Uterine artery embolization is a non-surgical outpatient procedure for the treatment of symptomatic fibroids

Posted on May 30, 2008
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At least 25% of all women develop benign uterine growths called fibroids. Usually fibroids do not cause symptoms, but in many cases they can cause excess menstrual bleeding, pain, heaviness and discomfort. When symptoms become severe, may women choose to have them removed. Procedures most often used to treat fibroids are hormonal therapy (which shrinks fibroids) in the form of a daily pill, myomectomy (surgical removal of fibroids) and hysterectomy (surgical removal of the uterus). Uterine artery embolization is an alternative and simpler procedure for the treatment of fibroids. Interventional radiologists have been using this embolization technique for over 20 years, but only in the last several years has it been used for the treatment of fibroids in the United States.
Suitable candidates for this procedure include: 1) age over 18, 2) documented fibroids symptomatic enough to justify surgery, 3) absence of pelvic infection, and 4) an evaluation by Dr. Carter verifying the absence of pregnancy and malignancy.

Advantages of the procedure over surgery include:
· Treats all fibroids simultaneously
· If the primary symptom is excessive bleeding, most cases experience a reduction within 24 hours.
· Allows preservation of an intact uterus
· No risks associated with general anesthesia
· Hospital stay is usually less than 24 hours. Read more

Prevention and Management of Laparoendoscopic Surgical Complications

Posted on May 30, 2008
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Table of Contents
Introduction

Surgical Anatomy = and Technique

INTRODUCTION
Uterine myomas are the most common tumors of the female genital tract. = Hysterectomy has been a very common therapy in patients who have completed reproduction. In fact, uterine myomas = account for 20% of the 650,000 hysterectomies performed annually in the United States. Interest in uterine = preservation and organ preserving surgery through techniques of minimally invasive surgery has increased since the first = reports of laparoscopic myomectomy in 1980.1
Laparoscopic myomectomy has evolved into a safe, efficient, and cost = effective approach for the treatment of intramural, subserosal, and pedunculated fibroids. At first the surgical approach = was limited by the technology available for myoma morcellation and uterine repair. Now with the availability of the = Sterner=99 Electro-mechanical Morcellator (Karl Storz Endoscopy - America, Inc., Culver City, CA), the Harmonic = Scalpel=99 (Ultracision, Inc., Smithfield, RI), and the development of instrumentation for suturing, linear = stapling, and combined bipolar coagulation with knife blade cutting the laparoscopic myomectomy is a procedure which = can readily become part of the armamentarium for all advanced laparoendoscopic surgeons.
Pre-treatment of the uterine leiomyoma with GnRH agonist reduces the = size of the myoma, decreases the blood supply, and makes removal of the tissue simpler because of the decreased tissue = hardness. An 8 cm diameter myoma shrinks to 6 cm in diameter - a forty percent reduction in volume of the myoma. = This reduction in volume results in a significant decrease in blood loss and a significant reduction in time required for = removal of tissue after resection.2 Read more

Laparoscopic Myomectomy is a Safe Procedure

Posted on May 30, 2008
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r. J. B. Dubuisson began the great debated entitled Laparoscopic Myomectomy is a Safe Procedure by outlining the conditions under which laparoscopic myomectomy is a safe procedure.
Dr. Dubuisson stated that there is is a great demand from patients for minimally invasive surgery and it is important that the surgeon apply certain conditions to the selection of patients for successful treatment of leiomyomas by laparoscopy. Dr. Dubuisson said that the indications for a safe laparoscopic myomectomy include the following:
1. Subserous or intramural myomas with a maximum of 3 in number and an overall size less than 9 - 10 cm.
2. A contraindication to removal of a leiomyoma is the existence of significant adenomyosis.
3. In addition, the dissection must be performed without opening the uterine cavity and the defect closed with. If the defect cannot be sutured, a mini-laparotomy should be performed. Read more

Surgical versus Medical Therapy for Urinary Incontinence

Posted on May 30, 2008
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Urinary incontinence can be divided into urge incontinence, stress incontinence (urethral hypermobility) and/or intrinsic sphincter deficiency, mixed incontinence and overflow incontinence.
Intrinsic sphincter deficiency (ISD) is also called Type III stress incontinence, low pressure urethra and drainpipe urethra. The risk factors for this are advanced age, radiation and prior incontinence surgery. The clinical features are severe incontinence often with minimal changes in position. The exam may reveal minimal bladder neck descent; the Q-tip angle will be less than 30°; there is poor urethral coaptation on endoscopy; and there is an open bladder neck on fluoroscopy. The mean urethral closure pressure is less than 20 cm of water and the leak point pressure is less than 60 cm of water
Low urethral pressures are associated with lower surgical success rates. Periurethral bulking injections are recommended as first line treatment for women with intrinsic sphincter deficiency without hypermobility. Read more

Menopause a time for reflection, a time for growth

Posted on May 30, 2008
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Menopause is the beginning of a new stage in your life. It is also a time when you can improve the way that you live. It is a time when you begin to face new health concerns. As you get closer to menopause, your ovaries produce less estrogen, progesterone and testosterone. Your periods eventually stop. Your body begins to go through many changes, which can increase your risk for certain diseases.

Many of these changes are simply related to aging. Some of them are an interaction between the natural aging process and the lack of estrogen, progesterone and testosterone.

As you age, you may also be at increased risk for:

1. Bladder control problems/pelvic floor dropping
2. Fibroids (for which there are non-surgical treatments)
3. Osteoporosis
4. Insulin resistance/diabetes
5. Heart Problems
6. Depression
7. Certain kinds of cancer (breast, colon, lung)
8. Abnormal uterine bleeding patterns

While these changes are happening in your body, you can make changes to protect your future health. Do you know your risks?

Evaluate your personal and family history. Everyone has a different personal and family medical history that affects their risk for developing certain diseases. Use these checklists to help you assess your risks of these conditions. Read more

PMS and Menopause

Posted on May 30, 2008
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PMS and Menopause If you suffer from PMS or if you are over 40 and concerned about the menopausal changes that will occur, please come in to discuss your alternatives with Dr. Carter. Natural hormone therapy can be tailored to your individual needs.

Services continued:

· General Medical Care Our skilled staff offers treatment for all general medical problems.

· Pelvic Pain and Endometriosis If you or a friend suffer form chronic pelvic pain, recent advances in the area of muscular, skeletal and myofascial causes of pelvic pain have resulted in a substantial improvement in efforts to resolve this difficult problem.

· Weight Control Diet, exercise, nutritional counseling from a “holistic” point of view are available at the office.

· Bone Loss Dr. Carter will help you with nutritional and therapeutic measures to keep your bones healthy.

· Pelvic Muscle Weakness and Bladder Leakage We now provide pelvic floor strengthening and training programs to improve vaginal tone and strength. These methods have been proven to prevent and treat incontinence in many women.

· Blood Pressure, Cholesterol Level and EKGs Concerned about your blood pressure, cholesterol level or need to have an EKG performed? Read more

Organ Preserving/Laparoscopic/Same Day Therapy

Posted on May 30, 2008
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Organ Preserving/Laparoscopic/Same Day Therapy With your active life-style, you’ll be glad to know that, if surgery is required, we provide minimally invasive, outpatient or short stay, therapies for the treatment of fibroids, abnormal bleeding problems, pelvic and abdominal pains, reconstructive pelvic surgery, stress incontinence and ovarian tumors. Dr. Carter’s pioneering work in this area was recognized in his certification for Accreditation Council on Laparoscopic and Hysteroscopic Surgery in December 1995. Remember, we can usually resolve the problem while preserving the uterus.

Services include:

· General Medical Care Our skilled staff offers treatment for all general medical problems.

· PMS and Menopause Natural hormone therapy can be tailored to your individual needs.

· Pelvic Pain and Endometriosis If you or a friend suffer form chronic pelvic pain, recent advances in the area of muscular, skeletal and myofascial causes of pelvic pain have resulted in a substantial improvement in efforts to resolve this difficult problem. Read more

Asthma

Posted on May 30, 2008
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Asthma State of the art testing and evaluation, such as pulmonary function testing, is available for asthmatics. If you haven’t had a recent evaluation, call for an appointment today. Read more

Weight Control Diet

Posted on May 30, 2008
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Weight Control Diet, exercise, nutritional counseling from a “holistic” point of view are available at the office. Together, with careful evaluation and treatment for thyroid conditions, glucose intolerance and proper use of natural hormones, we design a very sensible approach to your figure-management needs. You will be pleased with the results you can obtain with a minimum of effort on your part. Read more

Pelvic Pain and Endometriosis

Posted on May 30, 2008
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Pelvic Pain and Endometriosis Dr. Carter’s monograph on Chronic Pelvic Pain Diagnosis and Management has now been published and is available for reading in our office. If you or a friend suffer form chronic pelvic pain, recent advances in the area of muscular, skeletal and myofascial causes of pelvic pain have resulted in a substantial improvement in efforts to resolve this difficult problem. These advances especially have affected those who have pain with intercourse and constant pain in the pelvic area which increases with activity. Dr. Carter continues to treat pain with gynecologic causes, such as endometriosis, with advanced laser laparoscopic techniques. Also, is you are experiencing muscle spasms throughout your body, the evaluation and trigger point therapy we offer can alleviate this problem. Read more

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