Mais les résultats doivent être attendus longtemps et il n'y a généralement pas de temps azithromycine prix L'autre cas, c'est que l'achat d'un ou d'un autre antibiotique dans une pharmacie classique nécessite des dépenses matérielles considérables et pas toutes les personnes ne peuvent acheter des produits pharmaceutiques aussi coûteux.

Microsoft word - ablation 76-100.doc

Stenosis
Dilated canal
Lacerations
Fragile
Cervical Stenosis
False Passage & Perforation
Frequency: 1.3-3.0 %
Reasons:
Solution:
Perform diagnostic hysteroscopy to chart the endocervical canal Open Speculum
Cervical Dilators
Stenosis of the Cervix
Operative Hysteroscopy
22 – 26 F (7-9 mm)
Global Ablations
15-24 F (5-8 mm)
Cervix Dilatation
Diameter
Novasure
Her Option
ThermaChoice
Inability to Dilate the Cervix -
Stenosis
Laminaria
Misoprostol (Cytotec)
Vasopressin
Inability to Dilate the Cervix –
Cytotec (Misoprostol)
200-400 mcg
Oral or vaginal
3-24 hours prior to procedure
Tmax: 12mins
Time reduced: 40 vs 120 sec
Cytotec (Misoprostol)
Side Effects
Nausea
Diarrhea
Uterine cramps
Bleeding
Inability to Dilate the Cervix -
Vasopressin
Vasopressin 20 mL
(4U of 0.05 U/ml in 80mL of NS)
Intracervically 4 & 8 o’clock positions
• Decreased force from 37 to 20 lbs
• Complications: MI, cardiac arrest
Excessive Cervical Patency
Complication:
-Loss of a seal
Solutions:
-2 tenaculums
-Gimpelson tenaculum
-EndoLoop
-Use ThemaChoice, Her Option, Microsulis
Office Setting Recommended
Anesthesia and Pain Management1
Pre - Procedure
NSAID: Toradol 10 mg, (Ibuprofen 800mg
(Ponstel 250mg, Cataflam® 50mg, Celebrex® ) – Anxiolytic: Ativan 1 mg, (Diazepam 10mg)
Opiate analgesic: Lortab 10/500, (Vicodin® 2
***All are taken at home 1 -2 hours pre procedure. NSAIDs are also
taken the night before
Toradol® 30 mg IM (peripheral PG blocker) +
Atropine 0.4mg IM (prevents vaso-vagal) 30 min
pre procedure

1Author’s experience and recommendation Local Anesthesia
Potocky® Needle
Local Anesthesia
Toxic Dose Lidocaine
¾1% Lidocaine Without Epi =
300mg (30cc)
Uterine Pathology
Endometrial hyperplasia
Atypical endometrial hyperplasia
Adenomyosis
Polyps
Fibroids
Anticoagulated Patients
Need to stop anticoagulation?
Need to alter procedure?
Is there a best method?
Contraindications:
Prior Surgical
Classical C-section
Myomectomy
Metroplasty
Repeat Ablations
Was failure delayed or immediate?
If immediate, what is the reason for
failure:
¾ Technical problems
¾ Uterine deformity
¾ Adenomyosis
¾ New pathology: carcinoma, fibroids,
Adenomyosis
Repeat Ablations
Pre operatively, repeat studies
including biopsy and labs
What method should be used for repeat
ablation?
Depends on the reason for failure

Source: http://www.neogs.org/Syllabus/Ablation%2076-100.pdf

# 096 diarrhea in palliativ.

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