Multiple diagnoses and procedures during hysterectomy.

Seldom does a gynecologic patient, who needs a hysterectomy, have a single diagnosis. Among 2892 gynecologic patients who needed a hysterectomy, only 127 had a single diagnosis. The rest had two to ten separate diagnoses. Therefore, 96.4% also needed other gynecologic procedures at the time of hysterectomy--4842 other operative procedures during 1925 abdominal hysterectomies, and 2356 associated operative procedures during 864 vaginal hysterectomies. Prior to the time of hysterectomy, 15.07% of these patients had had major gynecologic operations, but after hysterectomy (+ +) only 2.9% needed any subsequent gynecologic operations. We conclude that among gynecologic patients, chart reviews or coding systems which are based only on a single diagnosis, or computer systems which are limited to 2, 3, or 4 diagnoses, will usually be incomplete, inaccurate, and misleading.

Diastasis recti and umbilical hernia causes, recognition and repair.

UNLABELLED: Among 1738 parous women who needed abdominal hysterectomies, 553 were found to have mild, 108 had moderate, and 12 had severe diastasis recti. Also, 97 had umbilical hernias. Methods of recognition and repair are diagramed and discussed. Postoperative improvement in firmness and function of the lower abdominal wall is greatly appreciated by respective patients. PRECIS: Methods of recognition and repair of mild, moderate, or severe diastasis recti are diagramed and discussed.

Decreasing numbers of patients for vaginal hysterectomy and plasty.

Among 2904 patients who needed hysterectomy, the numbers of patients who needed vaginal hysterectomy and plasty have decreased steadily during the 40 years, 1948-88, although indications have remained constant. There has been a steady reduction in the severity and numbers of patients with uterine sagging. Likewise, there has been a notable decrease in the severity of, and numbers of, patients with old perineal lacerations. The major reason for these changes is the steady improvement in prior obstetric delivery techniques. Both graphic and statistical evidence is presented.

Volume reduction of the uterus during and soon after hysterectomy.

Gynecologists observe perceptible and variable reduction from uterine size in vivo to subsequent size in the pathology laboratory. To measure this decrease in uterine size, the thickness, breadth, and height of the corpus were measured four times: as soon as the abdomen had been opened, as soon as the uterine arteries had been ligated, as soon as the uterus was removed, and after 45 minutes in fixative. The cervical diameter and length were measured two times as soon as the uterus was removed and after 45 minutes in fixative. Reduction in volume varies from 20% to 64% in different specimens. Reduction in volume is greatest in women who have uterine hypertrophy and hypermenorrhea. It is least in postmenopausal women who have atrophic uteri.

[History, organization and practice of American gynecology and obstetrics. An overview]. / Geschichte, Organisation und Praxis der amerikanischen Gynäkologie und Geburtshilfe. Eine Ubersicht.

After a short review about the history of obstetrics and gynecology in the United States of America the course of postgraduate training, standards for examinations, certifying competence and control of the quality of education organized by the specialists themselves are reported on. The purposes of the American College of Obstetricians and Gynecologists, its structure and organization are outlined, also its tendency, to preserve the specialty as a whole one and to do not allow becoming fragmentated by many subspecialties. A high percentage of american women chooses the gynecologists to provide needed basal medical care.

Enterocele, vaginal prolapse, pelvic hernia: recognition and treatment.

Notable cul-de-sac relaxations or defects in 624 patients included 49 small pelvic hernias, 551 enteroceles (265 small, 200 medium-sized, and 86 large), and 24 cases of total vaginal prolapse. Methods of recognition are described, and one is illustrated. Four methods of operative treatment are described briefly, and two of these are illustrated. Long-term postoperative follow-up is documented. Factors which may influence the development and evolution of enteroceles are discussed.

Early identification, differentiation and treatment of ovarian neoplasia.

Among 3205 patients who needed major gynecologic operations, only 250 (7.8%) had significant ovarian cysts or tumors (170 benign, 38 "low malignant potential," 42 gross cancers). Contrary to prior reports, this study show that most patients with ovarian neoplasia had had some symptoms (duration ranged from two weeks to ten years), or a palpable adnexal mass or both. Associated symptoms have been itemized in categories. Procrastination by patients, after occurrence of the first symptoms, resulted in the growth of later-stage cancers and lower survival rates. It may be inferred from age-incidence graphs that some benign cystadenomas may be present in ovaries for long intervals of time and then may become malignant. The importance of (a) careful recording of histories, (b) periodic pelvic examinations, (c) the use of preoperative methods of differential diagnosis and (d) the differentiation between gross tumor characteristics during operations are discussed. Earlier diagnosis and treatment of ovarian neoplasia are possible and will yield better long-term results.