ABSTRACT
Myomas, also known as fibroids, are a specific characteristic of the human species. No other primates develop fibroids. At a cellular level, myomas are benign hyperplastic lesions of uterine smooth muscle cells. There are interesting theoretical concepts that link the development of myomas in humans with the highly specific process of childbirth from an upright position and the resulting need for greatly increased "expulsive" forces during labor. Myomas might be the price our species pays for our bipedal and highly intelligent existence. Myomas affect, with some variability, all ethnic groups and approximately 50% of all women during their lifetime. While some remain asymptomatic, myomas can cause significant and sometimes life-threatening uterine bleeding, pain, infertility, and, in extreme cases, ureteral obstruction and death. Traditionally, over 50% of all hysterectomies were performed for fibroids, leading to a significant healthcare burden. In this article, we review the developments of the past 20 years with regard to multiple new treatment strategies that have evolved during this time.
Subject(s)
Leiomyoma , Uterine Neoplasms , Female , HumansABSTRACT
INTRODUCTION: Many young doctors in Europe and beyond are considering different career alternatives. Germany is one of the most sought after countries for medical specialization. Since there is no centralized structured application process, course, or nationwide rotating program, it may seem a little bit easier to find job opportunities in Germany than in other European countries. However, the process of changing country of residence, looking for and finding new employment, and obtaining all the required paperwork is far from easy. It is therefore essential to gather as much information about the application and its process when considering a career move in order to be well prepared about what may come before and after applying for a resident position. METHOD: The essential information about the application possibilities and process were reviewed and summarized. RESULT: This article provides a practical guide on how to proceed when considering job opportunities as a resident in Germany, the application process, and what to expect once a job has been found.
Subject(s)
Employment/organization & administration , Physicians/organization & administration , Specialization , Europe , Germany , HumansABSTRACT
PURPOSE: To compare patient-reported quality-of-life and sexual function outcomes in women after laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign uterine disease. METHODS: Out of a cohort of 1,952 patients from a previous implementation study of LSH and TLH, 1,886 patients who had not undergone intraoperative conversion to laparotomy or were ineligible for other reasons were invited by mail to participate in this prospective, questionnaire-based follow-up study. RESULTS: Of the 915/1,952 (48.5 %) survey respondents included in the analysis, 788 (86.1 %) and 127 (13.9 %) had undergone LSH or TLH, respectively. Women undergoing LSH reported significantly lower pain levels (p = 0.037) and faster partial (p = 0.015) and complete (p < 0.001) resumption of normal daily activities compared to those undergoing TLH. As regards sexual function, women undergoing LSH resumed sexual activity significantly sooner (p = 0.018), rated sexual desire as higher (p = 0.023), and reported more frequently that their sexual life had improved postoperatively (p = 0.008) than did women undergoing TLH. CONCLUSIONS: Women undergoing LSH for benign uterine disease may have better outcomes regarding certain quality-of-life and sexual function parameters than women undergoing TLH for benign uterine disease.
