tag:blogger.com,1999:blog-60930177188737467132024-03-21T20:00:45.279-07:00drhanifAnonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-6093017718873746713.post-39119248077424747942013-11-23T21:08:00.001-08:002013-11-23T21:09:25.619-08:00Silent<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
A 57
year old lady presented to me the other day with a complaint of abdominal
discomfort for the last 2 weeks. It was a vague sensation that wasn’t going
away, yet her appetite, bowel and urinary habits were all normal. She was 7
years postmenopausal and had 5 grown up children. Generally, she looked well,
but there was a mass felt in the abdomen just below the umbilicus. The
following are the ultrasound pictures.<o:p></o:p></div>
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<i><span style="color: #9fc5e8;">Seorang
wanita berumur 57 tahun mengadu perutnya tidak selesa sejak 2 minggu lepas.
Perasaan ini berterusan dan tiada kelegaan didapati, tetapai selera makan,
buang air besar dan kecil semuanya saperti biasa. Dia telah pun putus haid 7
tahun sebelum ini dan mempunyai 5 orang anak dewasa. Pada keseluruhannya, belia
nampak sihat, tetapi terasa satu ketumbuhan yang menghampiri pusatnya. Berikut
adalah gambar-gambar dari imbasan ultrasound yang dilakukan.</span></i><o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5heTHIPQZpmJSSwEEG2etlxsAFs2N0Zh76eFcyc5C6mak2IhYXm_dW7gR3bdT2hUhMRWs4MIp7mLRX08hMEPpetjMvDD_2gSQigdVYFdGbrpJjRSc05xOnJy4-RvQjvDo44nsrnQ9Bg/s1600/Measure+copy.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5heTHIPQZpmJSSwEEG2etlxsAFs2N0Zh76eFcyc5C6mak2IhYXm_dW7gR3bdT2hUhMRWs4MIp7mLRX08hMEPpetjMvDD_2gSQigdVYFdGbrpJjRSc05xOnJy4-RvQjvDo44nsrnQ9Bg/s320/Measure+copy.jpeg" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1BNuhQn7EQJBCiRhjMhtp4YlY4CacxMJokFs1Tvi7m1t7Gq58XqrcgMRB7BGuYdguzzcZsZ05tDOTv9E9KbI0EfWTmZJpTAkSjbuicITK30Q3P-PFKuaMuEJq-GeGH38HvbcdAwxJ9A/s1600/TrnsvrsExcresences.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1BNuhQn7EQJBCiRhjMhtp4YlY4CacxMJokFs1Tvi7m1t7Gq58XqrcgMRB7BGuYdguzzcZsZ05tDOTv9E9KbI0EfWTmZJpTAkSjbuicITK30Q3P-PFKuaMuEJq-GeGH38HvbcdAwxJ9A/s320/TrnsvrsExcresences.JPG" width="320" /></a></div>
<div style="text-align: center;">
This mass is 14.5 cm long and contains solid and fluid areas.</div>
<div style="text-align: center;">
Ketumbuhan ini sebesar 14.5 cm dan mengandungi cecair serta kawasan pepejal.</div>
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<br /></div>
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Unfortunately for her, these are hallmarks of ovarian cancer. The danger of this type of cancer is, as highlighted here, is the silent onset and progression. The only method of detection is routine ultrasound scans.</div>
<div style="text-align: justify;">
<i><span style="color: #9fc5e8;">Malangnya, ciri-ciri saperti ini adalah penanda kanser ovari. Bahaya kanser ini ialah penimbulan dan perkembangannya yang berlaku secara senyap. Cara pengesanan kanser ovari hanyalah melalui imbasan ultrasound.</span></i></div>
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<br /></div>
Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-88042040948982746472013-10-05T22:34:00.000-07:002013-10-05T22:34:11.135-07:00Fat uterusThis is a uterus removed recently from a 45 year old multiparous lady who presented with frequent and heavy menstrual bleeding unresponsive to medical therapy. The cut section shows a large area of adenomyosis adjacent to the endometrium with only a thin area of normal myometrium.<br />
<i>Seorang wanita berumur 45 tahun dan beranak ramai telah menjalani pembedahan buang rahim kerana kegagalan mengawal pendarahan haid yang lebat dan kerap melalui rawatan perubatan. Rahim yang dipotong ini mempamerkan satu ketumbuhan adenomiosis yang besar berdampingan dengan endometrium. Ketumbuhan ini dikelilingi oleh lapisan myometrium yang normal yang nipis.</i><br />
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Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-70694448446680925072013-09-16T07:26:00.001-07:002013-09-16T07:26:13.901-07:00Selling the Fantasy of Fertility
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<b>Satu rencana menarik yang mempamirkan komersialisme rawatan kesuburan demi meragut keuntungan</b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
<b>By MIRIAM ZOLL and PAMELA TSIGDINOS</b></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
ON
Sunday in New York City, a trade show called Fertility Planit will showcase the
latest inventions in the world of reproductive medicine under a banner that
reads: “Everything You Need to Create Your Family.” Two dozen sessions will
feature many of the sponsors’ products and therapies, with an emphasis on
hopeful breakthroughs ranging from genetic testing to embryo thawing techniques
to genome sequencing.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
But
the fair’s most powerful strategy is the suggestion that all your answers can
be found within the event hall — and that the power to overcome infertility can
be found within yourself.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
As
former fertility patients who endured failed treatments, we understand how
seductive that idea is.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Americans
love an uphill battle. “Don’t give up the fight” is our mantra. But the refusal
to accept physical limitations, when applied to infertility, can have
disturbing consequences.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Medical
science has achieved great feats, improved and saved the lives of many. But
when it comes to assisted reproductive technologies, science fails far more
often than is generally believed.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
The <a href="http://www.eshre.eu/">European Society of Human Reproduction and
Embryology</a> reports that, on average, of the 1.5 million assisted
reproductive cycles performed worldwide, only 350,000 resulted in the birth of
a child. That is a 77 percent global failure rate. In the United States, the
Centers for Disease Control and Prevention puts the overall failure rate at
almost 70 percent.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Behind
those failed cycles are millions of women and men who have engaged in a
debilitating, Sisyphus-like battle with themselves and their infertility,
involving daily injections, drugs, hormones, countless blood tests and other
procedures.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Thirty-five
years after British scientists brought the world’s first “test-tube baby” to
life, assisted reproduction is a <a href="http://www.healthcarefinancenews.com/news/global-infertility-drugs-devices-market-approach-48b-2017">$4
billion-a-year</a> industry. It’s hard to miss the marketing and advertisements
associated with fertility clinics and service providers that are understandably
eager to do what any business does best: sell to prospective customers.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
But
what they’re selling is packaged in hope and sold to customers who are at their
wits’ end, desperate and vulnerable. Once inside the surreal world of
reproductive medicine, there is no obvious off-ramp; you keep at it as long as
your bank account, health insurance or sanity holds out.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
It’s
no wonder that, fueled by magical thinking, the glorification of parenthood and
a cultural narrative that relentlessly endorses assisted reproductive
technology, those of us going through treatments often turn into “fertility
junkies.” Even among the patient-led infertility community, the prevailing
belief is that those who walk away from treatments without a baby are simply
not strong enough to run the gantlet of artificial conception. Those who quit
are, in a word, weak.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
As a
result, both of us pursued increasingly invasive and often experimental
interventions, many of whose long-term health risks are still largely unknown.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Now
we know better. Ending our treatments was one of the bravest decisions we ever
made, and we did it to preserve what little remained of our shattered selves,
our strained relationships and our depleted bank accounts. No longer under the
spell of the industry’s seductive powers, we study its marketing tactics with
eagle eyes, and understand how, like McDonald’s, the fertility industry works
to keep people coming back for more.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Some
people do, of course, become parents through this technology. But we rarely
hear from the other side, former patients who, in refusing to give up, endured
addictive, debilitating and traumatizing cycles. Those contemplating treatments
have a right to know about the health risks, ethical concerns, broken marriages
and, for many, deep depression often associated with failed treatments. They
need objective, independent advice from health care and mental health professionals
focused on the person’s well-being instead of the profit.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Being
unable to bear children is a painful enough burden to carry, without society’s
shaming and condemning those who recognize that their fertility fantasy is
over. It is time to rein in the hype and take a more realistic look at the
taboos and myths surrounding infertility and science’s ability to “cure” it.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<a href="http://www.miriamzoll.net/"><i>Miriam Zoll</i></a><i> is the author of
the memoir “Cracked Open: Liberty, Fertility and the Pursuit of High-Tech
Babies.” <a href="http://www.silentsorority.com/">Pamela Tsigdinos</a> is the
author of the memoir “Silent Sorority: A Barren Woman Gets Busy, Angry, Lost
and Found.”<o:p></o:p></i></div>
<div class="MsoNormal">
The New York Times, September 11, 2013</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<!--EndFragment--><br />Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-53835022829679208282013-03-03T05:29:00.000-08:002013-03-03T05:29:00.741-08:00Molar Pregnancy<div style="text-align: justify;">
Mrs ANF, a 35 year old lay in her fifth pregnancy, presented with headache, nausea and vomiting and her period delayed 1 week. Pregnancy was suspected and she had come for a confirmatory ultrasound scan. There was no bleeding and she was otherwise well. Nothing unremarkable was found on physical examination. However, ultrasound scan showed a mass in the uterus which contained multiple small cystic structures, as seen here.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8s34jEGm3gO74FbXNJDplYF_7kxtwMA_-s7gMJh1E9llbO15DWyYNKWxBSuqaKQ_qW2tehMKjSfASOTw1NF1TqPRDlrJit8xXgK_SyfLDq_i86tO6dbkQeqxwqHs-TQyrmfXO60aGRw/s1600/Molar4+copy.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8s34jEGm3gO74FbXNJDplYF_7kxtwMA_-s7gMJh1E9llbO15DWyYNKWxBSuqaKQ_qW2tehMKjSfASOTw1NF1TqPRDlrJit8xXgK_SyfLDq_i86tO6dbkQeqxwqHs-TQyrmfXO60aGRw/s320/Molar4+copy.JPG" width="320" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
This was characteristic of molar pregnancy. She underwent suction curettage the next day and a large amount of tissue was removed. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_WtDRhcIFF5X85SnGbRPIy3KLpKETvhTJT9L3hPGrbcxU8-Nnhc_FhZg99ITihU6Wjr5PpFAzzPIqFy6UyI5JcgbARNiBSMvAy1IRwtHPu6TBFOvSyMT7dzUMHBcy9Q3ipgSrHIUGxA/s1600/pic+Dr+100.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_WtDRhcIFF5X85SnGbRPIy3KLpKETvhTJT9L3hPGrbcxU8-Nnhc_FhZg99ITihU6Wjr5PpFAzzPIqFy6UyI5JcgbARNiBSMvAy1IRwtHPu6TBFOvSyMT7dzUMHBcy9Q3ipgSrHIUGxA/s320/pic+Dr+100.jpg" width="320" /></a></div>
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<br /></div>
<div style="text-align: justify;">
This was confirmed as hydatidiform mole. She is now being monitored for recurrence and counselled to practice contraception for at least the next 6 months.</div>
<div style="text-align: justify;">
Hydatidiform mole or molar pregnancy is a rare growth that can occur when a woman gets pregnant. In most instances there is no fetus but occasionally a mole can occur together. Apart from being considered a miscarriage and cause bleeding, a molar pregnancy has the potential to spread out of the uterus and even turn cancerous. Thus steps must be taken to evacuate it completely and prevent progression to cancer.</div>
Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-1876378571286087312013-03-01T17:38:00.002-08:002013-03-01T17:38:35.338-08:00Questions About Robotic Hysterectomy
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<span style="font-size: 15px;">This is an article published recently about the use of the robot to do laparoscopic surgery. This is a growing trend among gynae surgeons and sometimes shows "macho". Although the surgery is very precise, it takes longer to set up and the cost is expensive. That is the main reason why I don't do it. The other issue addressed in this article is the removal of the uterus, or hysterectomy. More and more women are tending to keep their uteri and ovaries till late, and I encourage you to question your doctor strongly whether you really require one. Many doctors do this because sometimes it is easier to do than removing a growth.</span></div>
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<span style="font-size: 15px;"><i>Artikel ini berkenaan pembedahan laparoskopi dengan mengguna robot. Makin banyak pusat perubatan di negara barat mula mengawal cara ini, tetapi hanya 2 pusat di Malaysia. Walaupun pembedahan jenis ini lebih tepat, belanja menjalaninya lebih tinggi dan hasilnya hampir sama. Ini adalah sebab utama saya tidak mengamalinya. Selain dari ini, artikel ini juga menyentuh berkenaan pembuangan rahim, atau histerektomi. Trend zaman sekarang adalah untuk menyimpan rahim serta ovari kecuali betul-betul perlu dibuang. Jikalau anda berada dalam keadaan memerlukan pembedahan, pastikan dengan betul dan secara mendalam keperluan menjalani histerektomi. Ramai doktor melakukan histerektomi hanya kerana ia lebih senang dilakukan daripada membuang ketumbuhan.</i></span></div>
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<span style="font-size: 15px;"><i><br /></i></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">FEBRUARY 25, 2013, 5:01 PM</span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">By <a href="http://well.blogs.nytimes.com/author/roni-caryn-rabin/">RONI CARYN
RABIN</a><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">in The New York Times</span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;"><a href="http://well.blogs.nytimes.com/2013/02/25/questions-about-a-robotic-surgery/?emc=eta1" target="_blank">You can access the original article here</a></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Ever since it was approved by the Food and Drug Administration
in 2005, robotic surgery for <a href="http://health.nytimes.com/health/guides/surgery/hysterectomy/overview.html?inline=nyt-classifier">hysterectomy</a>
has been heavily advertised. Surgeons promise that using the da Vinci robotic
device will bring better results and an easier recovery, and many hospitals
claim that patients will experience less pain and fewer complications, getting
back on their feet faster.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">The company that makes da Vinci robotic surgery
equipment promoted it last May at free health workshops organized by the
federal <a href="http://www.womenshealth.gov/about-us/">Office on Womens’ Health</a>.
On Sunday, the Liberty Science Museum in Jersey City will host its first “Let’s
Operate Day,” offering guests “hands-on” practice peering into video monitors
and using da Vinci’s robot arms to pick up and manipulate small objects.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">The cost of the new technology is rarely mentioned.
But last week, a new study that evaluated outcomes in more than a quarter of a
million American women raised questions about the manufacturer’s claims. The
paper, published in The Journal of the American Medical Association, <a href="http://jama.jamanetwork.com/article.aspx?articleid=1653522">compared
outcomes in 264,758 women</a> who had either laparoscopic or robotically
assisted hysterectomy at 441 hospitals between 2007 and 2010. Both methods are
minimally invasive and involve smaller incisions than open abdominal surgery.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">The researchers found no overall difference in
complication rates between the two groups, and no difference in the rates of
blood transfusion, even though one of the claims regarding robotic surgery is
that it causes less <a href="http://health.nytimes.com/health/guides/injury/bleeding/overview.html?inline=nyt-classifier">blood loss</a>.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">But the researchers did find a big difference in cost.
Robotically assisted surgery for hysterectomy costs on average about one-third
more than laparoscopic surgery.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">“It’s important to separate the marketing from the
data,” said Dr. Jason D. Wright, the study’s lead author, an assistant
professor of obstetrics and gynecology at Columbia University Medical Center.
“For the surgeon, there is a greater degree of movement and control of the
instruments and the visualization is better.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">“But the ultimate question is, does this change
outcomes for patients? This study suggests that there really is not a lot of
difference as far as quantifiable outcomes.”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">The majority of patients in both groups left the
hospital in less than two days, though patients who had robotic surgery were
slightly more likely to go home that early: 80 percent went home in less than
two days, compared with 75 percent of those who had laparoscopic surgery.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">But the cost of robotic surgeries was significantly
higher, with a median cost to the hospital of $8,868, compared with $6,679 for
laparoscopic hysterectomy. The study did not look at the difference in
patients’ bills, but according to <a href="http://newchoicehealth.com/">Newchoicehealth.com</a>,
the average patient price for a laparoscopic hysterectomy ranges from $7,700 in
Dallas to $11,600 in Los Angeles.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">With laparoscopic surgery — sometimes called keyhole
surgery — narrow instruments and a small video camera are inserted through tiny
incisions; the surgeon sees the image on a monitor and can cut and sew tissue
with the instruments. With robotically assisted surgery, the surgeon sits at a
console with a 3-dimensional view of the surgical site, and computer technology
translates his or her hand movements into precise, scaled movements of the
instruments.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Even without offering clear advantages the proportion
of hysterectomies performed robotically has increased rapidly, up to nearly 10
percent of hysterectomies in 2010 from less than 1 percent in 2007, Dr. Wright
said. Minimally invasive surgeries for hysterectomies are increasing across the
board, he found, even at hospitals not performing robotic surgery.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Dr. Myriam J. Curet, chief medical adviser to
Intuitive Surgical, which makes the da Vinci systems, did not dispute the
study’s findings, but said the important message was that more women were able
to receive minimally invasive surgeries because more options were available.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">“That’s good for patients and for the health care
system,” Dr. Curet said. Women who are not candidates for laparoscopic surgery
might still be candidates for robotically-assisted surgery, she added.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Right now, however, it is not clear how to identify
which women would benefit from robotic surgery and which would do well with a
less expensive method.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">The growing use of robotic surgery in hospitals will
continue to drive up health costs, said Joel S. Weissman, of Brigham and
Women’s Hospital and a co-author of <a href="http://jama.jamanetwork.com/article.aspx?articleid=1653509">an editorial
published with the study</a>.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">“Once you have that robot, the tendency is to use it
for all kinds of things, for which it may or may not have great value,” Dr.
Weissman said. Studies like this one, he said, demonstrate the waste of health
care dollars on “something that costs a lot more and doesn’t offer any added
benefit over current treatment options.”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Each year approximately <a href="http://www.cdc.gov/reproductivehealth/womensrh/00-04-FS_Hysterectomy.htm">600,000
American women have hysterectomies</a>, according to the Centers for
Disease Control and Prevention. By age 60, <a href="http://www.nlm.nih.gov/medlineplus/hysterectomy.html">one in three
American women has had her uterus removed</a>, often along with her ovaries
and cervix.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Critics who say far too many hysterectomies are done
in the United States worry that all the attention to surgical method distracts
from the question of whether patients should be having the surgery at all.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Most hysterectomies are prescribed for conditions that
are not life-threatening, and advocates worry that women are not fully informed
of the long-term harms, which may include a loss of sexual responsiveness,
depression and chronic <a href="http://health.nytimes.com/health/guides/symptoms/constipation/overview.html?inline=nyt-classifier">constipation</a>,
and higher risk for <a href="http://health.nytimes.com/health/guides/disease/osteoporosis/overview.html?inline=nyt-classifier">osteoporosis</a>
and heart disease, said Nora W. Coffey, the founder of the nonprofit <a href="http://www.hersfoundation.org/">Hysterectomy Educational Resources and Services
Foundation</a>.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">“That’s the conversation we should be having,” Ms.
Coffey said.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">Nora W. Coffey and other experts emphasize that women
considering a hysterectomy should discuss all options with their doctors.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">¶Ask what the alternatives are and whether watchful
waiting is an option. Remember that it is irreversible, regardless of how the
surgery is done.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">¶Learn about the nonreproductive functions of the
uterus, ovaries and cervix, and the potential long-term consequences associated
with their removal, as well as the function of the ovaries and cervix.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">¶If you proceed, discuss the advantages and
disadvantages of different surgical methods with your doctor. Interview several
surgeons and inquire about the cost and how much insurance will cover. Your
co-pay may vary depending on the surgical method.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 11.0pt;">¶Tell your surgeon if you do not want your ovaries and
cervix removed.</span></div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-68220895850615464532012-11-13T16:37:00.001-08:002012-11-13T16:37:21.993-08:00Hyperstimulation<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSuHFCyYWJeKb1qm7tZmoKQy8OfwezHxWMaIlCorEeN3yeCjvt6TBczdGBCXG9af-IUy4Wf8YiHdKtN-bc6abfpN1jYRdx2dOsLCY5mTj57W3zAY0MKYXMG_9o7soq2PWVvJb8ZbeDUw/s1600/201211092107020001GYN+copy.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSuHFCyYWJeKb1qm7tZmoKQy8OfwezHxWMaIlCorEeN3yeCjvt6TBczdGBCXG9af-IUy4Wf8YiHdKtN-bc6abfpN1jYRdx2dOsLCY5mTj57W3zAY0MKYXMG_9o7soq2PWVvJb8ZbeDUw/s320/201211092107020001GYN+copy.JPG" width="320" /></a></div>
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<div style="text-align: justify;">
<span style="font-family: Georgia, 'Times New Roman', serif;">This is an image taken from a patient who presented with left lower abdominal pain. She has a past history of surgery for endometriosis, GnRHa therapy and is currently seeking to get pregnant. She had been taking Clomiphene for the past 3 months prescribed by her gynaecologist. The ultrasound scan shows a bizarre multiloculated cyst about 9 cm in size. This looks like a hyperstimulated ovary due to clomiphene. Hyperstimulation with clomiphene is not common and usually subsides without complications. The main point here is to observe rather than to rush into any further surgery. </span></div>
<i style="font-family: Georgia, 'Times New Roman', serif;"><div style="text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRs5HrWPbzsgpEsg5_3BZe8Qwt3t2hZZGPUnWGnhCOPFlF93vmE9sPADtX5kRtWClJyzbIh1hEKFVOyml2n_e3I-VF4NmtmWxPDXBkxIAN7VzXbHy1LgIRSY5C_RIVxskmd2HAANRw9g/s1600/201211092107110002GYN+copy.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRs5HrWPbzsgpEsg5_3BZe8Qwt3t2hZZGPUnWGnhCOPFlF93vmE9sPADtX5kRtWClJyzbIh1hEKFVOyml2n_e3I-VF4NmtmWxPDXBkxIAN7VzXbHy1LgIRSY5C_RIVxskmd2HAANRw9g/s320/201211092107110002GYN+copy.JPG" width="320" /></a><i>Ini adalah gambaran yang diambil dari seorang pesakit yang mengadu perasaan sakit dibahagian kiri abdomen. Beliau pernah menjalani pembedahan dan rawatan ubat hormon untuk penyakit endometriosis. Buat masa kini, pesakit ini sedang melalui rawatan kesuburan dengan ubat clomiphene 3 bulan yang lepas yang diberi oleh pakar sakitpuannya. Imbasan ultrasound menampakkan sebuah sista sebesar 9 cm yang mempunyai banyak ruang dalamnya. Ini merupakan sebuah ovari yang telah terangsang berlebihan oleh ubat clomiphene. Rangsangan hiper saperti ini jarang belaku dengan ubat clomiphene dan biasa surut tanpa komplikasi. Tindakan utama ialah pemerhatian dan elak dari melakukan pembedahan tergesa-gesa.</i></div>
</i>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-44661474986609658662012-10-14T06:45:00.000-07:002012-10-14T06:45:29.619-07:00Clear 4D Pictures<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgljE2c__t9rAvn2NFttKqYNLFMd5bGz7wiUzvSPiNgy_qwGUQj2qkTH-5NpEdTgz9AjmVOuorcvdVYwrW6RTEsgKyRhgy6QGOTDNA2RooduD8ebxaki9C6mHfhNni2y_rQw11_MeMeaw/s1600/Telinga1+copy.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgljE2c__t9rAvn2NFttKqYNLFMd5bGz7wiUzvSPiNgy_qwGUQj2qkTH-5NpEdTgz9AjmVOuorcvdVYwrW6RTEsgKyRhgy6QGOTDNA2RooduD8ebxaki9C6mHfhNni2y_rQw11_MeMeaw/s320/Telinga1+copy.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Right ear and neck/Telinga dan leher kanan</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi_ZslTWYJvxbQfpA5xuU_wyjc26y-dd5l7Q5xJgZF7RW9YwkQyB1dInnkgfF-TzIaXCOi-5wS5dJbyZ9bRR-GVWj1uewpXubntTpDPOEcj0i9It4nW8sH3sBu2bIsZ2uDftEEDNwxvg/s1600/Tapak+kakix2+copy.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi_ZslTWYJvxbQfpA5xuU_wyjc26y-dd5l7Q5xJgZF7RW9YwkQyB1dInnkgfF-TzIaXCOi-5wS5dJbyZ9bRR-GVWj1uewpXubntTpDPOEcj0i9It4nW8sH3sBu2bIsZ2uDftEEDNwxvg/s320/Tapak+kakix2+copy.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Both feet/Kedu-dua kaki</td></tr>
</tbody></table>
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<span style="font-family: Georgia, Times New Roman, serif;">Everybody likes to see clear pictures of their baby, so it is important that a 4D scan is done at the right time. This is around 20-24 weeks of gestation, but a lot depends on the amount of liquor within the uterus. These pictures are from a pregnancy with excessive liquor, termed polyhydramnios, so the 4D scan pictures are particularly clear.</span></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;">Semua ibu-bapa ingin melihat gambaran yang jelas kandungan mereka. Dari segi imbasan 4D, penting supaya ia dilakukan pada waktu yang betul, biasanya antara 20-24 minggu usia kandungan. Walaupun demikian, banyak bergantung pada jumlah air ketumban yang ada dalam rahim. Gambar-gambar ini diambil dari kandungan yang mengalami air ketumban yang berlebihan, lebih dikenali sebagai polyhydramnios, dan nyata kejelasan gambarnya.</span></i></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeI7onMpDndsaSntujD_qnzydEMdv2R4pd583haGcriuDHd2hgTjRHsG2yraRenE2hAO8THKocqGTmhTkoL9jhgPTBUHubiQFzuTsiKsacFQdqop1gkl1dqKxncZQWrV2o0rxqWkhMsA/s1600/Pehalutu+copy.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeI7onMpDndsaSntujD_qnzydEMdv2R4pd583haGcriuDHd2hgTjRHsG2yraRenE2hAO8THKocqGTmhTkoL9jhgPTBUHubiQFzuTsiKsacFQdqop1gkl1dqKxncZQWrV2o0rxqWkhMsA/s320/Pehalutu+copy.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Right thigh and knee/Peha dan lutut kanan<br /></td></tr>
</tbody></table>
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<br />Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-77153421289601911462012-09-19T22:17:00.001-07:002012-09-19T22:17:48.456-07:00Funny Places for Endometriosis<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif;">The July edition of The Journal of Minimally Invasive Gynaecology (JMIG) presents 2 case reports of endometriosis occurring in abnormal places. In the first case, the patient had nose bleed and pain and was found to have growths there. The second case presented with gastric-like abdominal pain and was found to have a growth in the pancreas on scanning. Both cases were confirmed as endometriosis after surgical removal. Of note was that these patients had positive correlation with cyclical symptoms as well as previous suggestion of endometriosis. So, endometriosis in the nose and in the pancreas. Who would have thought it?</span></div>
<div style="text-align: justify;">
<i><span style="font-family: Georgia, Times New Roman, serif;">Tapak Aneh Penyakit Endometriosis </span></i></div>
<div style="text-align: justify;">
<i><span style="font-family: Georgia, Times New Roman, serif;">Dalam isu bulan Julai The Journal of Minimally Invasive Gynaecology (JMIG), terpapar 2 kes penyakit endometriosis yang ditemui di kedudukan yang aneh. Pesakit kes pertama melapor pendarahan dan perasaan sakit di hidungnya serta ternampak ketumbuhan. Pesakit kes kedua pula mempunyai perasaan sakit ala gastrik dan ternampak ketumbuhan di kelenjar pankreasnya melalui imbasan. Kedua-dua kes ini dipastikan mengidap penaykit endometriosis selepas pembedahan untuk mengeluarkan ketumbuhan-ketumbuhan tersebut. Yang penting dalam kes-kes ini ialah sejarah perubatan yang mengaitkan penimbulan simptom-simptom tersebut dengan kitaran haid serta sejarah lama penyakit endometriosis. Jadi, endometriosis di hidung dan pankreas, sungguh aneh!</span></i></div>
Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com2tag:blogger.com,1999:blog-6093017718873746713.post-83001740951787900042012-09-05T22:49:00.000-07:002012-09-05T22:49:00.057-07:00August Case - Twin Fibroids<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipwkVyKuGNnsYsOzxINMl8iJENEVxV3VxsBtmdXP5DJvNLM568PRK_I-0dHx80-aLKQt3_SGyZJ1z8l9yRAup3vsSQEBnKftZ6L-FPqyBmX9Ep6AOSChAxXOh9UW5le5S24epS8uK1XQ/s1600/TwinFibroids.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipwkVyKuGNnsYsOzxINMl8iJENEVxV3VxsBtmdXP5DJvNLM568PRK_I-0dHx80-aLKQt3_SGyZJ1z8l9yRAup3vsSQEBnKftZ6L-FPqyBmX9Ep6AOSChAxXOh9UW5le5S24epS8uK1XQ/s320/TwinFibroids.png" width="320" /></a></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif;">Sorry, I have been meaning to write but have been swamped with other things. This was a 51 year old lady who had never conceived in 30 years and presented with abnormal and heavy menstrual bleeding. There was a mass felt in the abdomen, about 6 months pregnancy size. Ultrasound scan showed multiple uterine masses suggestive of fibroids. This was the view on laparoscopy - twin, large fibroids. I had counselled hysterectomy, but it was difficult due to the restricted view. I had to remove the fibroids from the uterus first (myomectomy) before proceeding to hysterectomy. As usual, everything was done laparoscopically. </span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif;"><i>Fibroid Kembar</i></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif;"><i>Maaf atas kelewatan menulis. Kes ini adalah seorang wanita berumur 51 tahun yang tidak pernah mengandung walaupun kahwin selama 30 tahun. Beliau mengalami pendarahan haid yang berpanjangan dan lebat, dan setelah diperiksa, didapati mempunyai ketulan di perut sebesar kandungan berusia 6 bulan. Imbasan ultrasound telah menampakkan banyak ketumbuhan di rahim yang berciri fibroid. Gambaran ini dilihat melalui laparoskop - fibroid-fibroid besar dan berkembar. Pembuangan rahim menjadi rumit apabila penglihatan terhad kerana ketumbuhan-ketumbuhan tersebut. Akhirnya, fibroid-fibroid ini dipisahkan dahulu dari rahim sebelum histerektomi dilaksanakan. Saperti biasa, semua prosedur dilakukan dengan melalui pembedahan laparoskopi.</i></span></div>
Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-83748334016536800352012-09-05T21:14:00.001-07:002012-09-05T21:14:08.488-07:00Facts About Menopausal Hormonal Therapy<br />
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><span style="text-align: justify;">10
years after the seminal publication of the Women’s Health Initiative trials data</span><sup style="text-align: justify;">1</sup><span style="text-align: justify;">,
certain facts and data have emerged that can help guide us in this so
controversial an issue of Menopausal Hormonal Therapy (MHT). The following is a
summary of a review published lately in the journal Menopause</span><sup style="text-align: justify;">2</sup><span style="text-align: justify;">.</span></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif;">It
has always been a truth that MHT is an acceptable option for treating severe
early menopausal symptoms. As is the wont of these symptoms, they disappear
within 10 years of menopause, thus this treatment is prudent and applicable within
this time frame. Such therapy must of course be precluded in the presence of
medical problems, foremost of which are blood clots, heart disease, stroke and
cancer. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif;">Estrogen
replacement alone suffices for a woman who has lost her uterus, whereas
progesterone therapy needs to be added for the sole purpose of prevention of
endometrial cancer in those who retain theirs. If the symptoms are limited to
the vulva, vagina and the bladder, topical estrogen therapy to the affected
parts might be enough to soothe the symptoms. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif;">So
much is so true, and we must keep in mind that the whole controversy arose not
because of questionable beneficial effects, rather, the serious consequences of
MHT. Foremost in the mind of most women is the occurrence of breast cancer. The
WHI trials demonstrated an increased risk of breast cancer with more than 5
years continued use of the estrogen-progesterone combination therapy. This
increased risk was not present in users of estrogen-only preparations, thus
suggesting a causal link of breast cancer with progesterone. The data shows
that the risk is not that great and decreases after discontinuation of said replacement
therapy. Estrogen, whether given alone or together with progesterone, increases
the risk of thromboembolic events (TE) such as deep vein thrombosis, pulmonary
embolism and stroke, but these occurrences are rare before the age of 59 years.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif;">Thus
we have come to accept that combination estrogen-progesterone MHT is proven
effective in the management of early menopausal symptoms only (and not for
other indications) but should be used for the shortest duration and with the
lowest possible dosage. More flexibility is accorded to estrogen only therapy
but similar caveats should apply whenever possible. </span><o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
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<span style="color: #fce5cd; font-family: Georgia, Times New Roman, serif;"><i>Fakta Berkenaan Rawatan Hormon Menopause</i></span></div>
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<span style="color: #fce5cd; font-family: Georgia, Times New Roman, serif;"><i>10 tahun selepas maklumat daripada kajian unggul berkenaan
rawatan menopause diketengahkan<sup>1</sup>, situasi berkenaan rawatan ini
semakin jelas, saperti dipaparkan dalam jurnal Menopause baru-baru ini<sup>2</sup>.
Berikut adalah ringkasan tajuk utama.<o:p></o:p></i></span></div>
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<span style="color: #fce5cd; font-family: Georgia, Times New Roman, serif;"><i>Terapi hormon untuk menopause (MHT) sungguh berkesan
mengatasi gejala awal menopause dan boleh diteruskan selama 10 tahun, iaitu,
sehingga simptom-simptom keadaan ini hilang. Rawatan ini tidak boleh digunakan jikalau
seseorang wanita mengalami beberapa masalah perubatan, terutama sekali ketulan
dalam saluran darah, serangan angina ahmar, sakit jantung dan kanser. <o:p></o:p></i></span></div>
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<span style="color: #fce5cd; font-family: Georgia, Times New Roman, serif;"><i>Rawatan ini boleh dibahagikan kepada 3 – hormon estrogen sahaja
untuk wanita yang tidak mempunyai rahim, kombinasi hormon estrogen-progesteron
bagi mereka yang ada rahim dan krim estrogen setempat jikalau gangguan terhad
kepada kemaluan, faraj atau pundi kencing.<o:p></o:p></i></span></div>
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<span style="color: #fce5cd; font-family: Georgia, Times New Roman, serif;"><i>Risiko penggunaan MHT ialah kejadian saperti kanser payudara dan
kejadian tromboembolik (TE) saperti angina ahmar, ketulan darah dan embolasi
paru-paru. Tidak dinafikan yang MHT meningkatkan risiko mengalami kanser
payudara, tetapi jumlah kejadian ini kecil dan risiko tersebut hilang selepas
rawatan diberhentikan. Lagipun, risiko berlakunya kanser payudara hanya meningkat jika digunakan </i><i>terapi kombinasi estrogen-progesteron dan bukan estrogen
bersendirian. Kejadian TE lebih berkemungkinan berlaku dengan kesemua jenis rawatan
oral tetapi jarang dialami sebelum umur 59 tahun.</i></span></div>
<span style="color: #fce5cd; font-family: Georgia, Times New Roman, serif;"><div style="text-align: justify;">
<i><span style="font-size: 12pt;">Dengan ini, MHT didapati sesuai untuk rawatan simptom-simptom
awal menopause sahaja tetapi perlu digunakan dalam dos yang paling rendah dan
dalam jangkamasa yang paling pendek. Pengawasan untuk gejala kanser </span><span style="font-size: 12pt;">payudara dan kejadian TE mesti berterusan.</span></i></div>
</span><br />
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<!--StartFragment--><!--EndFragment--><span style="color: #0c343d; font-family: Georgia, Times New Roman, serif;"><i>
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<br /></div>
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<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;">1. Risks and Benefits of Estrogen Plus Progestin in Healthy
Postmenopausal Women. Principal Results From the Women's Health Initiative
Randomized Controlled Trial. JAMA 2002;288(3):321-333.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;">2. Stuenkel CA, Gass MLS, Manson J et al. A Decade After the
Women’s Health Initiative – The
Experts Do Agree. Menopause 2012;19(8):846-847.</span><o:p></o:p></div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-5729967687581973962012-08-05T09:55:00.000-07:002012-08-05T09:55:01.135-07:00Increased Risk of Type 2 Diabetes With Polycystic Ovary Syndrome<br />
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<span style="font-family: Georgia, Times New Roman, serif;"><i><b>Peningkatan risiko mengidap penyakit kencing manis untuk wanita PCOS</b></i></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif;">It
has been known for some time that a woman with PCOS has an increased risk of
getting Diabetes mellitus (DM) has been known for some time. Adding to this
knowledge is a new study from Cardiff that examined a very large number of
patients (more than 20000) to confirm this point. The data taken from the UK's
General Practice Research Database showed a 2-3-fold increase of DM among PCOS
women when compared with controls.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif;"><i>Telah
lama diketahui bahawa seseorang wanita yang mengalami PCOS berisiko lebih
tinggi mengidap penyakit kencing manis (DM). Kini, kenyataan ini menjadi lebih
kukuh berdasarkan satu kajian dari Cardiff, United Kingdom yang melibatkan
lebih dari 20 000 orang wanita. Maklumat daripada kajian ini mendapati wanita
PCOS berkemungkinan mengidapi DM 2-3 kali ganda lebih berbanding dengan wanita
tanpa PCOS. </i><o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;">Christopher
L. Morgan, Sara Jenkins-Jones, Craig J. Currie, and D. Aled Rees. Evaluation of
Adverse Outcome in Young Women with Polycystic Ovary Syndrome Versus Matched,
Reference Controls: A Retrospective, Observational Study. </span><span style="font-family: Georgia, 'Times New Roman', serif; font-size: x-small;">JCEM
jc.2012-1690; doi:10.1210/jc.2012-1690</span></div>
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<o:p></o:p></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-13124609552412262292012-07-23T20:41:00.000-07:002012-07-23T20:41:11.306-07:00Upside Down Baby<div class="separator" style="clear: both; text-align: justify;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">This baby at around 25 weeks gestational age was captured on a 4D scan in a na upside down position because of its transverse lie in the uterus. A fatal lie like this may be considered normal at this gestational age, and most babies stabilise into a normal lie between 28-32 weeks gestation. this baby's hand can also be viewed in the gallery.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuXhqGEyQgUo4-BPP02mybBonTrY3ccieY7Kxz_qEl76Dw1NrBQNg-9rGGWD54nf-FsdlUxJF7xZnap5jeQC19I8pcCMauusI6MoC-K3pUvppHq28HOBP88SBuUkq-UpyN-qnorx8ypg/s1600/Upside+down+copy.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuXhqGEyQgUo4-BPP02mybBonTrY3ccieY7Kxz_qEl76Dw1NrBQNg-9rGGWD54nf-FsdlUxJF7xZnap5jeQC19I8pcCMauusI6MoC-K3pUvppHq28HOBP88SBuUkq-UpyN-qnorx8ypg/s1600/Upside+down+copy.JPG" /></a></div>
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><i><b>Bayi Tertungging</b></i></span></div>
<div style="text-align: justify;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><i>Gambaran 4D seorang bayi (perempuan) dengan kepala tertungging didapati apabila bayi beruisa kandungan lingkugan 25 minggu berkedudukan melintang dalam rahim. Kedudukan saperti ini adalah biasa dalam usia ini dan kebanyakan bayi akan membetulkan diri selepas 28-32 minggu usia kandungan. Tangan kanan bayi ini boleh juga dilihat dalam galeri.</i></span></div>
<br />Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-52315094506042203762012-07-07T21:18:00.001-07:002012-07-07T21:18:29.457-07:00JULY CASE<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuIMVhWQfNrXYCC6_PeFnXzXVR4IKkKT32CtibSkP1WIiN3jb3zMWmmxdw-8zyCUIJ7P_bIX_egaFBvZsLc0rkPhkmUVUEhnRarZQjLUydML4ydpAwvP55c4TeuFnKB4ZIBTiIX6NsMw/s1600/Flame+lesion+++adhesion.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuIMVhWQfNrXYCC6_PeFnXzXVR4IKkKT32CtibSkP1WIiN3jb3zMWmmxdw-8zyCUIJ7P_bIX_egaFBvZsLc0rkPhkmUVUEhnRarZQjLUydML4ydpAwvP55c4TeuFnKB4ZIBTiIX6NsMw/s320/Flame+lesion+++adhesion.png" width="320" /></a></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: justify;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">This 37 year old lady with 3 children was diagnosed with a missed abortion. She was planned for Dilatation and Curettage (D&C) but also expressed the desire for tubal ligation (TL) as permanent contraception. Over the years she had developed mild period pain but was otherwise well. Under general anaesthesia, D&C was carried out followed by laparoscopy for the TL. Incidental endometriosis was then discovered on inspection of the pelvis. This picture shows some classical lesions. Firstly, the uterus was mildly enlarged but this could have been due to the pregnancy. There was a left ovarian cyst and the enlarged ovary was stuck to the back of the uterus. At the point of adhesion, a flame shaped endometriotic lesion was observed. This case demonstrates again the discrepancy between symptoms and the extent of the disease in endometriosise, as despite having severe endometriosis, she was relatively well apart from mild dysmenorrhoea.</span></div>
<div style="text-align: justify;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><i>Wanita berumur 37 tahun dan beranak 3 mengalami keguguran dan bersedia melalui prosedur cuci (D&C). Sambil itu, memandangkan usia meningkat serta ketidakrelaan mengandung lagi, dia juga ingin melalui prosedur ikat tiub (TL) sekali harung. Selain dari mengalami perasaan sakit senggugut sedikit, beliau sihat walafiat. Selepas dibius penuh, kandungan yang gugur telah dicuci dan laparoskop di masukkan melalui pusatnya untuk prosedur TL. Selepas diteliti, pesakit ini didapati mengalami penyakit endometriosis yang agak teruk dengan serba jenis lesi. Rahimnya bengkak sedikit tetapi ini mungkin disebabkan mengandung. Ovari kiri bengkak juga kerana kehadiran sista, dan ovari ini terlekat pula ke bahagian belakang rahim. Ditempat lekatan ini berlaku, terdapat satu lesi "flame". Kes ini memberi pengajaran lagi yang simptom atau tanda penyakit endometriosis tidak semestinya secocok dengan keterukan penyakit itu.</i></span></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-46788772347872837982012-06-15T21:43:00.003-07:002012-06-15T21:44:34.794-07:00Pembedahan Laparoskopi<div class="separator" style="clear: both; text-align: center;">
<img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh49yD7eBRPhjezl6TEayxoYliLeOZ_aD9EDHZ3y6cpVIcXPi7iV8CGH6PxEvONMngxfZODZoIfCajIatox1Go-dr4gUZSA-P0T1AeeTSSbmXPEyJRYPpr-sG1-OdjCpVeOsLMBOcdqUA/s1600/Operating.jpg" /></div>
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<span class="Apple-style-span" style="color: #ffd966; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><a href="http://hanifatlumut.blogspot.com/p/laparoskopi.html" target="_blank">Pembedahan laparoskopi adalah suatu jenis pembedahan moden yang melibatkan belahan-belahan kecil dan proses penyembuhan yang cepat. Perasaan sakit yang dialami sangat sedikit berbanding dengan pembedahan tradisional dan pada kebiasaannya, seseorang pesakit hanya perlu tinggal di wad kurang dari 24 jam. Untuk keterangan yang lebih lanjut berkenaan pembedahan yang mempunyai banyak kelebihan ini, layarilah mukasurat "Pembedahan Laparoskopi".</a></span></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-70395951413133004472012-06-08T04:20:00.002-07:002012-06-08T04:22:19.478-07:00<div class="separator" style="clear: both; text-align: center;">
<a href="http://hanifatlumut.blogspot.com/p/4d-scan.html"><img border="0" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi69a_0xhzS_vRYWOJtp63ySgmKILouIILAbCCOz_h_1NASP1WKIA1NQoydbVam0Xs8bGEgGr33uu7AYYXCjg5IZfOxoToJHUmMQSYQr2oqKQiHMLyGSpiBNPaxu1orhvOF5akvRHnKcg/s320/201206051236350011OB.JPG" width="320" /></a></div>
<div style="text-align: center;">
<span class="Apple-style-span" style="color: #6fa8dc; font-family: Georgia, 'Times New Roman', serif; font-size: large;"><a href="http://hanifatlumut.blogspot.com/p/4d-scan.html">Apakah dia 4D Scan? Jika anda berminat untuk mendapat maklumat lebih, layari muka terbaru blog ini.</a></span></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-18556281305747674492012-05-14T22:21:00.000-07:002012-05-14T22:28:48.877-07:00KES BULAN MEI<div style="text-align: justify;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b>Susah Mengandung</b></span></div>
<div style="text-align: justify;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Puan SI, seorang perempuan Melayu berumur 32 tahun yang telah berkahwin selama 4 tahun mengalami masalah susah mengandung. Dia telah membuat penelitian dan rawatan di hospital kerajaan tanpa jaya sebelum ini. Beliau tidak pernah mengalami apa-apa masalah lain dan mempunyai perjalanan haid yang sempurna tanpa sakit senggugut. Air mani suaminya didapati normal. Pemeriksaan fizikal tidak menampilkan keganjilan, cuma pesakit ini sedikit obese. Scan ultrasound menunjukkan rahim dan persekitarannya yang normal. </span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br /></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCSPNENV2Ero8WGOwfU1NwOoma_zMjPHtT5Qb6rRml4xvwyfT-4U7ybljrT90fviMaiCuiHgCwkrwYjx8TqzfHByRgvtU1mJtN2TQfUXISHgKtJmCxxlLOJZK-K3dwqvnz4oh5TdxWBQ/s1600/vascular+patterns.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCSPNENV2Ero8WGOwfU1NwOoma_zMjPHtT5Qb6rRml4xvwyfT-4U7ybljrT90fviMaiCuiHgCwkrwYjx8TqzfHByRgvtU1mJtN2TQfUXISHgKtJmCxxlLOJZK-K3dwqvnz4oh5TdxWBQ/s320/vascular+patterns.png" width="320" /></a></div>
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Gambar ini mempamerkan sebeuah rahim yang mempunyai banyak saluran darah halus dipermukaannya yang digelar "Vascular Patterns" seakan ia meradang. Kedua-dua saluran Falope tersumbat yang disebabkan oleh benjolan hasil dari penyakit endometriosis. Ovari-ovari normal kelihatan warna putih.</div>
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Puan SI telah menjalani pembedahan laparoskopi di mana nyata kelihatan sebuah rahim yang meradang (lihat gambar) dan saluran Falope yang tersumbat kedua belah. Ini disebabkan oleh penyakit endometriosis dan rawatan hormon kini sedang dilaksanakan untuk mengatasi masalahnya.</span></div>
<div style="text-align: justify;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Pelajaran yang boleh didapati dari kes ini ialah penyakit endometriosis kerap kali wujud tanpa tanda dan simptom utamanya mungkin hanya kesukaran mengandung. Tiada keganjilan yang kelihatan menerusi penelitian biasa, dan diagnosa hanya dapat dilakukan melalui pembedahan laparoskopi. Oleh itu, seseorang pesakit yang mengalami kesukaran mengandung tanpa sebab yang nyata berkemungkinan mengalami penyakit endometriosis.</span></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com1tag:blogger.com,1999:blog-6093017718873746713.post-88595019157078933082012-04-17T20:23:00.000-07:002012-04-17T20:23:11.468-07:00Surgery for diabetes?<!--[if gte mso 9]><xml>
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Recently,
two studies were published in the New England Journal of Medicine (NEMJ)
providing compelling evidence that surgical methods of achieving weight loss
can lead to better control of Type 1 diabetes mellitus (T1DM). It is well
established that weight loss in an obese person can show marked improvement in
the control of their DM.</span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">As
we are well aware, while T1DM results from the body’s failure to produce
adequate amounts of the hormone insulin, Type 2 DM (T2DM) is a consequence of
improper utilization of this hormone. Regardless of the type, DM becomes more
difficult to manage as it progresses and ultimately leads to serious and severe
complications such as heart disease, kidney failure, blindness and stroke. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Crucial
to proper management of this disease is the adequate control of blood sugar
centered upon lifestyle measures that encourage weight loss and physical
activity. The weight loss regimen involving diet and exercise can be a mentally
and physically painful process with often a less than desirable outcome. Many
patients are unable to achieve good glycemic control, leading to the addition
of medications, frequently with increasing number and dosage, and ultimately
the addition of insulin therapy. Counter to the aim of the therapy, one of the
side effects of insulin therapy is weight gain, thus rendering management more
difficult.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">It
is no surprise then that more patients are starting to resort to surgery to
decrease the size of their stomach. This type of weight loss surgery is termed
bariatric surgery and involves gastrectomy (removal of part of the stomach),
stapling or banding of the stomach. Although having been around for some time
now, an upsurge in cases of bariatric surgery for the management of DM has been
reported, mainly due to recent information from clinical studies that showed
significant weight loss and subsequent improvement in diabetic control. These
recent studies provide more dependable information because of their random and
rigorous comparison between medical and surgical forms of treatment. There is
now better proof that weight loss operations seem to work much better than standard
medical management.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Nevertheless,
caution must be employed and it may be wise to examine the studies in depth and
note their deficiencies. They involved only a small number of patients (150)
and were of a short duration. As well as not being able to prove long-term
benefits, it is also questionable if the results of bariatric surgery will be
as good in routine clinical practice, or for that matter, in patients who are
not as heavy as those in the studies. Since highly skilled surgeons performed
the operations in these studies, results by others may not be as good. Surgical
complications can range from infections, mineral and bone deficiencies and other
injuries. Furthermore, these studies compared bariatric surgery with standard
medical care involving medications, when in actual fact, the comparison should
have been with medical weight loss therapy (diet, exercise, behavior change and
other appropriate medical interventions). Patients succeeding with medical
treatment would then have no necessity to undergo surgery at all.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">To
be fair though, bariatric surgery has been recognized as appropriate treatment,
but only for those obese patients with Type 2 DM who are unable to reach their
glycaemic targets with the prescribed medical therapies. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In
conclusion, we should not rush to embrace bariatric surgery as a standard
treatment alternative for DM despite the strong evidence suggesting so. Due
recognition has to be given for the hard work put in by the researchers, but
benefit must be shown in a larger numbers of patients, and over a longer period
of time before we can determine the place of bariatric surgery in the
management of Type 2 DM.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">References:<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Schauer
PR et al. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients
with Diabetes. March 26, 2012 (10.1056/NEJMoa1200225)<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Mingrone
G et al. Bariatric Surgery versus Conventional Medical Therapy for Type 2
Diabetes. March 26, 2012 (10.1056/NEJMoa1200111)<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Zimmet
P, George K, Alberti MM. Surgery or Medical Therapy for Obese Patients with
Type 2 Diabetes? March 26, 2012 (10.1056/NEJMe1202443)</span><o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-974421867262858682012-04-09T06:24:00.000-07:002012-04-09T06:24:07.779-07:00Kes Bulan April 2012PENDARAHAN YANG LEBAT DALAM USIA MATANG<div>
Puan S, seorang ibu berusia 46 tahun dan beranak 3 telah mengadu pendarahan haid yang lebat sejak 3 tahun yang lepas. Walaupun pendarahan haidnya lebat, tetapi kitarannya tetap sama saperti masa-masa dahulu. Yang menyebabkan Puan S mencari rawatan selepas kian lama mengalami pendarahan ini ialah penimbulan simptom baru, iaitu, perasaan sakit senggugut.</div>
<div>
Selepas diteliti, didapati Puan S adalah seorang wanita yang obes dan bertekanan darah tinggi serta pucat akibat kekurangan darah. Dibahagian bawah perutnya terasa satu ketulan keras sebesar kandungan 4-5 bulan.</div>
<div>
Ultrasound scan telah menampakkan sekurang-kurangnya 3 fibroid dalam rahim, yang paling besar berukuran 9 cm.</div>
<div>
Beliau telah menjalani pembedahan laparoskopi dan pembuangan rahim (kedua-dua ovarinya dipelihara kerana masih menghasilkan hormon estrogen). Pembedahan yang agak rumit ini mengambil masa 3 jam dan memerlukan pemotongan fibroid dari rahim untuk menyenangkan pembedahan.</div>
<div>
Puan S telah bergerak dan makan saperti biasa pada keesokan hari dan balik rumah dengan hanya mengadu perasaan sakit sedikit saja.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhETRYwPpvIyHPLpIPlr5Dn6v23mm64pROjaGnsAM_lcLARqEwBoT4KPArwDAmHVGAiDV_tVQ2knJo23-DgLOKpViv7AiTt-4mNj_mSbHnlbQYkiAQGpNqYoIaV0_HnNelTxs8Ms0QV8A/s1600/Fibroid+dlm+Uterus.BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhETRYwPpvIyHPLpIPlr5Dn6v23mm64pROjaGnsAM_lcLARqEwBoT4KPArwDAmHVGAiDV_tVQ2knJo23-DgLOKpViv7AiTt-4mNj_mSbHnlbQYkiAQGpNqYoIaV0_HnNelTxs8Ms0QV8A/s320/Fibroid+dlm+Uterus.BMP" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
Gambaran ini mempernampakkan rahim yang besar hasil dari fibroid dikelilingi usus sebelum pemotongan dimulakan. Ovari kanan kelihatan di celah tiub kanan dan berwarna putih. </div>
<div>
<br /></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-2860100831412032542012-03-23T18:58:00.001-07:002012-03-23T19:08:54.785-07:00PCOS AND HYPERINSULINISM<div style="text-align: justify;">
<span class="Apple-style-span" style="color: #fce5cd;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The most common endocrine cause of anovulation is polycystic ovary syndrome (PCOS). Typically, women with this problem present with infertility associated with scanty menstrual periods and cycles of more than 35 days. Most patients have some clinical or laboratory evidence for hyperandrogenism, and polycystic ovaries appear on ultrasonography. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The familial association with diabetes mellitus (DM) is quite significant. As the risk for DM amongst PCOS women is increased several-fold, many of them become diagnosed with impaired glucose tolerance or insulin resistance. This disturbance in glucose metabolism is due to elevated baseline or stimulated insulin levels and may be a consequence of a genetic predisposition. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The role of insulin as a growth factor is well established. Insulin stimulates the ovarian theca cells to produced increased amounts of androgens. Considering that androgens serve as precursors for estradiol synthesis, it is therefore unsurprising that estradiol levels become elevated. Hyperandrogenism also interferes locally with the normal process of folliculogenesis thus propounding the hormonal and fertility problems. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Metformin is an insulin-sensitizing drug that is commonly used in the treatment of DM and serves to reduce insulin secretion. Its use is also associated with a normalization of the intraovarian paracrine milieu and is effective in PCOS. Despite the belief that metformin may not be totally effective in the management of fertility-related issues, it is quite logically an effective form of treatment that addresses the hormonal imbalance in patients with PCOS. Having said that, lifestyle changes remain in the forefront of combating abnormalities of glucose metabolism and associated metabolic problems.</span></span><br />
<span class="Apple-style-span" style="color: #fce5cd;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><a href="http://www.blogger.com/blogger.g?blogID=6093017718873746713#editor/target=page;pageID=8001467461256480910">http://www.blogger.com/blogger.g?blogID=6093017718873746713#editor/target=page;pageID=8001467461256480910</a></span></span></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-74374428046037671412012-03-22T19:08:00.000-07:002012-03-22T19:08:09.398-07:00<!--[if gte mso 9]><xml>
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<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Uterotonics and Postpartum Haemorrhage</span><o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 1.0cm; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0cm; text-align: justify; text-autospace: none; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;">Postpartum
hemorrhage is an important cause of maternal mortality in developing countries,
especially Africa and Asia. Active management of the third stage of labor
consists of the use of oxytocin soon after delivery of the baby, controlled
cord traction, and delayed clamping and cutting of the cord until the deliverer
is ready to apply traction. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0cm; text-align: justify; text-autospace: none; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;">In a study
published recently in The Lancet, Gulmezoglu et al showed that controlled cord
traction may be omitted from the management of the third stage of labor without
a significant increase in the risk for severe hemorrhage. Thus, the main component of active management is the
uterotonic and it is the key intervention that will prevent excessive bleeding
after childbirth.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0cm; text-align: justify; text-autospace: none; text-justify: inter-ideograph;">
<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;">Despite this,
controlled cord traction is safe and its use can be continued in settings in
which it is routinely practiced.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;">Hanifullah Khan<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;">22 March 2012<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;">Reference:<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span class="Apple-style-span" style="color: #fff2cc; font-family: Georgia, 'Times New Roman', serif;">Active management of the third stage of labour with
and without controlled cord traction: a randomised, controlled, non-inferiority
trial. Gulmezoglu AM, Lumbiganon P, Landoulsi S et al. <i>The Lancet</i> - 6 March
2012 DOI: 10.1016/S0140-6736(12)60206-2.</span><o:p></o:p></div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-13183340621539598852012-02-03T17:40:00.001-08:002012-02-03T17:40:06.476-08:00Long term effects of PCOS confirmedPolycystic ovary syndrome (PCOS) is the most common endocrine abnormality of reproductive-age women. These patients usually present with infertility or menstrual disturbances, conditions caused by anovulation or oligoovulation. It has now become evident that there are deeper and more significant metabolic consequences to this syndrome than just the reproductive ones. Whereas this was previously strongly suspected, the most recent meeting of the PCOS Consensus Group confirmed the long-term consequences of the disorder*. After resolving the issues of menstrual abnormalities and hyperandrogenism, these patients need to be screened for metabolic abnormalities (lipid profile, glucose metabolism, hypertension), potential psychological problems, and the possibility of precancerous or cancerous changes. If the anovulatory cycles persist long enough, endometrial hyperplasia and even endometrial cancer may develop over time in otherwise healthy young women. Thus, PCOS is a multidisciplinary disorder and must be managed as such.
* BC, Tarlatzis BC, Rebar RW, et al Consensus on Women's Health Aspects of Polycystic Ovary Syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97:28-38.e25Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-74683635546155941262012-01-17T21:39:00.000-08:002012-01-17T21:39:46.042-08:00PCOS and Diabetes<span class="Apple-style-span" style="color: #cfe2f3; font-family: Georgia, 'Times New Roman', serif;">Read a simple explanation on how PCOS and diabetes mellitus are related. Go to the PCOS page...</span>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-1001875482983106172012-01-04T20:52:00.000-08:002012-01-04T20:52:50.355-08:00<span class="Apple-style-span" style="color: #fff2cc;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">The Significance of Bleeding after the Menopause </span><br /><span class="Apple-style-span" style="font-size: x-small;">By J. Glenn Bradley, MD OBGYN.net Editorial Advisor | October 7, 2011 </span><br /> </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Bleeding after the menopause or "post-menopausal bleeding" ("PMB") can be defined as the resumption of vaginal bleeding at least 6 months after a woman experiences her last menstrual period. This assumes of course that she is indeed menopausal ie. in her late 40's, perhaps having hot flashes and night sweats, mood swings, insomnia, perhaps experiencing some vaginal dryness. </span></span><div style="text-align: justify;">
<span class="Apple-style-span" style="color: #fff2cc;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The bleeding pattern most women experience as they approach menopause is one where the periods become lighter, shorter in duration, and the interval between periods changes so that the periods are either somewhat closer together (between 21-26 days apart) or intervals greater than her customary 28 days. Cycles may be missed entirely for a couple of months. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">There are many causes of postmenopausal bleeding, and the most common is hormone replacement therapy. Women who are taking hormone replacement therapy very often may develop PMB because the uterine lining is very sensitive to estrogen, which promotes growth of the endometrium, just as it does in the normal reproductive cycle that was operative prior to menopause. Lack of estrogen, on the other hand, may cause atrophy of the lining, and in this condition, the blood vessels of the uterine lining become so fragile because of estrogen lack that they spontaneously break and then bleed. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Polyps and fibroids are common benign growths that develop in the uterine cavity. The former is most often associated with irregular light spotting, staining or actual light bleeding. The latter may also present this way, but in fact may be associated with much heavier bleeding. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Overgrowths of the uterine lining are called "hyperplasias", may be the cause of abnormal post-menopausal bleeding, Some specific types are associated with a malignant potential. About 20 % of true post-menopausal bleeders may have cancer of the endometrium (the uterine lining) </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">What should one consider doing for the diagnosis of post-menopausal bleeding? The first thing to consider is always the medical history. Is the patient taking hormones or not? Does she have a history of known uterine fibroids? A thorough pelvic examination of the vulva, vagina and cervix (including a PAP smear) should exclude causes in the lower genital tract. A uterine biopsy requires the passing of a small tube-like device through the cervix and into the uterine cavity, suction is applied and small fragments of tissue are removed for microscopic examination. Alternatively, the Doctor might order a special ultrasound examination, as this study can delineate the thickness of the uterine lining, and perhaps the presence of a polyp or fibroid. Thickened endometrial lining can be seen spontaneously without significant underlying pathology, as a result of hormone therapy, in cases of hyperplasias or cancer, or because of other benign growths. One must remember that ultrasound examinations are the sophisticated interpretations of "shadows" and do not make an absolute diagnosis, as is the case with microscopic analysis. Thus, an abnormal ultrasound examination requires further investigation. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Hysteroscopy is a special test that entails the passing of a tiny telescope through the cervix allowing the actual visualization of the uterine cavity. Fibroids or polyps can be seen and removed, and suspicious area of tissue biopsied under direct vision. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">A "D&C" is an old essentially obsolete procedure whereby a sharp spoon-like instrument is passed blindly through the cervix, and a scraping of the lining is performed in order to obtain tissue for microscopic analysis. More often than not, because it is truly a blind procedure, polyps and fibroids will be missed, as well perhaps as an early cancer. Hysteroscopy is far more precise and accurate. In this author's opinion, a "D&C" should be used only to evacuate the products of conception from the uterine cavity at the time of a miscarriage. A "D&C" is marginally useful for establishing an accurate diagnosis in the case of post-menopausal bleeding and is almost worthless for treatment. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">What about treatment options? This of course depends on the cause of the bleeding. Hormone related post-menopausal bleeding ("PMB") is usually controlled by manipulation and alteration of the hormone regimen. Certain hyperplasias may require extra </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">progesterone supplementation in order to reverse this process. Polyps or fibroids protruding into the uterine cavity can removed with the hysteroscope, and the lining may then be sealed with electrical energy ("endometrial ablation") to minimize any further PMB. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Cancer obviously requires a much more aggressive surgery, namely hysterectomy. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In conclusion, women who are experiencing post-menopausal bleeding require investigation and the bleeding should not be written off as a normal "menopausal" experience. Do see your gynecologist!</span></span></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-41681326745277708392011-11-03T16:36:00.000-07:002011-11-03T16:36:24.756-07:00Polycystic Ovary Syndrome Boosts Risk for Poor Pregnancy Outcomes<a href="http://www.medscape.org/viewarticle/751627?src=cmemp">Polycystic Ovary Syndrome Boosts Risk for Poor Pregnancy Outcomes</a>:<br /><br /><a style="font-size:13px" href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk">'via Blog this'</a>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0tag:blogger.com,1999:blog-6093017718873746713.post-30672764610902664032010-10-08T22:22:00.000-07:002010-10-08T22:22:24.519-07:00Cervical Cancer Vaccines<span class="Apple-style-span" style="color: #ffe599;"><br />
</span><br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: justify;"></div><ol><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Two prophylactic HPV vaccines, Cervarix™ (GlaxoSmithKline) and Gardasil™ (Merck) have been licensed for use. Both have been tested in large trials involving thousands of women from different countries across the world.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Impressive protection against persistent vaccine-specific HPV infection has been demonstrated over short- to medium-term follow-up periods. Long-term follow-up data are still required to answer the question of longevity of immune protection and whether booster vaccination(s) will be necessary, and at what time interval.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Because of ethical and consent issues, effectiveness cannot be determined among pre-adolescent girls, but is assumed by comparing data from the young women involved in the original vaccination trials. These suggest better cover if vaccination is given to young girls than to young adults.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">It is difficult to assess the impact of an immunisation strategy when many factors are still unknown. </span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">The coverage for the third dose is critical as the vaccine is locally painful and girls may be reluctant to complete the course.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">The vaccines remain prohibitively expensive - universal HPV vaccination is unlikely in resource-poor countries where they are most needed. </span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Merck was the first of two pharmaceutical companies to license its vaccine in October 2006, giving it a commercial head start. This quadrivalent vaccine confers immunity against the two oncogenic strains of HPV responsible for 70% of cervical cancers (HPV 16 and 18), as well as two strains that together cause 90% of genital warts (HPV 6 and 11). To many, a vaccine that protects against four strains has appeared to be inherently ‘better’ than one protecting against two strains.15 The bivalent vaccine Cervarix did not become available until almost a year later, in September 2007. Cervarix protects against HPV types 16 and 18, but does not prevent genital warts.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Insofar as Cervarix does not prevent genital warts, its use may amount to a ‘missed opportunity’. Genital warts are a very common sexually transmitted viral infection responsible for unsightly lesions that are both difficult and costly to treat. Women with genital warts also risk spread of the infection to the respiratory tract of their newborn infant during childbirth. Recurrent respiratory papillomatosis is a rare, but chronic, debilitating disease characterised by hoarseness, stridor and respiratory distress in the newborn, and requires lifelong repeated surgical intervention and prolonged hospital stays, even causing death in a minority of cases.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Published data do not distinguish either vaccine as superior in terms of clinical effectiveness or toxicity. </span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Future cervical screening - </span></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">vaccinated women are still clearly at risk of contracting other oncogenic HPV types that can cause cervical cancer, and cervical screening will still be necessary, even for vaccinated women.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Safety scares. In general, both Cervarix and Gardasil appear to be safe and well tolerated. Injection site adverse events, including pain, swelling and redness, have been reported Cervarix is recognised to be a more painful inoculation than Gardasil, but even so, most side effects disappear within the first day or two.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">There have been no deaths attributable to either vaccine in any of the clinical trials to date. Pregnancy and congenital anomaly data have been reported for Gardasil, but not for Cervarix. Higher rates of congenital anomalies unrelated to type have been observed.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">Maintaining high vaccine coverage. Interim results for the uptake of the third dose has shown a drop in coverage from 83% at the first dose to 74% for dose 3. Whether girls who receive only the first two doses of the vaccine will show sufficient immunity against HPV to prevent subsequent infection remains unclear.</span></span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: #ffe599;">The effect of mistimed doses is not fully understood. Data from hepatitis B vaccination studies suggest that longer intervals between second and third doses of the HPV vaccine may not be detrimental to the strength of the immunity generated, presumably as long as HPV exposure does not occur during the delay.</span></span></li>
</ol><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>Excepts from Crosbie EL, Brabin L. BJOG </i></span></span></span><span class="Apple-style-span" style="font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, sans-serif; line-height: 15px;"><a href="http://onlinelibrary.wiley.com/doi/10.1111/bjo.2009.117.issue-2/issuetoc" shape="rect" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: none; outline-width: initial; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;"><span id="volumeNumber" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>Volume 117</i></span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>, </i></span></span><span id="issueNumber" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>Issue 2</i></span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>, </i></span></span></a><span id="issuePages" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>pages 137–142</i></span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>, </i></span></span><span id="issueDate" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="color: #ffe599;"><i>January 2010</i></span></span></span></span></div>Anonymoushttp://www.blogger.com/profile/16644299254318633333noreply@blogger.com0