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Eliminating cervical cancer is about more than just spending money. It requires reckoning with the many intangibles that get in the way of this cause. Widespread adherence to patriarchal value systems, for instance, not only threatens women’s health and well-being, but discourages them from freely pursuing the means to a cure. Persons with cervixes must confrontnot only archaic notions about their worth, but also many other hidden barriers to prevention. These include the fear and superstition that arise from lack of knowledge and medical misinformation, a lack of appreciation for self-care, the burden of unpaid work, and the vulnerability resulting from racial and gender inequality. Challenging these societal factors will increase the volume of women’s voices and ultimately save thousands of lives. But until society is ready to acknowledge and address these barriers – the patriarchal structures thwarting women’s autonomy and decision-making power, the stigma associated with this disease, the religious intolerances and traditional values contrary to its prevention – a cancer that strikes only those with a cervix will continue to kill.
Refractory epilepsy from operculoinsular origin is increasingly recognized because of published descriptions of its clinical presentations, more attention in the interpretation of non-invasive focus localization techniques, and the development of invasive electrode implantation schemes to sample that area. Microsurgical techniques of operculo-insular cortical resection have been refined, taking into consideration the complex and deep anatomy and the high vascularity of the perisylvian area. Selective transsylvian and/or subpial transopercular insulectomies are performed, depending on the definition of the extent of cortectomy needed and the functional areas to preserve. Seizure control results after surgery are similar than those in other brain locations. Neurological complications and neuropsychological consequences are acceptable. It is crucial that these highly selected patients be investigated and operated in epilepsy centers dedicated to this complex type of refractory epilepsy, both to optimize the results of seizure control and keep the complication rate as low as possible.
The most common causes of death after the first year following liver transplantation are recurrent and de novo malignancy, return of the original liver disease in the graft, sepsis, cardiovascular disease, and chronic rejection. Review frequency varies between centers and depends partly on patient morbidity. The aim of follow-up is to screen for graft dysfunction and the late complications of liver transplantation. Complications of immune suppression may be related to the original etiology or unrelated and similar to other organs. Azathioprine (AZA) or mycophenolate mofetil (MMF) are often used as long-term maintenance immunosuppression. Up to 45% of liver transplant recipients have metabolic syndrome that includes excessive weight gain, hypertension, diabetes, and hyperlipidemia. Biliary stricture and incisional hernia are the most common late surgical complications after liver transplantation. Psychosocial health should be considered as an important facet in the long-term management of liver transplant recipient.
This chapter considers selected aspects of surgical technique, complications, and the management of some surgical problems that develop in association with pregnancy. The signs and symptoms of various surgical conditions are modified by the anatomic and physiologic changes that accompany pregnancy, paradoxically often resulting in their exacerbation, an apparent reduction in intensity, or a change in the location of the expected physical signs. Impaired healing and wound infections are among the most common complications of surgery, in pregnant as in nonpregnant patients. During abdominal surgery, iatrogenic injuries commonly involve the gastrointestinal and urinary tracts. Surgical complications involve gallbladder disease and appendicitis. The chapter discusses a series of neoplastic disorders encountered at varying degrees of frequency during pregnancy, and outlines their clinical management. In areas of developing surgical techniques, the most significant area of legal exposure falls in the lag between actual practice and the establishment of accepted safeguards.
An epidemic of surgical wound infections observed at the State Hospital of Sarajevo during June-September 1992 is reported.
Methods:
A cross-sectional survey of 138 surgical patients with wound infection treated by the Department of Surgery of the State Hospital of Sarajevo was performed in mid-September and again in mid-November 1992. A preliminary evaluation of the bactericidal effectiveness of a new antiseptic preparation called DI-ASEPT also was done.
Results:
The frequency of wound infection was 24.4% in September and 19.2% in November. Pseudomonas species was the primary etiologic agent in this epidemic. DI-ASEPT was as effective as povidone-iodine in producing wound asepsis.
Conclusions:
Because of limited resources large numbers of casualties, and an extremely adverse environment as a result of war that has affected hygienic conditions at the State Hospital of Sarajevo, a high frequency of contaminated or dirty operations were performed. This was the primary reason for the observed increase in wound infections. After hygienic conditions were restored, the epidemic of wound infections was terminated.