto Induzido , Adolescente , Feminino , Humanos , Período Pós-Parto , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez não Planejada , Adulto Jovem
18.
J Pediatr Adolesc Gynecol ; 32(5S): S7-S13, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31585618

RESUMO

Professional organizations agree that adolescents are good candidates for intrauterine device (IUD) use. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists affirm that IUDs should be considered first-line as contraceptive methods for adolescents. Although the number of teens using IUDs is growing, multiple barriers remain, including systems, and patient- and provider-level obstacles. Only through concerted efforts and a committed action plan will adolescents achieve better access to IUDs.


Assuntos
Acesso aos Serviços de Saúde , Dispositivos Intrauterinos/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/métodos , Adolescente , Feminino , Ginecologia/educação , Ginecologia/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Gravidez na Adolescência/prevenção & controle
19.
Gynecol Oncol ; 155(2): 359-364, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31575391

RESUMO

OBJECTIVE: To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. METHODS: We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. RESULTS: The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. CONCLUSION: The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Bolsas de Estudo/tendências , Procedimentos Cirúrgicos em Ginecologia/educação , Ginecologia/educação , Oncologia/educação , Bolsas de Estudo/estatística & dados numéricos , Feminino , Florida , Procedimentos Cirúrgicos em Ginecologia/tendências , Ginecologia/tendências , Humanos , Histerectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Oncologia/tendências , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
20.
Anticancer Res ; 39(10): 5631-5637, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570460

RESUMO

BACKGROUND/AIM: Pelvic exenteration is a radical procedure for certain advanced or recurrent gynaecological cancers, performed with curative or palliative intent. Its validity has evolved as operative mortality and morbidity have improved. This surgery was evaluated to determine the validity of these claims. PATIENTS AND METHODS: The details of surgery and outcomes of 13 patients who underwent pelvic exenteration (6 curative intent, 7 palliative intent) for advanced or recurrent gynaecological cancers in our Department were retrospectively evaluated. RESULTS: There were no significant differences in blood loss, surgical time, hospital stay, and complications between curative pelvic exenteration and palliative pelvic exenteration. The curative intent group had a good prognosis; the palliative-intent group showed a trend to a worse prognosis. All patients' symptoms were relieved, but in patients with short survival, symptom relief lasted for up to 3 months. CONCLUSION: Pelvic exenteration is an acceptable and valuable procedure for gynaecological cancers.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Duração da Cirurgia , Exenteração Pélvica/métodos , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Adulto Jovem
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