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The Usefulness of Sonohysterography

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This article is contributed by Sarah Scrafford, who regularly writes on the topic of how to become a pharmacy technician. She invites your questions, comments and freelancing job inquiries at her email address.

A recent study conducted at the Thomas Jefferson University Hospital in Philadelphia has found that sonohysterography (SHG) is a highly effective transvaginal ultrasound technique that improves the ability of doctors to diagnose adenomyosis, a condition that causes severe pelvic pain combined with abnormal and unexplained vaginal bleeding.

SHG is a relatively new technique that allows medical practitioners to view a woman’s uterine cavity more clearly. A soft, plastic catheter is placed in the cervix in conjunction with transvaginal ultrasound, and a sterile saline infusion passed through this tube expands the uterus and also provides a contrast to the lining, thus giving doctors a better idea of what the problem really is.

  • Sonohysterography is especially useful in treating women with infertility – it helps determine the presence of polyps, fibroids or tumors that prevent conception.
  • Besides, it allows doctors to examine the uterine cavity before any surgery like a hysterectomy or a D&C procedure.
  • It also helps in investigating unexplained infertility and repeated miscarriages.
  • It’s a good diagnostic tool to explore unexplained vaginal bleeding in pre and post menopausal women.
  • It allows examination and assessment of the endometrium and reveals endometrial abnormalities.
  • A sonohysterography that’s performed before a suggested hysterectomy can sometimes help you avoid the hysterectomy altogether. So you’re saved the cost, mental stress, physical pain, and recovery from a surgery.

The main advantages of a sonohysterography are:

  • It’s painless and can be administered in a normal ultrasound scan room
  • It does not require the patient to be sedated or under the influence of anesthesia.
  • It is not as expensive as an MRI scan which is normally used to investigate abnormal bleeding
  • It is commonly available at most healthcare facilities.
  • It helps avoid invasive diagnostic procedures
  • It has no side effects and is not very uncomfortable for the patient
  • Diagnosis is quick
  • There are no complications to be worried about

Reference:
Verma SK, Lev-Toaff AS, Baltarowich OH, Bergin D, Verma M, Mitchell DG
Clinical Observations. Adenomyosis: Sonohysterography with MRI Correlation
Am. J. Roentgenol. ; 192: 10.2214/AJR.08.1405

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Wii for surgeons

Q&A with Dr. Mark Smith and a news report regarding use of Nintendo Wii to train surgeons from News 8 Austin.

Mark Smith, M.D., a gynecological surgeon at Banner Good Samaritan Hospital in Phoenix, explains how the Nintendo Wii is helping train new surgeons.

Q: Part of your job is to train residents learning to be surgeons?

Smith: Yes. I have been in teaching for over 20 years and one of my responsibilities is training residents in surgery.

Q: When you started your job did you ever think you would be using video games to train?

Smith: I have never thought I’d be in video games to this extent. We have surgical simulators in virtual reality, but this has taken it to a whole new level, which is exciting.

Q: What have you found that the Nintendo Wii can do for practicing surgeons and for people learning how to perform surgery?

Smith: One of the problems we’ve had over the years is we had no method to teach surgeons surgical skills without going into surgery. We now have simulators that help them develop those skills. The problem is they are incredibly expensive — like a flight simulator for a pilot. This gives us a much less costly way to train these fine motor skills that the surgeons employ during surgery.

Q: Can a video game really help somebody improve as a surgeon?

Smith: We used cyber gloves which computerize hand movements of surgeons and we put those on surgeons. We have data on that. We put them on people playing the Wii. There is a very, very high correlation between the two and this is documented statistically.

Q: What did you find happens to the skills of people when they train this way as opposed to those who don’t train this way?

Smith: They develop an increased efficiency, less errors, more fluid movements … they’re just better.

Q: What has been the traditional method of training?

Smith: Up until the last ten years, they learned in actual surgery … what’s called the apprentice method — standing beside an expert surgeon, watching and helping to do it.

Q: Does this generation of doctors, having grown up playing video games, tend to be better at this training?

Smith: Actually, they tend to be better, but that’s not all of it. We can expand the skills that they have developed growing up. They certainly jump in a lot quicker. There is less training to start. For instance, in laparoscopy, which has differences than the more traditional type surgery, but it’s really as much an innate ability as it is for what they’ve grown up with.

Q: Have you adapted the Wii to use actual surgical tools?

Smith: We are using the actual tools. What some people don’t realize is there are very basic skills we have to teach. If you teach someone to drive a car, you first have to teach them how to put the gas down … put the break down. You have to learn all these skills before you can drive a car.

Q: What kind of skills are they learning by doing this?

Smith: Very fine motor skills … very precise, exact movements that surgeons need to know and have the ability to do. This teaches them those fine movements — fine motor skills — so that they are very proficient in those types of skills when they go into surgery.

Q: What did your study on this new training technique show?

Smith: Our initial pilot study … we showed a 50 percent improvement in their surgical skill level just by playing on the Wii.

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Top three free iPhone health apps

More and more health iPhone applications are available each day in the App Store. Most of them are for sale, but there are some which you can download for free. Here is my current top three of free health apps.

1. Epocrates Rx

Includes the drug guide, formulary information and drug interaction checker. Also offers continual free updates and medical news.

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2. Eponyms (for students)

Offers a list of 1,600 common and obscure medical eponyms (e.g., Rovsing’s sign, Virchow’s node) with descriptions.

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3. OBWheel

A simple pregnancy calculator to determine the estimated delivery date and gestational age.

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Operation room manual

Vodi? za operacijsku saluToday I published a recently finished medical manual on my website. I wrote it in collaboration with colleagues from the Department of Gynecology and Obstetrics at the University Hospital Rijeka. It is aimed at all health workers who are for the first time starting to working in an operating room and encountering aseptic work techniques. For now only Croatian language version is available, but the one in English will be appearing soon. Anyway, even if you do not speak Croatian be sure to take a look because the material is full of visual data.

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Neonatology vodcast

Couple of months ago my colleague Ileana Lulic, also a medical doctor from Croatia, and myself started to produce a vodcast in collaboration with Department of Gynecology and Obstetrics at the University Hospital Rijeka. Vodcast is essentially a video podcast, online delivery of video on demand content via RSS feeds. Our vodcast was conceived with an idea to offer a quick review of the clinical examination of the newborn infant. Until today we have published 11 videos, in both Croatian and English, demonstrating the proper way to inspect primitive reflexes in the newborn infant, and 2 videos demonstrating procedures in neonatology (lumbar puncture and umbilical vein catheterization), currently only in Croatian.

You can view our videos here. To change between videos just change the slide at the left bottom.

Additionally you can visit our YouTube channel, our page at the iTunes store or subscribe to our RSS feed.

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