ABSTRACT
M.A. Mendes de Leon (1856-1924) was appointed private lecturer at the Department of Obstetrics of the University of Amsterdam in 1884. He promoted gynaecology in the Netherlands as a separate speciality, partly because of the new surgical possibilities following the discoveries of anaesthesia and antisepsis, but also due to the prevailing belief that the physiology of reproduction qualified the physical and psychological disorders of women. In his private gynaecological clinic he devoted himself to the surgery of ovarian tumours, uterus myomatosus and genital prolapse, but also to the diagnosis and treatment of supposed inflammations of the cervix and endometrium as cause of psychological disorders. In this he followed the opinions of contemporary English gynaecologists. As he was not aware of physiological histology, he nearly always found signs of inflammation. He treated this with curettage and drastic caustics, sometimes after using a dilation knife (hysterotome) for the cervix. At the turn of the twentieth century Dutch gynaecologists such as Treub and Nijhoff began to cast doubt on such theories of "reflex neurosis", but Mendes de Leon persisted in his views. Nevertheless, he can still be considered one of the founding fathers of gynaecology in the Netherlands, partly because of his surgical skills, but also due to his study into the interaction between gynaecological and psychological problems.
Subject(s)
Gynecologic Surgical Procedures/history , Gynecology/history , Female , History, 19th Century , History, 20th Century , Humans , NetherlandsABSTRACT
In the collections of the Society of the Dutch Journal of Medicine there is a small box containing a small obstetric forceps modelled on that of the British physician Smellie and some documents with information about its origin. The instrument belonged to the Amsterdam surgeon-obstetrician Albertus Titsingh and is claimed in the documentation to have been used during the birth of the later King William I (1772-1843) in 1772. However, historical research indicates that this is very unlikely: it is an established fact that the birth of William I was rapid and successful, while Albertus Titsingh was an authoritative obstetrician in an 'obstetric climate' of biding one's time and taking no action until the natural powers have failed.
Subject(s)
Obstetrical Forceps/history , Obstetrics/history , Female , History, 18th Century , Humans , Netherlands , Obstetric Labor Complications/history , Obstetrics/instrumentation , Pregnancy , Pregnancy OutcomeABSTRACT
In the archives of the Dutch royal family there is a hitherto unknown report of a childbirth by the Leiden court physician Prof. H.D. Gaubius, in which he provides a detailed description, in French, of the first, prolonged and unfortunate parturition, in 1769, of Wilhelmina of Prussia, the wife of the hereditary stadholder Willem V. There was apparently a discrepancy between the presenting head and the size of the birth canal. Initially, an expectant policy was followed in the hope that the natural course of events would prevail, but ultimately and after due consideration it was decided to terminate the expulsion by means of a Van Roonhuysen lever, the vectis; this procedure was carried out by the Amsterdam obstetrician Albertus Titsingh. It turned out that the infant had died during delivery. Following the spontaneous delivery of the placenta, the puerperium proceeded without complications.
Subject(s)
Famous Persons , Obstetric Labor Complications/history , Pregnancy Outcome , Adult , Female , History, 18th Century , Humans , Netherlands , Obstetric Labor Complications/therapy , PregnancyABSTRACT
In a 72-year-old woman with micturition problems, in whom a genital prolapse had been diagnosed earlier, a urethral caruncle was diagnosed, i.e. a prolapse of the dorsal mucosa of the urethra.
Subject(s)
Urethral Diseases/complications , Urethral Neoplasms/diagnosis , Urination Disorders/etiology , Aged , Diagnosis, Differential , Female , Humans , Polyps , Prolapse , Urethral Diseases/surgeryABSTRACT
In a 16-year-old girl with non-appearing menarche vaginal and uterine aplasia was diagnosed: Mayer-Rokitansky-Küster-Hauser syndrome.
Subject(s)
Abnormalities, Multiple/diagnosis , Amenorrhea/etiology , Uterus/abnormalities , Vagina/abnormalities , Abnormalities, Multiple/pathology , Adolescent , Female , Humans , Syndrome , Uterus/pathology , Vagina/pathologyABSTRACT
In a 61-year-old woman uterus and adnexa were surgically removed because of endometrial carcinoma. In the tuba accumulation of pigment-laden macrophages was observed. She had been a victim of World War II concentration camp gynaecological experiments. Her left forearm showed the Auschwitz Jew tattoo.
Subject(s)
Adenocarcinoma/surgery , Endometrial Neoplasms/surgery , Salpingitis/diagnosis , War Crimes , Female , Humans , Middle Aged , Salpingitis/etiology , TattooingABSTRACT
An open Filshie clip is sometimes detected during the evaluation of a case of sterilisation failure. This spontaneous opening of the clip does not need to have been caused by material failure, but may be produced by jamming of the clip what can occur by incorrect squeezing during closure. On superficial observation, the clip will appear to be closed, but it may easily open itself by its spring mechanism when the clip is moved or merely touched. Especially in the teaching situation one should be careful for this lapse.
Subject(s)
Sterilization, Tubal/instrumentation , Equipment Failure , Female , HumansABSTRACT
In an 8-year old negroid girl vaginal bleeding was caused by urethral prolapse.
Subject(s)
Urethral Diseases/diagnosis , Black People , Child , Child Abuse, Sexual/diagnosis , Diagnosis, Differential , Female , Humans , Prolapse , Urethral Diseases/ethnology , Urethral Diseases/pathology , Vaginal Diseases/diagnosisABSTRACT
Colposcopic image of early transformation zone of portio cervicis without abnormalities in a 31-year-old multiparous woman.
Subject(s)
Cervix Uteri/anatomy & histology , Colposcopy , Adult , Female , Humans , ParityABSTRACT
In a 48-year-old woman suffering from acute strong pain in the lower abdomen spontaneous partial delivery of a submucous fibromyoma was diagnosed.
Subject(s)
Abdominal Pain/etiology , Leiomyoma/diagnosis , Uterine Neoplasms/diagnosis , Diagnosis, Differential , Female , Humans , Leiomyoma/complications , Middle Aged , Prolapse , Uterine Neoplasms/complicationsABSTRACT
In a 28-year-old woman recurrent abdominal pain was caused by a partially torded cystic teratoma of the ovary.
Subject(s)
Abdominal Pain/etiology , Ovarian Neoplasms/diagnosis , Teratoma/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Laparotomy , Ovarian Neoplasms/complications , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Teratoma/complications , Teratoma/pathology , Teratoma/surgery , Torsion AbnormalityABSTRACT
In a 48-year-old woman staging laparotomy revealed adhesions between liver and diaphragm as part of the FitzHugh-Curtis syndrome.
Subject(s)
Chlamydia Infections/complications , Chlamydia trachomatis , Diaphragm/pathology , Liver/pathology , Salpingitis/complications , Chlamydia Infections/microbiology , Chlamydia trachomatis/isolation & purification , Female , Humans , Laparotomy , Middle Aged , Salpingitis/microbiology , Syndrome , Tissue Adhesions/microbiologyABSTRACT
In a 52-year-old woman lichen sclerosus vulvae was diagnosed as the cause of severe vulvar itching.
Subject(s)
Lichen Sclerosus et Atrophicus/complications , Lichen Sclerosus et Atrophicus/diagnosis , Vulvar Lichen Sclerosus/etiology , Diagnosis, Differential , Female , Humans , Lichen Sclerosus et Atrophicus/pathology , Middle Aged , Pruritus Vulvae/etiology , Vulvar Lichen Sclerosus/pathologyABSTRACT
In a 62-year-old woman with aspecific symptoms in the lower abdomen a lithopaedion was diagnosed mimicking an ovarian tumour.
Subject(s)
Fetal Resorption/diagnosis , Calcinosis , Diagnosis, Differential , Female , Humans , Middle Aged , Ovarian Neoplasms/diagnosis , Pregnancy , Pregnancy, Abdominal/pathology , Teratoma/diagnosisABSTRACT
An 18-year-old woman sought treatment for primary amenorrhea. Crushing trauma of the pelvis in her childhood had caused separation between the uterine corpus and the cervix. Through a combined abdominal and vaginal approach the continuity of the uterine outflow tract was restored. Years later, after in vitro fertilization, the patient was delivered of a healthy term baby in an elective cesarean procedure.
Subject(s)
Amenorrhea/etiology , Fractures, Bone/complications , Pelvic Bones/injuries , Adult , Cervix Uteri/injuries , Female , Fertilization in Vitro , Fractures, Bone/diagnostic imaging , Humans , Pregnancy , Pregnancy Outcome , Radiography , Uterus/injuries , Wounds, Penetrating/etiology , Wounds, Penetrating/surgeryABSTRACT
PURPOSE: By means of a randomized double-blind study, the effect of providing taped initial consultations on cancer patients' satisfaction, recall, and quality of life was investigated. PATIENTS AND METHODS: Consecutive cancer patients referred to either the gynecology or medical oncology outpatient clinic were eligible. Initial consultations were audiotaped. Patients were either provided with the tape (experimental group) or not (control group). Baseline variables included sociodemographics, preferences for information, coping styles, and clinical characteristics. Follow-up (after 1 week and 3 months) variables included attitudes toward the intervention, satisfaction, recall, and quality of life. Assessments took place through mailed questionnaires and telephone interviews. RESULTS: Two hundred one patients were included (response, 71%), 105 in the experimental group and 96 in the control group. Most patients (75%) listened to the tape, the majority of which (73%) listened with others. Almost all patients, both in the experimental group (96%) and control group (98%) were positive about the intervention. Expectations were confirmed; patients provided with the tape were more satisfied (P <.05) and recalled more information (P <.01) than patients without the tape. The intervention did not have an effect on quality of life. An interaction effect was found between the intervention and patients' age on satisfaction with the taped consultation (P <.01) and recall of diagnostic information (P <.01); access to tapes seems more helpful in enhancing satisfaction in younger patients and recall of diagnostic information in older patients. CONCLUSION: Cancer patients and their families value the taped initial consultation. This intervention enhances their satisfaction and improves their recall of information. Tapes seem more helpful in enhancing satisfaction in younger patients and recall of diagnostic information in older patients.
Subject(s)
Neoplasms/psychology , Patient Acceptance of Health Care , Physician-Patient Relations , Tape Recording , Truth Disclosure , Adaptation, Psychological , Adult , Age Factors , Aged , Aged, 80 and over , Attitude to Health , Double-Blind Method , Female , Humans , Male , Mental Recall , Middle Aged , Neoplasms/therapy , Patient Satisfaction , Quality of Life , Surveys and Questionnaires , TelephoneABSTRACT
In a 14-year-old girl who suffered from anuria and abdominal pain, atresia of the hymen was diagnosed.
Subject(s)
Hematocolpos/etiology , Hymen/abnormalities , Abdominal Pain/etiology , Adolescent , Anuria/etiology , Decompression, Surgical , Diagnosis, Differential , Female , Hematocolpos/pathology , Hematocolpos/surgery , Humans , Hymen/surgery , Vaginal Diseases/complications , Vaginal Diseases/diagnosisABSTRACT
In this study, the relationship between (a) doctor's and patients' communication and (b) doctors' patient-centredness during the oncological consultation and patients' quality of life and satisfaction was examined. Consultations of 96 consecutive cancer patients were recorded and content analysed by means of the Roter Interaction Analysis System. Data collection (mailed questionnaires) took place after 1 week and after 3 months. Oncologists' behaviours were unrelated to patients' quality of life. Their socio-emotional behaviours related to both patients' visit-specific and global satisfaction. Patients' behaviour related to both patient outcomes although mostly to satisfaction. Multiple regression analyses showed that patients' quality of life and satisfaction were most clearly predicted by the affective quality of the consultation. Surprisingly, oncologists' patient-centredness was negatively related to patients' global satisfaction after 3 months. In summary, doctor-patient communication during the oncological consultation is related to patients' quality of life and satisfaction. The affective quality of the consultation seems to be the most important factor in determining these outcomes.
Subject(s)
Communication , Patient Satisfaction , Physician-Patient Relations , Quality of Life , Female , Humans , Male , Middle Aged , Neoplasms , Referral and Consultation , Regression Analysis , Surveys and QuestionnairesABSTRACT
BACKGROUND: The indications for radiotherapy after radical hysterectomy for early stage cervical cancer are changing. In the past only tumor outside the cervix was considered an indication for radiotherapy. Today adjuvant radiotherapy is also considered for an "intermediate-risk" group with tumor confined to the cervix but poor prognostic primary tumor parameters such as large tumor diameter, vascular space invasion, and deep stromal penetration. OBJECTIVE: The aims of this study were to determine the risk of isolated pelvic recurrences in an intermediate-risk group (GOG Study No. 92) and to analyze whether this group will theoretically benefit from adjuvant pelvic radiotherapy. PATIENTS AND METHODS: A retrospective analysis was performed on 271 patients with early cervical cancer treated by a radical hysterectomy in a uniform fashion in one institute. Radiotherapy was administered only when tumor was found outside the cervix. Tumor diameter, capillary lymphatic space invasion, and depth of stromal penetration were assessed in all patients. Recurrence pattern, disease-specific survival, and recurrence-free interval were determined in the intermediate-risk group and compared with the remaining patients of the group with tumor confined to the cervix. RESULTS: A significant difference in disease-specific survival (89% versus 97%, P < 0.03) and 5-year recurrence-free interval (86% versus 95%, P < 0.02) was noted in the intermediate-risk group (n = 56) compared with the total group with tumor confined to the cervix. Three patients in the intermediate-risk group died of disease with a pelvic recurrence. Two of these patients had a combined pelvic and distant recurrence. CONCLUSION: Our retrospective results fail to support a survival benefit of extending indications for adjuvant radiotherapy other than postive nodes, parametrial extension, and positive margins.
Subject(s)
Hysterectomy/methods , Neoplasm Recurrence, Local/epidemiology , Pelvic Neoplasms/epidemiology , Pelvic Neoplasms/secondary , Uterine Cervical Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/surgery , Female , Follow-Up Studies , Humans , Radiography , Radiotherapy, Adjuvant , Retrospective Studies , Risk Factors , Survival Rate , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/pathologyABSTRACT
Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients' and doctors' behaviors. The present study aimed at investigating the relation between cancer patients' coping styles and doctor-patient communication and global affect. Coping styles were assessed by means of the Threatening Medical Situations Inventory (TMSI). Since a shortened version of the TMSI was used, the validity of this instrument was also evaluated. First, it was examined whether the two factor structure of the original TMSI could be confirmed in our version. Then, the relation between coping style and patients' preferences for information and participation in decision-making was evaluated. Second, the relation between monitoring and blunting and patients' age, sex, education, quality of life and prognosis was investigated. Finally, the relation between patients' coping styles and communicative behaviors and global affect of both patients and physicians during the initial oncological consultation was examined. Patients (N = 123) visited their gynaecologist or medical oncologist for an initial discussion of possible treatment. Patients' coping styles, socio-demographics, preference for information and participation in decision-making, quality of life and prognosis were assessed by postal questionnaire prior to the visit to the outpatient clinic. The consultation was audiotaped and analysed according to Roter's Interaction Analysis System, to identify instrumental and affective communicative behaviors of both patients and physicians. The two factor structure of the TMSI could be confirmed. A monitoring style was related to a preference for detailed information (r = 0.23) and participation in medical decision-making (r = 0.23). A monitoring style was also related to patient question-asking (r = 0.25) and patient dominance (r = 0.23). To conclude, the validity of the shortened TMSI is satisfactory. Also, cancer patients' coping styles are not related to other personal and disease characteristics. Further, a monitoring style seems to have an impact on patients' question-asking and dominance during the oncological consultation.
