Laparoscopy-assisted and -prepared hysterectomy. A series of 80 cases

OBJECTIVE: Our objective was to determine the interest of laparoscopic assisted vaginal hysterectomy. STUDY DESIGN: Between January 1991 to december 1994, 80 patients had laparoscopically assisted vaginal hysterectomy. We reviewed with particular emphasis characteristic indications, complications. RESULTS: Eighty were performed as laparoscopically assisted vaginal hysterectomy. 14 patients (17.5%) had laparotomy conversion; because of size of uterus in 3 cases, suspected ovarian tumor in 3 cases. Pelvic adherences in 4 cases, urinary tract injuries in 1 case, hypercapnia in 1 case, hemorrhage in 2 cases. 9 patients experienced febrile morbidity and 1 urinary infection. 1 patient received 2 units of packed red blood cells. The hospital stay was 5 days for laparoscopically assisted vaginal hysterectomy versus 5.9 for laparotomic hysterectomy. CONCLUSION: Laparoscopically assisted vaginal hysterectomy offers a technique to convert certain abdominal hysterectomies into vaginal hysterectomies with a 17.5% laparoconversion rate.     

Alcohol in Munich secondary school students--a study for dissemination of experiences, knowledge, attitude and behavior

The Munich Community Health Service (Medical School-Service Department) conducted an alcohol prevention project in ten public secondary schools. The 423 pupils (11-17 years of age) filled in a questionnaire on alcohol and discussed it afterwards under the guidance of a school physician and a teacher using guideline information. The results of the survey are presented in this paper. Additionally, suggestions for transferring the results to conceptualize and carry out preventive measures are made. The results indicate that the first experience with alcohol occurred early in life. One-fifth of the sample had already tried alcohol at the age of six. Immediate effects of alcohol (e.g. state of drunkenness) were experienced by 35.7 percent of the sample group. Kiosks, shops, and beverage stores were named most frequently as sources for alcohol. The sources of social support varied with respect to sex and age. With increasing age of the children, parents were contacted less frequently whereas the role of peers increased. The present results supply possible paths of action for the development of successful prevention strategies, e.g. by pointing out the early age of onset as well as specific sources of alcohol acquisition.     

Symptom prevalence and worry about high voltage transmission lines

Few studies have documented public perceptions of environmental health risks from exposure to overhead transmission lines. In particular, little information has been provided on the impact of worry on symptom prevalence in residents living adjacent to high voltage transmission lines. The current study assessed symptom prevalence and worry in 152 Orange County female residents living either adjacent to overhead transmission lines or one block away. Forty-five percent of the respondents were either very worried or somewhat worried about the transmission lines and 55% were slightly worried or not worried at all. Results indicated that for those who did not live on the easement level of worry did not affect the prevalence of health problems. For those who lived on the easement, the most worried respondents were more likely to report health problems. Disclosure of health problems may depend more on individuals' level of worry about rather than proximity to overhead transmission lines. Possible limitations of this study include personality variables such as hypochondriasis which were not assessed, recall bias, and social desirability. The homogeneity of subjects may also limit the generalizability of findings.     

The importance of geriatrics to family medicine: a position paper by the Group on Geriatric Education of the Society of Teachers of Family Medicine

The role of geriatrics and geriatricians in family medicine remains unsettled. Despite a rapidly aging population, a tremendous shortage now exists of faculty with interest and expertise in geriatrics. Relatively few family practice residents choose to enter geriatric fellowship programs, and federal funding for such programs has been reduced. Despite accreditation requirements, residency programs are not always able to provide the range of geriatric experiences needed to properly prepare graduates to provide care for the broad range of older patients. Medical students' exposure to geriatrics remains limited. The Group on Geriatric Education of the Society of Teachers of Family Medicine believes that family medicine faculty must recognize and be committed to the notion that geriatrics is integral to family medicine. Both undergraduate and residency training programs should emphasize experience with geriatric patients in multiple settings. In particular, the nursing home should not be the main focus of geriatric training. The small number of certified geriatric faculty will be able to provide leadership, but a broad range of faculty must become involved in teaching geriatrics. Faculty development activities and continuing education programs to foster the necessary expertise will be essential to the accomplishment of this task.     

Haemophilia A: mutation type determines risk of inhibitor formation

The formation of factor VIII antibodies is a major problem for replacement therapy of haemophilia A patients. Antibodies occur in 5-30% of patients with severe haemophilia A. The reason for antibody formation is still unknown. In this study we correlate for the first time different factor VIII gene mutations, stop- and missense mutations, large and small deletions and intrachromosomal intron 22 recombinations to antibody formation. A total of 364 patients with known inhibitor status of our institute, of the database, and of 3 studies representing intron-22-inversion data are included. The results show that the risk for developing factor VIII antibodies is strongly related to stop mutations. large deletions and intrachromosomal recombinations. A probable explanation could be the complete lack of endogenous circulating factor VIII protein in these cases. Other factors that might be important for the pathogenesis of inhibitor formation, e. g. the antenatal period, as well as possible therapeutic effects, are discussed.