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The most severely patients are those showing widespread chronic pain syndrome and chronic physical disability. Among them, there are oral issues [32], functional digestive symptoms [33], kinesiophobia [34], autonomic symptom burden [35], anxiety and depression [36,37], shoulder dysfunction [38], and iatrogenic injuries [39]. The authors also selected pain, fatigue, and psychological distress as the likely major contributors to disability. They found a strong relationship with fatigue and psychological distress, while the association with pain was moderate. History of varicose veins, hernia, visceral prolapse Diagnosis: both major, or 1 major and 2 minor, or 4 minor criteria. Positive family history Diagnosis: both major criteria (irrespectively of the presence/absence of minor criteria which are "simply" considered supportive) 3. A summary of the Beighton score for assessing generalized joint hypermobility, the Brighton criteria for the joint hypermobility syndrome and the Villefranche criteria for the Ehlers-Danlos syndrome hypermobility type. To date, the joint hypermobility syndrome and Ehlers-Danlos syndrome hypermobility type are considered not distinguishable at the clinical level by many experts according to the available diagnostic criteria. A spectrum comprising individuals with generalized joint hypermobility alone on one end and those fulfilling the Brighton and/or Villefranche criteria on the other is proposed. This spectrum also comprise patients with generalized joint hypermobility and single associated manifestations. Different mechanisms intervene at different ages and/ or disease phases with variable, often unpredictable outcomes. It is likely related to the widespread joint instability which may manifest with both macro- and microtraumatism. Macrotraumatism presents with occasional, habitual, or intentional dislocations and increased propensity to soft-tissue traumatisms, especially at the lower limbs and fingers. The combination of joint laxity and poor proprioception/coordination can lead to a restricted movement with consequent hypotonia and amplification of joint instability. Early observations suggested a causal relationship between joint hypermobility and osteoarthritis [55], but available data are contrasting to date. The different functional and structural factors are listed on the left, while the potentially linked forms of pain are summarized on the right. Practice again supports the association and a mildly reduced bone mass, while does not significantly predispose to fractures, may still contribute to degenerative joint changes in adults. Patients often report paresthesias, numbness, and dysesthesias that are hardly explained by the abovementioned processes [26,44]. Compression and axonal neuropathies have been evoked as possible explanation [67]. However, many patients describe neuropathic pain also at rest and with strikingly bilateral presentation, a combination that is unlikely related to compression neuropathies. It usually occurs in association of various functional gastrointestinal disorders [20]. It was speculated that an increased hollow viscera compliance can facilitate visceral sensitivity and hence generate abdominal pain [26]. However, the type(s) of head pain reported by patients is wider and, presumably, different pathophysiological mechanisms may lead to the same overall symptom. Comorbidities influencing pain Psychological distress, fatigue, and sleep disturbances are common comorbidities and their presence may negatively affect pain manifestations and evolution, and ultimately contribute to pain chronification and disability. Whether psychological distress is secondary to the preexistent pain, or rather is an independent primary feature amplifying each other with pain, remains to be clarified. The authors confirmed the association with depression and demonstrate a statistically significant link with bipolar disorder, autism spectrum disorder, attention deficit hyperactivity disorder, and suicide attempt. An excess of depression, suicide, suicide attempt, and attention deficit hyperactivity disorder was also found in nonaffected siblings. The frequency of fatigue is influenced by age with a rate of 28% in the first decade of life to 90% in adults over 40 years of age [25]. A complex presentation of fatigue resembling chronic fatigue syndrome according to Fukuda et al. The slow progression from episodic, low-moderate, and treatment-responsive pain at single joints to chronic, severe, and disabling pain affecting the entire body is probably the sum of various contributors.

Intervillous space: the in the placenta in which maternal blood bathes chorionic villi, thus allowing exchange of materials between the fetal and maternal circulations. Karyotype: A photographic reproduction of the chromosomes of a cell in metaphase arranged according to standard classification. Labor: the process of expulsion of the fetus from the uterus: Induced: Labor that is initiated artificially. Lactation: the production of milk through the actions of prolactin and other hormones on appropriately prepared breast tissue to create polyamines, casein, lactose and phospholipids. Lactogen, human placental (chorionic somatomammotropin): A polypeptide hormone produced by the synctiotrophoblast. It bears similarity to prolactin and somatropin from the pituitary and is intimately involved in carbohydrate metabolism of the mother and fetus. Laparoscopy: Transabdominal endoscopic examination of the peritoneal cavity and its contents after inducing pneumoperitoneum. Ligation, tubal: Surgical interruption of the continuity of the fallopian tubes for the purpose of permanent contraception. Membranes, premature rupture: Rupture of the amniotic membranes before the onset of labor. Menopause: Permanent cessation of the menses, naturally caused by ovarian failure. Menorrhagia (hypermenorrhea): Excessive or prolonged uterine bleeding in amount and duration of flow occurring at regular intervals. Metrorrhagia: Uterine bleeding occurring at times other than the expected menses; for example, intermenstrual bleeding; usually not excessive. Micro/Macroadenoma of the pituitarv secreting prolactin: Refers to tumors usually located in the lateral aspects of the pituitary which are surrounded by a pseudo capsule which contain secretory granules of prolactin. Hypotheses for their origin include reduced pituitary doparnine concentration and/or a vascular isolation of the adenoma cells. Midpelvis: An imaginary plane that passes through the pelvis and is defined by three points: the inferior margin of the symphysis pubis and the tips of the ischial spines on either side. Mosaicism: the presence in an individual of cells of differing chromosomal constitutions. Mucus, cervical: the secretion of the cervical mucous glands; its quality and quantity are influenced by estrogen and progesterone. Estrogen makes it abundant and clear, with spinnbarkeit and a fern pattern on drying. Progesterone makes it scant, opaque, and cellular without a fem pattern on microscopic examination. Normal Menstrual bleeding: every 24-32 days, lasting 3-7 days, average loss 30 cc, 80% blood loss occurs in first two days. Oxvtocin: An octapeptide formed in the hypothalamus and stored in the posterior lobe of the pituitary. Papanicolaou smear: Cytologic smear of exfoliated cells (for example, from the cervix, endometrial cavity, or vagina) used in the early detection of cancer or the evaluation of the hormonal status of the patient. Parity: the number of pregnancies of a particular woman in which the fetus has reached viability. Parlodel: Bromocriptine mesylate, dopamine agonist that inhibits prolactin secretion. Pelvic floor: the floor or sling for the pelvic structures located at the level of the pelvic outlet. Pelvic inlet: An imaginary plane passing through the pelvis that represents the upper boundary of the true pelvis. It is bounded posteriorly by the promontory and alae of the sacrurn, laterally by the linea terminalis, and anteriorly by the horizontal rami of the pubic bones and the upper margin of the symphysis pubis. Placenta previa: A condition in which the placenta is located in the lower portion of the uterus, extending to or covering part or all of the internal os. Polycystic ovary syndrome: (Stein-Leventhal syndrome) A syndrome of secondary oligomenorrhea and infertility, associated with multiple follicle cysts of the ovary and failure to ovulate. Polymenorrhea: Frequent but regular episodes of uterine bleeding, usually at intervals of 21 days or less. Position: the relationship of a designated point on the presenting part of the fetus to the anterior, transverse, or posterior portion of the maternal pelvis.

Costminimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. Conventional laparoscopic and roboticassisted spleen-preserving pancreatectomy: Does da Vinci have clinical advantages. Initial experiences using robotic-assisted central pancreatectomy with pancreaticogastrostomy: A potential way to advanced laparoscopic pancreatectomy. Factors determining functional outcomes after radical prostatectomy: Robotic-assisted versus retropubic. Contemporary trends in nephrectomy for renal cell carcinoma in the United States: results from a population based cohort. Differences in postoperative outcomes, function, and cosmesis: Open versus robotic thyroidectomy. The economics of robotic cystectomy: Cost comparison of open versus robotic cystectomy. A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: A casematched controlled study of the first one hundred twenty two patients. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: Perioperative and pathologic results. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: A randomized controlled trial. Robotic-assisted versus laparoscopic surgery for low rectal cancer: Case-matched analysis of short-term outcomes. Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Robotic-assisted roux-en-Y gastric bypass performed in a community hospital setting: the future of bariatric surgery. S052: A comparison of roboticassisted, laparoscopic, and open surgery in the treatment of rectal cancer. A comparison of costs for abdominal, laparoscopic, and robotic-assisted sacral colpopexy. A three-arm (laparoscopic, handassisted and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery. Shortand medium-term outcome of robotic-assisted and traditional laparoscopic rectal resection. Robot assisted laparoscopic pelvic lymphadenectomy at the time of radical cystectomy rivals that of open surgery: Single institution report. Comparison of totally robotic laparoscopic roux-en-Y gastric bypass and traditional laparoscopic roux-en-Y gastric bypass. A Comparison of Early Complications Between Open and Robotic-assisted Radical Cystectomy. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: Establishing the benchmark against which percutaneous interventions should be judged. Robotics versus laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: A multicenter study. Ileovesicostomy for the neurogenic bladder patient: Outcome and cost comparison of open and robotic assisted techniques. Singleport laparoscopic abdominal sacral colpopexy: Initial experience and comparative outcomes. Robotic versus laparoscopic rectopexy for complex rectocele: A prospective comparison of short-term outcomes. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Single-port robotic cholecystectomy: Results from a first human use clinical study of the new da Vinci single-site surgical platform. Morbidity and Mortality Weekly Report Recommendations and Reports January 16, 2004 / Vol. Applying public health strategies to primary immunodeficiency diseases: a potential approach to genetic disorders. Shaver Information Technology Specialists Disclosure of Relationship Our subject matter experts wish to disclose they have no financial interests or other relationships with the manufacture of commercial products, providers of commercial services, or commercial supporters. This report does not include any discussion of the unlabeled use of commercial products or products for investigational use. The material in this report originated in the National Center for Environmental Health, Richard J.

Estimating menstrual blood loss in women with normal and excessive menstrual fluid volume. Laparoscopic occlusion compared with embolization of uterine vessels: A randomized controlled trial. A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: A systematic review and meta-analysis. Previous tubal ligation is a risk factor for hysterectomy after rollerball endometrial ablation. Thermal balloon and rollerball ablation to treat menorrhagia: A multicenter comparison. Prospective data collection of a new procedure by a specialty society: the fibroid registry. Long-term treatment of menorrhagia with levonorgestrel intrauterine system versus endometrial resection. A 41-year-old woman with menorrhagia, anemia, and fibroids: Review of treatment of uterine fibroids. The relationship of bleeding patterns to daily reproductive hormones in women approaching menopause. I used the online medical article index PubMed to search for articles using the terms "menstrual" or "menstruation" and "contraceptive. Out of these, 41 articles that included substantive discussion of both hormonal contraceptives and menstrual bleeding were included in the analysis for Chapter 3. Nine articles that had been previously analyzed and included in Chapter 2 were not included in the sample for Chapter 3. The remaining 76 articles were excluded because they did not substantively discuss both hormonal contraceptives and menstruation/uterine bleeding. For example, one excluded article discussed bleeding as a symptom of sexually transmitted diseases, but only included oral contraceptive use as a background variable for study participants. Chapter 4 Websites One important element of the data for this paper is the "Frequently Asked Questions" section on each of the websites. They frame the knowledge presented as knowledge that the user has already asked for (or at least should already be asking for) and therefore draw viewers into active knowledge-seeking and information about the technological product. In doing so, they configure both a particular identity for the user (as someone who is concerned with naturalness/normalness of her body or future fertility, for example) and the knowledge and practices that the technology requires (What do I do if I miss a pill Nearly every website has one, and visitors are well-trained to seek them out and peruse them to find answers to "their own" questions. We can understand the connection between these two processes by viewing the websites as technologies of neoliberal subjectivity, producing and prescribing consumer-oriented health knowledge that also carries with it individualized responsibility for maximizing health and transforming the body. Advisory Committee for Reproductive Health Drugs Committee Members (voting) Charles Lockwood, M. Professor and Chair Department of Obstetrics and Gynecology University of Colorado Daniel Gillen, Ph. Assistant Professor, Department of Statistics University of California, Irvine Julia V. Interim Division Director Department of Surgery, Division of Urology University of Texas Medical School at Houston 130 Obstetrics & Gynecology, Reproductive Endocrinology, and Infertility University of Vermont Temporary Voting Members Paula J. Department of Maternal and Child Health School of Public Health the University of North Carolina at Chapel Hill Diana Petitti, Ph. Senior Advisor, Health Policy and Medicine Kaiser Permanente Southern California Pasadena, California Bruce Stadel, M. Associate Professor, Obstetrics and Gynecology Department of Obstetrics and Gynecology University of Chicago Johanna Perlmutter, M. Two of the clinicians worked for public health clinics, one on site at a high school. Interviews lasted between 30 and 60 minutes and covered topics such as knowledge about extended regimens/menstrual suppression, experiences prescribing extended-regimen contraceptives, and typical discussions with patients.