Surgical Gynecology

Gynecology is principally an operative specialty and the range of gynecologic procedures managed is constantly expanding due to improved instrumentation and minimally invasive techniques. Covering the entire spectrum of gynecologic surgery through a case-based, digestible format, procedures such as vaginal, transvaginal, hysteroscopic, laparoscopic, robotic, and abdominal procedures are included, as well as common surgical challenges and complications. For each case, a clinical vignette outlines the situation and the clinical context of the patient, followed by a comprehensive discussion of the evidence-based management approach and key teaching points. The decision to operate, contraindications, alternatives to surgery and preoperative counseling is discussed in detail along with the level of care needed for each case. Readers will improve their knowledge base of gynecologic surgery and gain multiple tools to overcome common surgical obstacles.

Analysis of the styles of coping with stress in women in the preoperative period

IntroductionStress constitutes a serious social and health problem. At the beginning of the 21st century, it became a very common and popular topic in medicine. As such, it is important to conduct studies on the causes of preoperative stress and strategies of dealing with it, especially in a hospital environment. Our research results, alongside numerous other studies, show that the problem is still present.The aim of the study was to analyze the styles of coping with stress in women before surgeries using the Coping Inventory for Stressful Situations (CISS).Materials and methodsThe study was conducted on 339 women admitted to a surgical gynecology clinic. A diagnostic survey with a questionnaire CISS was conducted.ResultsThe most dominant style of coping with stress is the avoidance-oriented style which is prevalent in 35.4% of respondents. The study shows that use of the avoidance-oriented style decreases with age (p = 0.007). Younger women try to avoid stress by socializing more frequently than older individuals. Less-educated women focus on avoiding stress more often (p = 0.017) than well-educated women who are more task-oriented (p = 0.011). Women with fewer past surgeries seek social contact to avoid stress more frequently (p = 0.019). Engaging in substitutive activities is more prevalent among women who underwent surgeries where the abdominal cavity is opened.Conclusions1. Gynecological surgeries are a source of stress and a great emotional burden for women. 2. Older, well-educated women show better skills in coping with preoperative stress. 3. Most respondents use the avoidance-oriented style.

Frequency of etiologies of acute kidney injury in Faisalabad and surrounding districts

Background: To find out the causes of Acute Kidney Injury (AKI) in population.Methods: A total of 150 patients were enrolled from medical, surgical, gynecology and obstetrics units of Allied Hospital and Madinah Teaching Hospital, Faisalabad, Pakistan. History, physical examination and investigations were recorded on specially designed proforma. Patients were evaluated to find out the etiologies of AKI. All patients were subjected to urine analysis, complete blood count, blood biochemistry (urea, creatinine, electrolytes, uric acid, calcium and phosphorus) and ultrasound scan of the abdomen and pelvis. Renal biopsy, immunological assays, such as hepatitis B surface antigen, anti-hepatitis C virus antibody, complements level, antinuclear antibody, anti-double-stranded DNA, anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody were performed in selected cases.Results: Male (36%) and female (64%). Pre-renal AKI was most common and was reported in 80 patients (53.33%). Intrinsic Renal azotemia in 56 patients (37.33%). Post renal azotemia in 14 patients (9.33%). Among 80 patients of prerenal AKI, hemorrhage in 45(56.25%), gastroenteritis in 16(20%), sepsis in 8(10%), cardiac diseases in 4(5%), hepatorenal syndrome in 3 (3.75%), peritonitis in 2 (2.50%) and burns in 2(2.50%) were the main causes of Pre-renal AKI. Among 56 patients of intrinsic renal AKI, 40(71.4%) had acute tubular necrosis (ATN), 12(21.4%) with multifactorial causes and 4(7.14%) were found to have glomerulonephritis. Among 14 patients of post renal AKI, 6(42.9%) were having calculi, 6(42.9%) were to have enlarged prostate and 2(4.3%) were having stricture urethra. In this study, contribution of obstetrical, medical and surgical etiologies were recorded as 40%, 36% and 20% respectively.Conclusions: In contrast to study reported from neighbouring country, this study shows rather increase in pregnancy related AKI.

Single clinical observations pseudopapillary solid neoplasms of the pancreas in pregnant women

The article presents the world data on the incidence, clinical picture and diagnosis of solid pseudopapillary neoplasm both in general and in pregnant women. Two clinical cases of solid pseudopapillary neoplasm in pregnant women were described in detail, with highly specialized surgical and perinatal care in the hospitals of the Center for Surgery of Liver, Biliary and Pancreatic Diseases n.V.S.Zemskov (surgical department) and in the department of surgical gynecology of the SI «Institute of pediatrics, obstetrics and gynecology National Academy of Medical Sciences of Ukraine». Demonstrate the features of diagnosis, surgical treatment of patients with solid pseudopapillary neoplasms during pregnancy. Key words: solid pseudopapillary neoplasm, surgical treatment, pregnancy, management of pregnancy and childbirth.

The experience of laparoscopically assisted vaginal hysterectomy

Introduction.Surgical laparoscopy has been widely adopted in gynecological practice. The first laparoscopic operation was carried out in our center in 1991. Lately different types of laparoscopic hysterectomy have been applied in surgical gynecology. In our clinic we widely use laparoscopically assisted vaginal hysterectomy, which was first performed here in 1996.