Diane M. Hartmann

Lower urinary tract injury during the Burch procedure: is there a role for routine cystoscopy?

OBJECTIVE This study was undertaken to evaluate the use of intraoperative cystoscopy for the detection of incidental bladder or ureteral injuries during abdominal urethropexy procedures and to determine whether the incidence of injuries warrants the routine use of cystoscopy. METHODS We reviewed the medical records of 109 consecutive patients who underwent abdominal urethropexy procedures between November 1990 and February 1996 at a teaching institution. Each underwent intraoperative cystoscopy. We determined the incidence of cystotomy and ureteral obstruction and attempted to determine surgical factors that might be associated with an increased risk of injury. RESULTS Ten of 109 patients (9%) had bladder or ureteral injury, including 1 cystotomy during retropubic dissection, 6 cases of a transvesical suture noted during cystoscopy, 1 cystotomy recognized before closure, 1 case of ureteral obstruction found during cystoscopy, and 1 case of ureteral obstruction not recognized at cystoscopy. Cystoscopy allowed detection of 7 of 9 (78%) otherwise unrecognized events. The only injury that resulted in significant postoperative morbidity was the unrecognized ureteral obstruction. There was no association between incidence of lower urinary tract injuries and surgical risk factors. CONCLUSION Intraoperative bladder or ureteral injuries during urethropexy procedures are not uncommon, with an incidence of 9% in our series. There is minimal morbidity if these injuries are detected and corrected during the operation, whereas morbidity may be significant if they remain unrecognized. With a potential for unrecognized injury in 8% of Burch procedures without the use of cystoscopy, routine use of cystoscopy during urethropexy procedures appears to be warranted.

A comprehensive review to establish priority learning objectives for medical students in the obstetrics and gynecology clerkship

OBJECTIVE This study was undertaken to describe the process used to identify, externally validate, and establish the priority learning objectives for medical students on the obstetrics and gynecology clerkship. STUDY DESIGN We conducted a review of the APGO Medical Student Objectives in Obstetrics and Gynecology to establish which of these objectives should be given first priority. We used recommendations from external references to assess the validity of these selected objectives. We compared the distribution of objectives with levels of expected competency from Millers pyramid. RESULTS From a list of 267 unique learning objectives we identified 134 (50.2%) Priority 1 objectives students must master by the end of the clerkship. The recommendations from 17 external references were compared with this set of objectives, which demonstrated a significant correlation between the 2 (P < or = .001). Priority 1 objectives were associated with advanced levels of competency. CONCLUSION External sources validated and helped prioritize the learning objectives.

MORBIDITY OF OSTEOPOROSIS: CAN ESTROGEN USE MAKE A PUBLIC HEALTH IMPACT?

The personal morbidity and economic burden associated with osteoporosis is substantial. Estrogen has been shown to have positive effects on the prevention and treatment of this disabling disease. Information is available with regard to when to initiate estrogen therapy, how long to maintain treatment, and how best to identify those women who will benefit most from its use.

Massive hydronephrosis mimicking theca lutein cysts in association with partial hydatidiform mole.

We present an unusual case of partial hydatidiform mole in which extensive, multiple cystic structures encompassing the entire right abdomen and pelvis, initially thought to represent theca lutein cysts, were subsequently shown to consist of massive unilateral right hydronephrosis. Percutaneous nephrostomy decompression bypassing the ureteropelvic obstruction revealed functional renal parenchyma.

Effects of Hormones and Hormone Therapy on Cardiovascular Health in Women

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in American women, causing approximately 250,000 women to die each year of ischemic heart disease, roughly six times more than the number of women who die from breast cancer [1]. When compared to age-matched men, the incidence of coronary heart disease (CHD) is much lower in younger women [2]. The Framingham population study showed that coronary artery disease usually manifests 10 years later in women than it does in men [3]. This lag was punctuated by the age of menopause and was suggestive of a protective effect of estrogen [4]. The potential protective effects of female hormones on the cardiovascular system have been a topic of great interest. Loss of this protection after menopause may be linked to the increased incidence of CHD in older women [2].