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19 results

Clinical Gynecology
  • 2nd edition
  • Edited by Eric J. Bieber, Joseph S. Sanfilippo, Ira R. Horowitz, Mahmood I. Shafi
  • Published online:
    05 April 2015
    Print publication:
    23 April 2015
  • Written with the busy practice in mind, this book delivers clinically focused, evidence-based gynecology guidance in a quick-reference format. It explores etiology, screening, tests, diagnosis, and treatment for a full range of gynecologic health issues. The coverage includes the full range of gynecologic malignancies, reproductive endocrinology and infertility, infectious diseases, urogynecologic problems, gynecologic concerns in children and adolescents, and surgical interventions including minimally invasive surgical procedures. Information is easy to find and absorb owing to the extensive use of full-color diagrams, algorithms, and illustrations. The new edition has been expanded to include aspects of gynecology important in international and resource-poor settings.

  • 9 - Pediatric and Adolescent Gynecologic Laparoscopy

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 82-90

  • Summary

    This chapter focuses on the use of laparoscopy in treatment and diagnosis of patients with pelvic pain, adnexal masses, and pelvic inflammatory disease (PID). A discussion of incidental appendectomy in these patients will also be presented. The decision to perform incidental appendectomy is based on the premise that the appendix is a vestigial, functionless organ, with the potential only to contribute to pathological change. PID can have devastating consequences to adolescent females. With the advent of in vitro fertilization, surgeons should attempt to perform the most conservative surgery that is safely possible, in order to maintain the option of future childbearing. Diagnosis of endometriosis should not be delayed in adolescents. A delay may not only postpone symptomatic relief but also worsen the patient's future fertility and allow the disease to progress. Laparoscopy, as it applies to the pediatric and adolescent population, is a relative newcomer to the field.

  • 4 - Abdominal myomectomy

  • Edited by Togas Tulandi, McGill University, Montréal
  • Book:
    Uterine Fibroids
    Published online:
    10 November 2010
    Print publication:
    23 October 2003, pp 31-40

  • Summary

    Introduction

    It is estimated that approximately 25% of women in the reproductive age have uterine leiomyomas. Even more convincing is that autopsy studies show an incidence as high as 75%. Uterine leiomyoma is responsible for a hysterectomy in up to 1.7 million women. Women of reproductive age who have symptomatic myomas have a number of alternative approaches of treatment available to them including abdominal myomectomy, laparoscopic myomectomy, laparoscopic assisted myomectomy, which includes a mini-laparotomy for uterine repair, and hysteroscopic resection, plus a host of other approaches such as freezing, i.e., cryomyolysis, as well as utilization of high energy sources for destruction of the myoma.

    Most importantly, clinicians should be aware of current thinking regarding myomas from a number of perspectives including cytogenetics, hormonal effects, growth factor effects, and also extracellular matrix related factors.

    With respect to cytogenetics, there is evidence that myomas are three to nine times more frequent in black than in white women. This information suggests a probable genetic pre-disposition. While a specific gene has not been clearly identified, chromosomal analysis of uterine myomas has revealed non-random tumor specific cytogenetic abnormalities in up to 40% of specimens evaluated. Multiple genetic loci have been proposed in the pathogenesis of leiomyomas.

    Estrogen and progesterone have an effect on myoma growth following onset of menopause. More specifically, leiomyomas express increased concentrations of aromatase cytochrome P450 mRNA with an associated lower rate of conversion of estradiol to estrone.