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A very Emergency case, The Mother of my best friend, the results of her MRI said that she had nodular peritoneal thickening that suggested peritoneal serosal carcinoma, and ovarian cancer, also she has ascites, what is the source of ascites in case of high CA-125? We are suggesting a surgery to remove the ovarian, peritoneal biopsy and taking different samples to histology laboratory for culture and characterization, Any Informations would be helpful and well Appreciated, Many Thanks
Ali
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I am NOT a doctor but as compter science professional, little more AI provided detail:
In cases where there is nodular peritoneal thickening, ovarian cancer, and ascites, the source of ascites can be the result of various factors, including the presence of cancer cells in the peritoneal cavity.
CA-125 is a tumor marker that is often elevated in cases of ovarian cancer, although it can also be elevated in other conditions. The presence of high CA-125 levels, along with the imaging findings of nodular peritoneal thickening, suggests the possibility of peritoneal serosal carcinoma, which is a type of cancer that affects the lining of the abdominal cavity (peritoneum). Ovarian cancer can sometimes spread to the peritoneum, leading to peritoneal serosal carcinoma.
Ascites refers to the accumulation of fluid in the abdominal cavity. In the context of ovarian cancer, ascites can occur due to several reasons, including:
1. Peritoneal involvement: Cancer cells can spread to the peritoneum, leading to inflammation and the production of fluid.
2. Impaired lymphatic drainage: The presence of cancer can disrupt the normal flow of lymphatic fluid, leading to its accumulation in the abdomen.
3. Liver involvement: Advanced ovarian cancer can involve the liver, leading to impaired liver function and fluid accumulation.
Surgery, as you mentioned, is often a crucial component of the treatment plan for ovarian cancer. The specific surgical procedures performed can vary depending on the individual case, but they may include removal of the ovaries (oophorectomy), peritoneal biopsy, and collection of various samples for histological examination. These procedures aim to obtain a definitive diagnosis, determine the extent of the disease, and guide further treatment decisions.
Please consult qualified healthcare professionals who can provide personalized advice and guidance based on the specific details of your best friend's mother's case. They will be able to provide the most accurate information and help determine the most appropriate course of action.
Hope it helps
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The patient is 4 days postpartum after a physiological delivery. Complaints of unbearable pain in the perineum and lumbar pain. There were minor internal tears. On examination, there is no inflammation, no swelling. Pain relief with ketoprofen is of little help. Can you please advise how to anaesthetise or partially relieve the pain?
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Volodymyr, it is important to find the reason of the pain.
- Infection (endometritis, perineal, UTI)?
- Urinary retention?
- Haematoma or other trauma?
- Neurological? (for example from sacral plexus or pudendus?)
Women postpartum generally can receive both paracetamol and NSAID, some few days of Oxykodon can be okay if the neonatologists are fine with it (or if she is not breastfeeding). In some cases, epidural or nerve block can help postpartum also. But the priority is to find out what's the problem, not just releive pain.
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In which trimester i.e. 1st or 2nd or 3rd, the mean score was higher on Revised Pregnancy Distress Questionnaire (NuPDQ) 17 items, references to the previous researches ?
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Dear Dr :Atiq Ur Rehman
looking forward to read good answer and participation . thank you for this question .
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Women undergoing risk reducing bilateral salpingo-oophorectomy especially if they are BRCA1 or BRCA2 pathogenic variant carriers are warned of a residual risk of primary peritoneal cancer. A meta-analysis of studies showed only a 79% reduction in risk of ovarian type cancer after BSO in BRCA1 and BRCA2 carriers. Meaning for a BRCA1 carrier there could still be a 10% risk of primary peritoneal cancer with a high likely mortality rate. Having been involved in referring women to a gynaecological service that undertakes very careful surgery with bagging of the tubes and ovaries we have only now seen our first primary peritoneal cancer after more than 38 years of operations on nearly 600 carriers. Given that it is now thought that the great majority of high grade serous ovarian cancers originate from fimbrial precursor cells rather than for instance ovarian rest cells we feel that if careful surgery is undertaken early enough before the main risk period that this risk reduction is likely to be >95% rather than only 79%. This means a residual risk of only around 2% for BRCA1 and 1% for BRCA2. Do fellow clinicians agree?
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Risk of peritoneal cancer after risk reducing SO in BRCA mutation carries depends on timing and technique of surgery ranging from 1to 10%.Counselling and patient selection is important.
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Hello
Recently, I am curious to know about mechanisms of endometriosis and signaling pathways.
I have a question about the difference between signaling pathways in benign tumors and malignant tumors.
Since I studied, I noticed that the signaling pathway involved in benign and cancerous cells is similar, like MAPK signaling, Wnt Signaling, Apoptosis, Cell adhesion and angiogenesis.
So, what is the difference between endometriosis and ovary cancer in terms of pathway ?
Thank you in advance.
Kimiya
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It would be better to compare benign and malignant conditions in the same organ/tissue: endometriosis vs endometrial cancer, for example, instead of uterus compared with ovary tissue.
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I want to find the elastic modulus of the uterine artery. I know it may differ from a person to another but I guess an average value should exist.
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The elastic modulus of the uterine artery is particularly variable not only between individuals but also hugely variable in the same individual from time to time. This is specially correct during pregnancy, Menstruation, Ovulation.
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Like a new, better way of performing C-sections or avoiding pregnancy complications?
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Single port laparoscopy and single port robotic assisted laparoscopic surgery.
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COVID-19 has pull people apart from each other. Social distancing is the main way to prevent spreading of infection. Tele-medicine, once used for rural area remote healthcare model, is the emerging new way of practice under COVID-19.
Different specialties have different practicing needs, what difficulties do you encounter on applying tele-medicine under COVID-19 in your specialty? Will tele-medicine totally uproot the usual face-to-face room consultation of medical practitioners? And becoming the new service model?
What is your view?
Some references:
Virtually Perfect? Telemedicine for Covid-19
NEJM
DOI: 10.1056/NEJMp2003539
Covid-19 and Health Care’s Digital Revolution
NEJM
DOI: 10.1056/NEJMp2005835
Telemedicine in the Era of COVID-19
The Journal of Allergy and Clinical Immunology: In Practice
DOI: 10.1016/j.jaip.2020.03.008
Keep Calm and Log On: Telemedicine for COVID-19 Pandemic Response.
DOI: 10.12788/jhm.3419
‘Healing at a distance’—telemedicine and COVID-19
Public Money & Management
DOI: 10.1080/09540962.2020.1748855
The Role of Telehealth in Reducing the Mental Health Burden from COVID-19
Telemedicine and e-Health
DOI: 10.1089/tmj.2020.0068
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Hello, in Portugal, during Covid there was a huge increase of tele consultation. Still some barriers were found:
- older people have more difficulties in using digital tools.
- 3G and 4G coverage is still low in some rural areas.
- Lack of good tele consultation tools available to be used, some physicians then still want to do the face to face consultation.
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A study of the factors influencing the knowledge and attitude of mothers of under five children of a selected area of Kunderki, Moradabad U.P. regarding immunization and efficacy of a need based intervention strategy towards its improvement. In this experimental research study i need a conceptual framework .so please help me to design a conceptual model.
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Health belief model would be helpful. It encompasses behavior change interventions are more effective if they address an individual’s specific perceptions about susceptibility, benefits, barriers, and self-efficacy [5]. Interventions focusing on this model may involve risk calculation and prediction, as well as personalized advice and education.
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We have recently seen a pregnant lady presented ln last trimester with cyanosis and breadthlesness for the first time and latter found to have pulmonary arteriovenous fistula.. 
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Pregnancy is a hazardous period for women with PAVMs. There are incresed risks of pulmonary emboli and myocardial infarction with normal coronary arteries.
You can also follow this link.. Pulmonary Arteriovenous Malformations
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The operation (Vaginal Hysterectomy) took place 14 days ago, and she will undergo K.U.B scan (Radiology procedure) and she is wondering if taking castor oil (oral) will affect her negatively?
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Castor oil causes increses gut motility and use as laxative effective befor KUB . It has no side effects on surgical site .
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Medical History:
53 Y F, last degree prolapsed uterus presents with four ulcers, 2 on the surface of the uterus, one on the surface of cervix and another one (Can't recall the location). There is daily discharge. What is the appropriate treatment to eliminate the discharge until she undergoes vaginal hysterectomy? Local antibiotic therapy or what?
Medications she takes:
Bisoprolol 2.5 mg once daily for Atrial Fibrillation
Cetirizine 10 mg once daily for Allergic Rhinitis
Daflon 500 mg once daily for chronic venous insufficiency
Non-Alcoholic-Fatty liver disease (Not managed with medications)
Blood tests were done and no other abnormalities.
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This patient need to sent pap smear and accordingly she may need punch biobsy for ulcerative edges to exclude premalignant and malignant condition
regard her compleant she can putted on medication that improve the healing of these ulcers ,by return her uterus back inside pelvice by pack and local antibiotic eg.flumazin and treatment that decrase frction of pack with ulcer and treatment improving healing of ulcer
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Surgeons who treat patients with vulvar malignancy should be aware of the serious defect (Fig) following radical vulvectomy, which need immediate reconstruction.
Numerous vascularized flaps have been designed and validated for obliterating the dead space and closing the vulvoperineal skin defect. But the reconstructive surgery with flaps is somewhat like a way that rob Peter to pay Paul.
I had systematically searched the relevant articles in Pubmed with the search strategy and selection criteria “vulvar malignancies”; “vulva”, “vulvar”, “vulval”;“vulvectomy” ; “vulvar reconstruction” combined with“vulvovaginal reconstruction”; “quality of life”, no paper regarding the procedure of vulvar transplantation was found.
Is it possible to perform allogeneic vulvar transplantation with anastomosis of the internal pudendal artery aiming at recovering an acceptable cosmetic appearance.
Thank you for your attention.
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Hamid Asmouki Dear Dr. Hamid Asmouki, Many thanks for your comment, I agree with your suggestion. As the skin defect is close to anus opening, colostomy should be considered before reconstructive surgery or vulvar transplantation for avoiding the postoperative infection.
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There is a uterine prolapse (Last degree) and there is an ulcer. The Q is how can the patient apply the cream prescribed for the ulcer along with the antiseptic and Gauze (Also Vaseline is prescribed).
Is the cream (Mebo cream aids in healing) applied on the ulcer only?, and we impregnate the gauze with the antiseptic (Betadine) and apply it on the cervix and the vagina only, or apply it on the entire prolapsed uterus, and if so, how? Because as we previously applied the cream on the ulcer, so there will be overlapping of two ingredients (Mebo and Betadine) ? And finally how we raise the uterus with the Gauze?
I downloaded the image for illustration.
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Recommended treatment. For decubitus ulcer includes
1. Reduction
2. Ring pessary
3. Estrogen cream
Without pesaary there will be no improvement due to persistent cause which is tiusse necrosis.
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Maslach burnout inventory questionaire is used to assess burnout in health professionals.
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i can send it to you...
email me
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In the beginning of my study (2002),  I treated my POF patients with COC. But the results of my study confirm that, RHT is better.
Thank you for your answers.
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combined contraceptive pills had a synthetic estrogen which has no effect on removal of menopausal symptoms like hot flushes, osteoporosis and vaginal dryness but it had a negative effect on coronaries and heart attacks in opposite to HRTs so HRTs only recommended in management of premature ovarian failure
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There are contradictory data, two references are attached. What would be your decision ? Recommend it or not ?
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Studies show that Enalapril and enalaprilat have been detected in human breast milk; because of potential for serious ADRs in breastfed infant, including hypotension, hyperkalemia and renal impairment, there it is preferred not to use enalapril while breast feeding.
Source: @Medscape
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]Dear Colleagues and Researchers,
it is my great honor and privilege to invite you to submit original research or review for the upcoming special issue entitled "Natural Products and their Compounds in the Gynaecological Cancer Treatment". Your support and collaboration helps the special issue in reaching heights. It would be great if you could apply until 28 July 2017.
 
Please do let me know if you have any further questions.
Have a nice and healthy day!
With Kind Regards,
Guest Editor
Robert Kubina
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Yes, eCAM is an open access journal . We would like to invite you to submit original research or review for the new special issue entitled "Natural Products in a Breast Cancer Treatment and Chemoprevention".
With Kind Regards,
Guest Editor
Robert Kubina
Lead Guest Editor: Agata Kabala-Dzik Guest Editors: Marcello Iriti, Robert Kubina Submission Deadline: Friday, 4 May 2018 Publication Date: September 2018
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Some medical professionals in our country believe that if amniotic sac sac stays intact during giving birth, it needs to be artificially broken at least at cca 8 cm of cervical opening during the first stage of labor. They believe pushing with intact membranes can otherwise CAUSE placental abruption, which is dangerous for both mother and a child. What is the origin of this claim ? Is there any evidence supporting or refuting it ?
(I have seen a Cochrane review, which does NOT recommend a routine amniotomy during first stage of labor. Frustratingly, though, in that article, amniotomy is framed only as a measure to speed up labor. Placental abruption is not among the outcomes. )
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Amniotomy may hasten Labour progression by allowing fetal axis pressure to come into play early and hasten the release of prostaglandins , all which may impact positively on Labour progression but not necessarily Labour outcome has been well documented.
Similarly amniotomy is a well documented integral and cardinal component of management of placental abduction but not it's prevention. Of crucial significance is the fact amniotomy should be performed in a controlled fashion in order to prevent sudden decompression of intrauterine pressure particularly in cases of uterine overdistension due to e.g. polyhydramnios which may then predispose to placental abduction.
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Any tool to measure the postnatal quality of life would be perfect.
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If someone found the MGI tool, kindly share.
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Recently I've experienced strange finding in hysterectomy specimen with multiple myomas and adenomyosis and endometriosis in the serosal surface. Several clusters of endometrial tissue was found in the parametrial blood vessels and attached to the vessel lumen which doesn't seem to be just tissue contamination. What do I have to consider in this lesion?
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Endometriosis can spread via blood and lymphatic vessels. This underestimated fact can explain several rare symptoms or histopathological findings, e.g. endometriosis within the sciatic nerve or endometriosis at very distant localisations. Please, see also: Tempfer CB et al. Lymphatic spread of endometriosis to pelvic sentinel lymph nodes: a prospective clinical study. Fertil Steril. 2011 Sep;96(3):692-6. doi: 10.1016/j.fertnstert.2011.06.070 or Zamurovic M. Rare extrapelvic endometriosis on iliac vein wall--diagnosis and treatment. Clin Exp Obstet Gynecol. 2014;41(3):349-50.
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Ovarian reserve testing for fertility prediction is a common practice in gynecological routine. Even in scientific events, some may have listened to the postulate that tests should be part of a periodic female evaluation, as a counseling tool for reproductive planning. I do not know any reference of the value of ovarian reserve testing for women who have not tried to conceive. As a matter of fact, in my point of view, the value of ovarian reserve testing (if there is any) is exclusive for infertile women. What is your opinion?
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No single test is reliable to predict ovarian reserve, however, checking antral follicle count (AFC) by ultra sound on day 3 of the menses cycle and testing levels of Anti-mullerian Hormone (AMH) is considered reliable.  Both are non-invasive tests and are available almost everywhere.
The oocyte loss is a continuous process.  Regardless of conception, every month every woman will loose a certain number of follicles and even during the menstrual cycle.
I think there is no need to check ovarian reserve in young (<35 yrs) non-infertile woman.  These tests are required when a woman is having difficulty in conceiving and she is planning to do assisted reproductive technology procedure (IVF or ICSI).
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I received reasonable number of photos on breast from our colleagues in Research Gate.
I am looking for following as well, please see whether you can contribute. You will be acknowledged.
1. Nipple or breast piercing/ and their complications
2. tattooing in breast skin
3. breast implants and complications
4. developmental defects in breast
5. psoriasis, hydradenitis in submammary area/ breast skin
best regards
Ranthilaka
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hi
Ranthilaka, i also need breast skin infection images .please share with me
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Patient is married from last 5 years and has a child. Now she has difficulty in conceiving the second child. She is on Metformin 500mg twice a day.
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Laparoscopic ovarian drilling can be of help. Ofcource she may be advice on weight reduction if she is overweight
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I can't find any case report about it 
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Interesting case, it would be important to know/report on;
how they removed the subserosal fibroid, did they tie off the base and leave a good nubbin of fibroid tissue or did they shave the myometrium in the process; did they use adhesion prevention techniques or did an adhesion attached to the operative site rent the defect in later pregnancy. Was the original fibroid a solitary lesion or was it a multi-fibroid uterus, and one of the intramural fibroids undergo degeneration in pregnancy (predisposing to rupture). All the best.
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I assume this is an haematoma... But which exams will be mandatory after she'll give birth to her boy ?
Thank you
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Haematoma can occur in pregnancy. Adrenal mass detected during pregnancy is very uncommon. Because pheochromocytoma in pregnancy is associated with high mortality and morbidity, it always to be excluded. Because of nonenhanced and non hormonal nature of mass, pheochromocytoma is very unlikely in this patient. However contrast CTScan of whole abdomen will be helpful in this case.. MRI of abdomen will be also helpful. Cortisol estimation to done after delivery to look for late development of hypofunction of adrenal which can occur after adrenal haemorrhage to avoid adrenal crisis. 
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The pause of the female genital tract due to hormonal contraceptives, prevents abnormal ovules from recruitment during ovulation?
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such type of any correlation is not evident 
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CT and MRI of the pelvis with contrast, confirmed no evidence of bowel/vaginal fistula.
Hysteroscopy biopsy showed no malignancy
The patient had tubal sterilisation 30 years ago
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I think that we are in front of a case of severe vaginal discharge may be due to chronic infection associated with immune disturbance , vaginal swap and culture may be benificial 
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Dear friends and colleagues,
it is my great honor and privilege to invite you to submit original research or review for the upcoming special issue entitled "Natural Products and their Compounds in the Gynaecological Cancer Treatment". Your support and collaboration helps the special issue in reaching heights. It would be great if you could apply until 28 July 2017.
Please do let me know if you have any further questions.
Have a nice and healthy day!
With Kind Regards,
Robert Kubina
Guest Editor
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Dear,
I have a manuscript now but the is: phytochemistry investigation in relation with antioxidants.
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There is a significant gap in the management of oligometastatic disease, especially in endometrial and cervical cancer relapses. 
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No, sorry
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Does anyone have a questionnaire for endometriosis survey among adolescences ?
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Don't have a survey for adolescences but would suggest adapting any existing questionnaire to include age of onset of menses, cycle length - heavy/light/days, ? pain - severity, location
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hey guys, do you know more about that why the VEGF was highly expressed in stromal cells but not in epithelial cells of endomertiosis lesions? pls help me to understand 
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stroma is responsible for the activity of the disease , while glands isn`t active. over expression of VEGF is mandatory for neovascularisation and proliferation of the disease. but the epithelium and the glands also, express VEGF as well.
refer to : doi: 10.1093/humrep/13.6.1686 
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For a dilatation more than 2cm is a high risk for rupture of membrane during the cerclage. From 24 weeks of gestation the fetus is viable (OMS definition).
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I wish the subject were so simple as some of the answers above indicate. It is unfortunate that most if not all of the studies (RCTs) regarding cerclage in singleton as well as twin gestations were poorly designed, poorly executed, poorly analyzed and poorly interpreted. Our specialty has been unable to resolve the question, "does cerclage improve outcomes?" for more than 6 decades now. Is it not time then to realize and accept that the paradigm of incompetent cervix needs total overhaul?
The entire treatment scheme in patients with short cervix with or without dilation is based on the concept of cervical incompetence. Such intrinsic cervical failure is rare and we all know the possible causes for such a failure. Instead, the main cause of cervical shortening is intrauterine proinflammatory changes; and I do not mean to indicate here the highly overrated intrauterine infection, which is usually a secondary event. I mean non-infectious pro-inflammatory changes which lead to breakdown of the collagen structure of the cervix (proteolysis) and at the same time create a low level of uterine contractility, which might be felt or not by the patient. Careful and properly guided history in such patients reveals always symptomatology that is identifiable but for the most part discounted by obstetricians as well as their patients, as normal pregnancy nuisances.
1.     Low pelvic pressure
2.     Lower back pain in the coccygeal area
3.     “Gas pains”
4.     Pulling sensation in the lower pelvis
5.     Feeling of wetness in the vagina; not excess discharge, just feeling wet.
The above symptoms can be elicited in the vast majority of patients who present with a short cervix with or without dilation, if one only knew what questions to ask.
The inflammatory changes in the uterine environment that are responsible for such cervical injury are the result of subchorionic clots, placental thrombosis with necrotic changes in the chorionic villi (fetal thrombotic vasculopathy), decidual ischemia and thrombosis. Such pathology is almost always overlooked prenatally and it is only realized after the poor outcome has happened and only when the placenta is sent to pathology. This is not the way it should happen. We have the technology and the know how to assess such intrauterine changes, identify their cause and treat them accordingly. There is nothing that can stop preterm labor unless the primary cause of the inflammation is addressed and treated. Therefore, any role of the cerclage should be only secondary to address the potential cervical weakness that might have been caused by the inflammation and the primary treatment should be to address the cause of inflammation, eliminate it and at the same time treat the patient with anti-inflammatory agents. Synthetic and natural progesterone exert a mild anti-inflammatory effect and can be helpful but if one truly wishes to stop the inflammatory process in its tracks, Indomethacin is the best choice and well proven to prolong the pregnancy significantly as well as reduce prematurity. {Zuckerman H, et al. Obstet Gynecol 1974;44:787, Niebyl J. et al. Am J Obstet Gynecol 1980;136:1014, Zuckerman H. et al. J Perinat Med 1984;12:2}
We have presented evidence of superior outcomes when progressive cervical shortening is treated with Indomethacin; 70% of patients responded to Indomethacin only and 30% required cerclage placement due to partial response to Indomethacin. {J Matern Fetal Neonatal Med. 2011 Jan;24(1):79-85 } It is clear that Indomethacin can be used safely and achieves excellent results.
One need be aware however of the complications and the fact that fetal cardiac assessment is in order prior to the use of the drug as well as during the treatment. We have treated as of today more than a thousand patients and we have never experienced any fetal side effects beyond mild and temporary increase in the ductal peak systolic velocity, which however remained always well within the normal ranges. (data to be published soon) There were never a need to stop the medication due to side effects and we have treated patients on an intermittent fashion until 34 weeks.  The best that can be achieved with progesterone (natural or synthetic) is a 30% prematurity; well, this is almost 3 times the national USA average prematurity rate. Is it really wise to consider this a successful treatment modality?
In all the studies that progesterone was successful it was not because it reduced prematurity below the national average but below the control group, which for some unknown reasons presented unnaturally high levels of prematurity { N Engl J Med. 2003 Jun 12;348(24):2379-85}.
What works well for singleton pregnancies, usually works well also for multiple gestations, albeit, less successfully. The minimum goal of every obstetrician should be to get any such pregnancy to 32 weeks by all means. This is the time where quality of life can be acceptable without serious immediate and long-term consequences. To be comfortable with any baby been delivered before 28 weeks is insanity. Survival is not the important requirement here; high “quality of life” survival should be the demanded outcome. One should understand that no matter what we do, we will fail in a number of cases; failing after intense effort is part of life but failing because of lack of effort should be unacceptable. There is enough evidence for those willing to find it that doing nothing should be only a rare event and not the norm.  
Therefore, and with the above in mind, the answer to your question is as follows:
1.     Prepare the pregnancy for the worst possible outcome, early delivery
a.     Steroids
b.     Possible neuroprophylaxis with MgS04.
2.     Rule out infection
a.     Possible amniocentesis (controversial) of twin A to rule out intra-amniotic infection (10% of twin A have evidence of bacteria in the amniotic cavity when the cervix is dilated, most likely a secondary event). {Am J Obstet and Gynecol, 1990 Sep;163(3):757-61}.
b.     Cervical and vaginal cultures
3.     If you consider antibiotics (controversial), the use of Macrolides is a better choice due to inhibition of proteolysis that reduces the risk for amniotic sac damage.
4.     Indomethacin 50 mg p.o. stat and then q6h for a minimum of 7 days.
a.     Evaluate ductus arteriosus prior to indomethacin initiation and complete fetal echo (any MFM specialist should be able to do so).
b.     Baseline amniotic fluid for further evaluation during indomethacin treatment. Mild and clinically insignificant reduction of fluid is common in such cases but it reverses within 24 hours post discontinuation of treatment.
c.      After initial 7-day course, use Indomethacin for 2-3 days per week until 32-34 weeks and as long as the fetal ductus remains normal.
d.     Nifedipine XL 60 mg p.o. BID
5.     When infection has been ruled out, cerclage should be performed unless the cervical length responded well and improved after the start of Indomethacin.
a.     If the cervix remains dilated, use of 30 cc Foley balloon should be used to push the membranes back into the cavity so the cerclage can be placed at least 2-3 cm above the external cervical os. The mild reduction of the amniotic fluid from the use of Indomethacin will help also reduce the pressure of the amniotic sac and make it easier to push back again during the cerclage. In rare occasions, amniocentesis for amnioreduction might be the only way to place a cerclage. {Evans DJ, Kofinas AD, King K. Obstet Gynecol. 1992 May;79(5 ( Pt 2)):881-2.}
This might be the best treatment plan that could help you get this pregnancy to a safe gestational age assuming she has not been infected already.
Educate your patients about the mild symptoms mentioned above so you will identify such patients at an earlier stage at which time you will have a much better chance to succeed and prevent prematurity.
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Fundus images
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Thank you very much.
I need retinal image samples of women during and after pregnancy. A link will be of immense help to me. Any other ideas will be great.
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A 28 years old lady, height 5 feet, weight - 70 kg has been trying to conceive for the last on and a half years. She has a  32-33 days' menstrual cycle. Husband's semen analysis, follicular study and HSG reports are normal. Ultrasound of pelvis reveals evidence of polycystic ovaries with normal sized one ovary and other of 11 cc. She has been put on Tab Metformin 500 mg three times a day and Chirocyst by another Gynaecologist. She gives H/O partial seizures and is on Tab Orcabezapine. The patient uses Ovulation predictor kit to time intercourse. She used it on 14th and 16th day of the present cycle. The menstrual period got overdue by 6 days, yesterday. The patient used the Ovulation predictor kit and the result was positive. Today, she had a normal period. This is the first time that she had a delayed period. The query is, can ovulation predictor kit show positive result just one day prior to the onset of the menstrual period? Do the drugs she is taking interfere with LH levels?
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The specialty of the prescriber and age of the patient suggests possible PCOS in which case I would incline to link metformin to the unexpected changes noticed. Drug use is in that case appropriate and expected to contribute positively in the overall context
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A 23 years old unmarried lady had reported during last week of August 2016 with C/O amenorrhea of approximately 55 days' duration. She used to have regular menstrual periods before that. Ultrasound of pelvis revealed complex cystic lesion in right adnexa  ? Haemorrhagic cyst. She had normal periods on 01 Sep and 01 Oct. Repeat ultrasound on 14 Oct revealed complex rt adnexal cystic lesions. MRI pelvis was advised. Patient got MRI done on 10Nov. It shows rt adnexal complex cystic lesions showing septa and solid components. Contrast study has been suggested. She hasn't had periods after 01Oct. Otherwise, she is asymptomatic. How to go further in this case?
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Dear Veena
I agree with Dr Cassani as I recommend in my first answer besides I suggest if during laparoscopy you are suspect for malignant lesion , it is advise to take a biopsy from contralateral normal ovary also.
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In all published literature available to me it is stated that in 1848, Henry Hancock, President of the Medical Society of London, presented a paper to that society describing the treatment of a 30-year-old female eight months pregnant in the Charing Cross Hospital in London [Hancock H. Disease of the appendix caeci cured by operation. Lancet. 1848;2:380–2.].
In only one book (published in 1899) it is written that François Mestivier, in 1759, incised an abscess in the right groin, in a woman eight months pregnant, and on autopsy found at the bottom of the abscess, the appendix vermiformis perforated by a pin [Mestivier FF. Observation sur une tumeur, située proche à la région ombilicale, du côté droit, occasionée par une grosse épingle trouvée dans l'appendice vermiculaire du cécum. J Méd Chir Pharmacol. 1759;10:441-2.].
I cannot reach the full-text of that article to confirm that this is the first published case. In all texts that mention Mestivier's article, a male patient is described and there is no mention of pregnancy (of course).
Please if someone has the full-text of that article send it to me or if anyone has the knowledge of some earlier descriptions of appendectomy during pregnancy or postpartum inform me.
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Kelly's book cited here is available at: https://archive.org/details/appendicitisand00kellgoog
 just like many other old books, maybe Stumpf's work is also somewhere here. Kelly also didn't make a proper reference to Stumpf in his book (page 427) and I guess that is the reason Maes et al. also missed to reference him. All in all, blame Howard Kelly, I guess he wouldn't be able to publish this way today (haha).
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mitogen-activated protein kinases
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There are some articles on abortion.
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I know that the production and maintenance of lactation is predominately the hormonal game triggered by the sucking reflexes of the little one. Do the galactogogues ( foods that promote breastmilk production) like fenugreek , garlic, oats do an effective job. 
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I would look for a IBCLC research but as a CLC that works with preterm infants and pregnant mothers, I have found this to be a problem.  I hope your research goes well.  I would love to see what research you get out of this.
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Ruptured corpus hemorrhagicum is a common cause of pelvic collection in patients with uncontrolled anticoagulant therapy. When to operate and when to restart anticoagulation? What is the best time to remove the drains postoperative and start anticoagulation?
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Dear Ahmed
Your answer is excellent. The guiding principle always is, "First treat the patient, then treat hte disease". In terms of risk, death from haemorrhage is the immediate risk. It must be dealt with immediately. Against this is a complication of embolus which may or may not occur later. We have found that where there is a major bleed which does not respond, we have saved the patient's life by giving  fresh blood from OR volunteers.
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I have thought if patient with ovarian  cancer needs compulsorily  lymph node ressection when surgery is performed after neoadjuvant chemotherapy or of rescue once disease is already advanced and para aortic and pelvic lymph node ressection increase morbidity to surgery process.
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Dear Dr.Batista. its regarding the removal of lymphnodes after NACT, prophyactically lymphadenectomy  is required if the tumour mass is more than of 2cm size in the pelvic region.
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We can analyse or visualise the presence of connexins between an oocyte and the surrounding granulosa cells but this does not mean these connexins are functional. Is it possible to follow the uptake of a dye or a fluorescent molecule from granulosa cell to oocyte ? And in another experiment add a gap junction blocker to prove that gap junctions are involved ?
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Dear Kris,
I know a lot of cell biologists use the dye-uptake methods that are easier to implement. However, I am not a great fan, as there are many things that one needs to take into account with the dye uptake experiments that can give false positives.
best wishes, Refik
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Harmonal changes, Gingivitis,gingival enlargement, bleeding, epulis, periodontitis, tooth mobility, dental erosion, caries
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Pregnancy makes oral tissues more fragile and with tendency to inflammation and bleeding. The gravid granuloma erroneously called pyogenic granuloma is one of the most frequent situations. Minor trauma can trigger important inflammatory reactions. It is important to emphasize the role of strict hygiene due to gingival swelling due to hormonal stimulation
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A 47 years old lady who is not in physical relationship for the last few years develops rashes over face following masturbation. Areas of hyperpigmentation are left over face after few days. What could be the reason? How to manage?
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Please do not post any pictures of the patients face - we should always preserve anonymity and confidentiality. Other than that, you provide too little clinical information to conclude or give you any advice. All I can say is that in my opinion, false causality with masturbation is assumed and all possible causes of this rash should be explored (infectious, allergenic or autoimmune ethiologies).
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Could iron-deficiency anaemia secondary to heavy menstrual bleeding be a potential risk factor to the formation of venous thromboembolism (bilateral PE)?
I encountered two cases  within 2 months of obstetrics and gynaecology posting? Especially those were given trenaxamic acid.
Appreciate your comments and thoughts. 
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Women after severe hemorrhages are at risk of thrombosis.  I suppose the hemorrhage causes an unbalance in clotting factors.  This could be true for heavy menstruation as well.
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A 33 yr woman with 8.4 weeks estimated gestational age with last menstrual period revealed following reports on transvaginal ultra-sonography:
1. Bulky uterus
2. Single gestation sac of about 5.43X4.62X3.34 cm size in uterine cavity.
3. Crown to rump length of embryo is 16.3 mm which correspond to 8.2 weeks of gestation.
4. Normal yolk sac seen in gestation sac.
5. Trophoblastic rim is normal in thickness and ecogenicity. A small anechoic area seen right laterally.
6. Gestation sac contains single embroyo without cardiac pulsations.
Pathology impression: finding suggstive of missed abortion. Minimal separation of membranes noted.
Physician recommend to undergo D&C (dilation and curettage). What would be the actual action to be taken under such circumstances i.e.  D&C or wait for few weeks. Is such kind of sonography reports are always true.
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While waiting and re-scanning is probably safe, it is also unnecessary. Given the advanced size of the foetus, the lack of heartbeat is inconsistent with normal pregnancy and is diagnostic of nonviable pregnancy (missed abortion)
Diagnostic criteria for nonviable pregnancy early in the first trimester.  N Engl J Med. 2013 Oct 10;369(15):1443-51.
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Dear colleagues, does anybody know MHT drugs or OCP containing estetrol (E4) that are already used in routine practice? I’ve read about the results of the finnish research FIESTA and OCP “Estelle” (produced if I’m not mistaken at Belgium). But the last news was that clinical investigations are still at the phase III (please, correct me if I’m wrong).
I appreciate your comments.
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Sorry but Im not competent .
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Especially for primipara mothers?
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To date, ExT during pregnancy is not recommended by the American College of Obstetricians and Gynecologists for women at risk of certain gestational complications, such as gestational hypertension and preeclampsia,80 based on studies showing that ExT has deleterious effects on uteroplacental perfusion in at-risk pregnancies.
encourage to regular period of rest among preeclampsia women may last study 
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Is there a place of leaving the placenta in-situ without removal or any other conservative measures
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And hysterectomy  , but it's not a conservative therapy
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I try to find an answer for a question which part of follicle have an importance role in initial primordial follicle. I think if we can stain mice oocyte  before they were born could partly answer this question. Do you know any chemical which can go through mother mice to prenatal mice ?
Thank you so much for your help.
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Thank you so much for your help. Even I could not apply your suggestions, however it is interesting to know utero-injection and Lei lei's teachnology. I could know we can order mutant mouse form Jackson's lab. Thank you so much and sorry for my late reply.
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Hello dear colleagues, my topic of study is about human vaginal lacobacilli. I want know if my isolates produce bactoriocin or bacteriocin like substances. How this please, and I should test them against all pathogens that I have?. Thank you in advance. best regards
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One indirect way to check if your culture of interest is producing bacteriocin or like substance is to plate them out on bacteriocin containing agar as it is expected that producing strains are generally resistant to the antimicrobial substance they produce. More expensive way will be to achieve some purification of the bacteriocin from the broth by using already reported purification scheme(s)  and the crude substance that you may obtain  may be checked on HPLC with reference standard of Bacteriocin.
Best luck. 
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we will be very grateful if we can get an approval for instruments related to male midwives for final year projects.   
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 You will need a sizeable group to say anything significant.   I do not think you will find one.   I would like to know what is interesting to you about this topic.    I do not think it warrants your time or efforts when there are so many important topics waiting to be researched in the field of midwifery.
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By comparing total scores (better the score, better the sexual function) or by determining the rate of dysfunctional women in each group using the cutt-off of 26?
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Did you try to use my questionnaire "Libido Scorring System" in the literature. You can find my full text article free of charge and this questionnaire is very user friendly.
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Looking for validated questionnaires to investigate psychological and sexual impact of dysplasia/HPV/colposcopy.
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   For 90 year old women, uterine prolapse can be a daily struggle, but surgery is not worth the risk,  pessaries are not comfortable and result in putrid discharge sometimes.    In a woman who is no longer having intercourse, why not sew up the lips to keep the uterus in?    Has anyone tried this? 
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Ok. I have to explain. 
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I can't find any data about the post commercialization data on ectopic pregnancies and  Jaydess.
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some data shows that IUD increases the rate of ectopic pregnancy but decreases the intrauterine pregnancy.
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Dear Anik,
Decreased 5-HT uptake was observed in patients with thrombocytopathies. There may be possible relation with uterine bleeding. Also, MAO inhibitors are known inhibitors of platelet function
See: Platelet Physiology and Pathology, Stratton Intercontinental Medical Book Corp., New York, 1977; ISBN 0-913258-46-6
Regards
Peter
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Hi, I am interested in measuring reproductive functionality in women aged 18-35 (menstrual irregularities, pain, duration, etc). Are these any scales out there?
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I concur with the views expressed by Dr Firas M.A Al-Rshoud.
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The yang patients with metabolic syndrom, have a lot of disorders a MC. Frequently syndrome was present oligomenorrhea. What is managment of this pathology?
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High insulin drives overproduction of androgens at the expense of progesterone, in the ovaries, by upregulation of the 17,20-lyase system.  I've seen a handful of people who also overproduce progesterone, but more often than not, if you profile these women throughout an entire cycle, via saliva, you see a diminished or absent progesterone surge.  Giving a small amount of progesterone for the 2nd half of the cycle often helps re-regulate these women.  In a small percentage it will elevate androgens, so you have to start low and go slow: 5-10 mg qd topically 14 days/month. It doesn't fix the underlying problem, but a little bit of progesterone can work wonders. 
If there's no selenium in the diet, conversion of T4 to T3 in the ovary won't be optimal. The ovary won't make Pg if it can't get any local T3 formation; it won't respond to LH.  (Ditto males: guys won't make testo in response to LH if they can't make T3 in the testicles.)
Alot of these women are overloaded with estrogens due to overproduction of androgens/androgen precursors, so anything you can do to increase fecal excretion is helpful: increased fibre intake, calcium-glucarate (to avoid de-conjugating estrogens in the colon).  Zinc supplementation will also help to downregulate/normalize the expression of aromatase, lowering the conversion of androgens to estrogens.
But I agree.  You have to get their insulin down with a low glycemic index diet, maybe some intermittent fasting, and losing processed foods from the diet.  In order to get the most bang for the insulin buck, each insulin molecule needs to co-ordinate with 4 chromium ions, so if chromium intake is low (eating sugar is a great way to deplete chromium!) your insulin signaling is impaired.  Chromium polynicotinate with each meal can help with that.
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Which one would you prefer most of the time and why?
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I agree with Hamin. But if you take all these facts together it is better to have excellent training and expertize in laparosocopic appendectomy so the surgeon could have less preoperative strategic difficulties. When I started laparoscopic appendectomy it was easier for me to do open appendectomy. Now after more than 200 lap appendectomies I realise that it is more simple procedure technically (for me) and the easiest operations last 15 min and the patients recover ealier.
Therefore whatever the studies claim, my opinion is that laparoscopic appendectomy is better procedure in experienced hands.
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24-years-old came for fertility consultation. She is obese (75 Kgs), Primary Amenorrhoea, Karyotype 46XX/47XXX (50%/50%) and streak ovaries on laparoscopy. She has almost all features of triple X syndrome. FSH 76, LH 25, AMH 0.6 (low fertility), estradiol 36pg/ml (Premenopausal range). she bleeds on withdrawal with MPA or Ovral-L.
Someone has advised her IVF-ET.
My question is that can she be tried for IVF with so high FSH and does she need physiological sex steroid replacement till 45 years of age (even when she has fair amount of estrogen production)?
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When you karyotyped her what tissue did you use?  blood, I presume.  It could be useful to determine the extent of her mosaicism -is it also in ectoderm? Karyotypng from a fibroblast biopsy may be useful or even FISH on hair follicles.  
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In my study, the particularities of the POF treatment differed, and  depending on the age at which POF appeared. If it happened at the reproductive age, than HRT was preferential, with dosage corresponding to the early follicular phase Estradiol valerate – 2 mg+ progestins. The COC for this group was not most appropriate. The selected progestin depended on the hormonal status and phenotype of the woman. The clinical symptoms of the menopause have disappeared after 3 months of HRT treatment.  During following 11 years of treatment there was no case reported on osteoporosis, coronary heart disease, depression, Cr., and other late POF symptoms. 
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I prefer HRT with tailored dosage, as this permits the possibility of pregnancy in the unlikely event of recovery.  Of course, the patient must be warned that pregnancy is a possibility, and if this is not desired, other methods must be employed.
It remains of concern that I am starting a treatment that will be continued for 20-30 years. This also mandates considerable discussion with the patient.
Regards
CJ van Gerlderen
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is there any current publications of efficent drugs
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Thanks so much Emilija
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I have a patient, 23 years old, primigravida, pregnant 7 weeks with single, viable intrauterine pregnancy.Diagnosed 1 month before pregnancy as having a low-grade squamous intraepithelial lesion.That time was presented with postcoital bleeding since the beginning of her marriage(& months).Next Pap smear is due after 5 months, but she presented now with postcoital bleeding.What do You advise?
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thank you very much! The next Pap smear is due after 5 months. iIam hesitant to proceed to another pap smear and biopsy now.Is there any evidence to do so?
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From literature i found that OGT is a promising placental biomarker for prenatal stress but I am unable to find it.I want to separate the case and control group by using the OGT level in cord blood. so someone you there help me to aware about the exact level.
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Dear researcher,
Sorry. I don't have information about your question.
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29-yrs-old delivered 6 months back in a village, following which she developed severe difficulty in passing motions. Rectocele is present on examination. After all conservative failed, MRI defecography revealed severe rectocele and Recto-Rectal Intussusception. Stapled transanal resection of the rectum (STARR) is planned but will she benefit from combined rectocele repair or it should be performed in separate setting.
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In my opinion this patient complaining about obstructive defecation and clinical and imaging diagnosis of recto-rectal intussusception and rectocele, should be studied first of all in her distal digestive function, so ano-rectal manometry can give us interesting information. If outlet obstruction is detected, a biofeedback re-education should be carried out prior to any surgical treatment.
My surgical choice in this case is a laparoscopic (or open) mesh ventral rectopexy.
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There is a definite cohort of women that this is true of. Often they are the ones not responding to stabilisation exercises.
I am wondering if they are the minority or not?
Should we be assessing pregnant women's pelvic floors internally and treating with manual therapy if they are overactive?
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Dear Niamh,
Our specialism, besides chronic backpain is pelvic girdle pain. We treat about 600 chronic pain patients annualy, Among which a vast amount of pelvic girdle pain. It is our experience that if there are pelvic floor problems (predominantly incontinence) it almost always concerns hypertone pelvic floors. 
When control of the pelvic girdle improves, the pelvic floor can relax and the problems diminish in most cases. So from our perspective these hypertone pelvic floors may be considered compensating muscle activity to control and support the pelvis. 
Because the pelvic floor mostly responds adequately, There is usually no need for internal investigation. An important consideration is that in the early phase of treatment the focus should be on relaxation (whole body, not only the pelvic floor) Retraining stabilizing activity in an already hypertone system is not effective.
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What criteria do you use to surgery? Which embolization technique do you use?
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To my opinion the ovarian/iliac vein embolization/coils is indicated only in symptomatic cases with important pain or dyspareunia. I consider that in varicose veins (recurrent varicose veins) due to PCS the treatment can be limited to local intervention - phlebectomy or sclerotherapy. If symptoms are mild - the course of MPFF (micronized purified flavonoid fraction) can be tried.
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We are trying to organize a fertility preservation program for prepubertal girls
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We are working on cryopreservation of ovaring tissue but most of the tissue come from the women at the age above 35y/o.
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If the answer is yes what is the mechanism?
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There are two explanations for differences between CC and rec FSH regarding rise of progesterone-
1) FSH leads to multifollicular development leading to more progesterone
2) CC to some extent inhibits estrogen induced rise in LH leading to relatively less progesterone rise, compared to FSH
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Direct trocar insertion through Palmer's point with 10 mm trocar OR Veress needle insufflation prior to trocar entry through Palmer's point? Which one is preferable or practiced?
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I think that everyone should use the technique that he is familiar with and there are no major concern in experienced hands. We should always keep in mind that in previously operated patient, if you encounter a problem with veress or direct insertion it is then so difficult to justify your approach legally. The use of the hasson technique is safer and should be advocated in these cases. 
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I am working on a psychiatric case report related to Postpartum case
1. Like Pubmed is there any research literature database for Psychiatry articles
2. Is depersonalization present in any other condition other than psychiatric condition ?
3. What about in any gynaecological disorder or pregnancy relataed complication ?
4. Is there any criterion for justifying that a patient has depersonalization?
5. Can depersonalization be present independant of depression ( no depression) in Postpartum case?
6. Has there been any systemic review and meta analysis on non pharmacologic vs pharmacologic basis in managing depersonaltion
7. Can you suggest any good journal(relevant for this case report) which will give a good academic lesson even if it rejects this case report
8. Has there been any case report  of Depersonalization independant of depression in Postpartum case
if anyone has a reference to this question please attach pdf too 
Thankyou
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Beatrice - thankyou mam
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Does anyone have experience of hair loss with LNG IUS (Mirena or Jaydess)?
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Have seen it on occasion on DMPA. But also with women not using contraception. Women use contraception for years of course they develop medical conditions in those years. Difficult to prove that the contraceptives are responsible or not, for that a randomised study is needed. But that hairloss can have hormonal causes seems clear ask women who delivered. The pill is claimed by some to suppress hairgrowth (on legs and face) 
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Does anybody have experience from pregnant female patients with Idiopathic Scoliosis? I think about research other clinical experience.
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Usually, there are no problems with pregnancy and delivery per vias naturales in females with IS (operated or not). In my 42-year experience with scoliosis surgery I have never had negative experience with similar patients. Indications for cesarean section are to be considered in patients with an extreme pelvis tilt or increased pelvis inclination secondary to major lumbar scoliosis (usually  neuromuscular not idiopathic genesis).  
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I have across across two patients with cronh's disease. They have quiescent disease and have been complaining of malodorous vaginal discharge with persistent vaginal irritation. They have sought multiple treatments.  They don't have enterovaginal fistula or the desquammative inflammatory vaginitis. 
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This is not easy to address. Hygiene is the first thing to tackle if culture & pap smear are negative then reassurance with a clinical psychologist
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Female of age 45: Had a fibroid uterus and underwent a hysterectomy surgery of 2 years before. From that surgery she took many medications for 2 years, but has pain in the right and left hypochondrial, hypogastrial, iliac fossa as well as irritation along the line of suture.
How can it be cured?
Please help!
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Hi Karthik
What you report is not uncommon after hx.
If she also has some other symptoms such as urgency, nocturia, frequency, abnormal micturition (see ref 2 below) , she probably has posterior fornix syndrome which is a consequence of the lax uterosacral ligaments which often occur after hysterectomy.
Treatment: (see ref 1). Make a transverse incision 3-4 cm below the hysterectomy scar and plicate the uterosacral ligaments with 2-3 non-absorbable sutures.  This approximates and tightens lax USLs. Initial cure rate is good, sometimes up to 70-80%, but it decreases over time because USL iigaments loosen again.
1. Petros PE Severe chronic pelvic pain in women may be caused by ligamentous laxity in the posterior fornix of the vagina. Aust NZ J Obstet Gynaecol. 1996; 36:3: 351-354.
 2. Petros PEP, Inoue H Letter - Pelvic pain may be caused by laxity in the uterosacral ligaments as part of the “Posterior Fornix Syndrome”. ANZJOG 2013; 53(3):325-6. DOI:10.1111
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Is there laparoscopic training box especially for laparoscopic Gynaecology now? and do you think that is it useful?
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Here in Chile we give every year Laparoscopic Courses for Gynecologist basic and advanced (www.eieschile.cl ) from 2007. EIES (www.eiesonline.com) give these courses from 2003 uo today in Latinamerica and another countries.
We use pelvic training models called "Evas" from Prodelphus: www.prodelphus.com.br from Brasil. Look at the website and you will found a lot of accesories to put into evas for training in diferent tipes of disections and sutures. Dr. Marcos Lyra the owner of Prodelphus is a Gyn who knows about laparoscopy and Hysteroscopy and he is a very Smart designer of these models for endoscopic surgery training
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Postpartum hemorrhage managment is a major concern to reduce maternal mortality.
We are interested to know the results in different scenarios.
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I had the pleasure of working with B-Lynch  taught how to do the procedure. I feel the procedure is simple but appropriate for surgically atonic uterus. This is not an alternative to uterine bleeding from other cause like uterine angle or placenta bed especially in placenta previa.
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The increase of the ligand increases the receptor and the enzyme or only one or the other.
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Do you think your observation in vitro may indicate the same behavior in vivo?
From the study of the literature it seems that this statement is not correct. The concentration of endocannabinoids would affect the receptor level but the effect of the variation of endocannabinoids would be different depending on the local microenvironment. 
In vivo  do CB1 and FAAH vary in parallel or in revers ?
Please read our work on AJOG and send me a comment. Many thanks in advance