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Vaginoplasty is a surgical procedure designed to rejuvenate and tighten a woman’s vagina, by removing excess lining and repairing the surrounding soft tissues. It is designed to decrease the diameter of the vagina, resulting in increased friction during intercourse to make the experience more pleasurable for both partners.
General Considerations Because a discussion of reproductive issues may be difficult for some women, it is important to obtain the history in a relaxed and private setting. The patient should be clothed, particularly if she is meeting the provider for the first time. Ordinarily, the patient should be interviewed alone. Exceptions may be made for children, adolescents, and mentally impaired women, or if the patient specifically requests the presence of a caretaker, friend, or family member. However, even in these circumstances, it is desirable for the patient to have some time to speak with the clinician privately. The manner of address should be formal using the title Mrs., Ms., Miss, or Dr. with the patient’s surname, unless the patient requests otherwise. In some settings, it may be appropriate for nursing staff to be involved with history taking. A nurse may be perceived as less threatening, and may be able to take the history in a less hurried manner.1 The provider can verify the history and focus on areas of concern. Alternatively, it may be helpful to ask the patient to complete a self-history form on paper or by computer prior to speaking with the provider. This allows the provider to devote time to addressing positive responses, and ensures that important questions are not missed. Hasley2 showed that responses to a computer-based questionnaire designed to update a patient’s gynecologic history were equivalent to those obtained during a personal interview. Several studies involving patients in non-gynecologic settings have shown that patients are more likely to provide sensitive information when responding to a computer-based questionnaire as opposed to a personal interview or even a paper questionnaire.3 In order to increase a patient’s level of comfort during the interview, questions should be asked in an open-ended and nonjudgmental way. Assumptions should not be made about aspects of the patient’s background such as sexual orientation. At the conclusion of the interview, patients should be asked whether there are concerns that they would like to discuss that were not addressed previously in the interview.
In PRK the epithelium (top layer of the cornea) is scraped off and then the laser treatment is applied. A contact lens is used as a "bandage" to decrease discomfort. The epithelium then grows back over the bare area during the next few days.
In LASEK the epithelium is exposed to 20% alcohol which helps separate epithelium from the cornea. The epithelium is pushed to one side and laser treatment applied. The epithelial layer is replaced back onto the eye and held in place with a contact lens. The contact lens is then removed a few days later. LASEK is hence a "no knife"/flap operation.
Epi-Lasik is a similar procedure that uses a keratome like that used for Lasik, but engineered to only separate the epithelium. The epithelium is left on a hinge, laser treatment applied and flap replaced.
Red blood cells, which form one of the major constituents of blood, are characterized by the absence of nuclei, hence they are unable to undergo cellular division or generate new erythrocytes from old ones. This eventually leads to cell disintegration, which typically occurs 4 months after the fully developed red blood cells have been in circulation within the bloodstream. During the degeneration of the red blood cells, some components of the hemoglobin are excreted from the body while other parts are conserved.
Open heart (coronary artery bypass, or CABG) surgery is performed in order to reroute, or "bypass," blood around blocked arteries, thereby improving the supply of oxygen-rich blood to the heart. Surgeons usually use an artery from the chest wall to construct the "detour" around the blocked part of the artery. Veins from the legs are also used.
Most women have vaginal discharge at many different times throughout their cycle. During ovulation, white and watery discharge is common and accepted as normal. But, discharge after ovulation is widely believed to be a sign of pregnancy.
Dacryocystorhinostomy (DCR) is a procedure performed for the treatment of tearing (epiphora) due to blockage of the nasolacrimal duct. Tears originate in the lacrimal gland, located at the upper outer margin of the eye. As tears cross the eye with each blink, they are directed into small openings in the eyelids called puncta. From this point, tears travel through a pathway known as the canalicular system into the lacrimal sac. The lacrimal sac is located between the eye and the nose, and funnels tears into the nasal cavity through the nasolacrimal duct (Figure 1). As this is quite a long path for tears to travel, there can be many causes of excessive tearing. Blockage of the nasolacrimal duct is one common cause, and can be treated by creating a direct opening from the lacrimal sac into the nasal cavity in a procedure known as DCR. The evaluation and management of tearing may involve both an ophthalmologist and an otolaryngologist.
The fetal circulation is the circulatory system of a human fetus, often encompassing the entire fetoplacental circulation that also includes the umbilical cord and the blood vessels within the placenta that carry fetal blood.
The fetal circulation works differently from that of born humans, mainly because the lungs are not in use: the fetus obtains oxygen and nutrients from the mother through the placenta and the umbilical cord.
Weight loss is the most effective nonpharmacologic measure to decrease blood pressure in overweight individuals. Weight loss with other nonpharmacologic measures can prevent or delay the onset of hypertension and reduce the overall risk of cardiovascular events in such patients. In some patients with established hypertension, lifestyle changes alone may control their blood pressure.