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Query: UMLS:C0277787 (stigma)
 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A colony of Macaca fascicularis have been under continuous observation for the past 4 years to ascertain the follicular morphological changes that occur prior to ovulation and during the development of the corpus luteum. Of 609 experimental cycles, laparoscopy was performed at least once in 44-5% of the cycles. Of the 104 cycles where the ovulatory status was definitely known, 89-4% were deemed ovulatory and 10-6% anovulatory. The presence or absence of ovulation in the previous cycle did not have an effect on the cycle length either for the total cycles or when analysing only cycles over 28 days. Similarly, the occurrence of two consecutive ovulations (in consecutive cycles) on the same vs. opposite ovaries did not have a significant effect on the cycle length. Neither laparoscopic stress or anaesthesia effected the normal cyclicity of the animals. The characteristic changes in follicular morphology are most clearly defined in M. fascicularis. In this species the 24 of 36 hr prior to ovulation are accompanied by discrete changes which occur in a fixed sequence, allowing one to predict the time of ovulation with reasonable accuracy. In S. sciureus ovulation is preceded by extensive bulging at the follicular apex and haemorrhaging at the base of the follicle. Due to this haemorrhaging post-ovulatory follicles in S. sciureus are generally more easily discernible than in fascicularis. The formation of clear areas (stigma) is not as evident in either S. sciureus or G. senegalensis as in the macaque. Actual ovulation has been observed four times in M. fascicularis and twice in S. sciureus.
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PMID:The morphology of follicular development and ovulation in non-human primates. 12 41

Twenty primiparous mothers who had cesarean births were compared with 30 primiparous mothers who had vaginal deliveries to determine differences in their perceptions of the birth experience. The effect of general versus regional anesthesia on the satisfaction level of the cesarean mothers was also investigated. All subjects were between 20 and 32 years of age, were interviewed within 48 hours postpartum, and completed a 29-item questionnaire that measures maternal perceptions about the labor and delivery experience. Satisfaction with the birth experience was significantly lower among cesarean mothers and among those who had general anesthesia. The cesarean group displayed greater hesitancy in naming their infants and tended to view their deliveries as abnormal and having social stigma. The presence of a support person in the operating room for a cesarean birth seemed to lessen anxiety among these mothers. These findings suggest that a cesarean birth has a negative impact on the mother's perceptions of her labor and delivery experience. There is a need for further study of factors that can enhance this experience for families.
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PMID:Comparison of primiparas' perceptions of vaginal and cesarean births. 25 99

Although the cesarean section rate has increased steadily for the past 12 years, further increase seems unlikely since the indications for performing the operation are already broadly defined. Most of the earlier indications will remain unchanged (eg, the presence of placenta previa and cephalopelvic disproportion). The trend toward vaginal delivery in perhaps 30% to 40% of breech births will probably have no material effect on the number of cesarean sections performed, and the present use of cesarean section for multiple pregnancy will probably continue. The two conditions under which cesarean section rates might become significantly lower are (1) automatic repeat cesarean section (which now accounts for more than 25% of all cesarean sections), a procedure which will probably decline as increasing numbers of such women have vaginal deliveries, and (2) a redefinition of the present midforceps classification, which will permit some of the easy midforceps deliveries from a low level to be performed without the legally abhorrent stigma of mid-forceps delivery. The value of prophylactic antibiotics for women predisposed to infection has now been proved, and further placebo studies to demonstrate this are not warranted. In the past, "type and match 2 units" was a routine prelude to cesarean section, and for every unit of blood transfused to cesarean section patients, some 25 units were cross-matched and held in (unnecessary) readiness. This formula is gradually giving way to type and screen, eliminating countless crossmatches. Because of possible harmful fetal effects, preoperative fluid loading, a necessary part of conduction anesthesia, is changing from the customary 5% glucose to the use of fluids containing no glucose. It has been suggested that conduction anesthesia may not offer unlimited time for cesarean section, as used to be thought. Apgar scores are lower if the time from uterine incision to delivery is longer than three minutes, a diminution that may be a function of the anesthesia or may reflect difficulty in delivery. Cesarean section mortality is much lower than it was in former years, but one may expect from one to two deaths per 1,000 operations. Overall, the maternal mortality from cesarean section per se is probably from three to five times higher than that of vaginal delivery (in one series, 11.5 times higher than vaginal delivery). The incidence of mild, transient respiratory signs in the newborn is higher after cesarean than after vaginal delivery, and the incidence of respiratory distress syndrome is also slightly higher.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cesarean section. 388 13

Although female circumcision is a health condition unfamiliar to most Western obstetrician-gynecologists, immigrants from parts of the world where this procedure is routinely practiced may be encountered. Such women pose unique management problems during labor and delivery. Presented is the case of a 36-year-old Sudanese woman who had undergone pharaonic circumcision, with substantial vulvar scarring, as a young girl in her country of origin. After emigration to the US, she had 2 Cesarean section deliveries. When she presented to the University of New Mexico with a 3rd pregnancy, she requested vaginal birth (to overcome the stigma of moral weakness her family associated with cesarean section) and a female obstetrician familiar with female circumcision. The patient had spontaneous membrane rupture at 39 weeks' gestation. Epidural anesthesia was necessary to examine the patient without severe discomfort. The external genitalia were missing the labia minora, and the clitoral area and external urinary meatus were obscured by bands of scar tissue that had to be cut. The major obstetric problem associated with this profile is prolongation of the 2nd stage of labor due to scar or soft tissue dystocia and the consequent need for deinfibulation. Women who labor unattended with an obstructed introitus are at risk of vesicovaginal and rectovaginal fistulas, laceration of scar tissue with hemorrhage, and fetal asphyxia or death. Incision of the fibrous tissue in this patient allowed sufficient widening of the introitus for expulsion of the fetal head. Delivery was uneventful and occurred after 19 hours. Although some women may desire reinfibulation, this patient sought less discomfort in future vaginal examinations, so the vulvar scars were not reapproximated. The raw surfaces were oversewn loosely after delivery.
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PMID:Female circumcision: obstetric issues. 794 93

Although ECT has been the subject of controversy for decades, ECT has brought increased chances for recovery to many people suffering from severe depression. Crossfield (1988) states the evidence is overwhelming that treatment of some depressive clients with ECT is the best treatment available. Other researchers have found that ECT is equal to, and sometimes superior to, other therapies for major depressive disorders (Gomez & Gomez, 1993). Depression is a treatable condition about which nurses have a responsibility to educate clients and their families (Valente, 1991). If clients and their supportive families and friends are to understand rather than undermine treatment, education about ECT is essential (Valente, 1991). Well-meaning friends and family who are misinformed could strongly discourage ECT, so it is important that their myths about ECT be dispelled (Valente, 1991). Furthermore, if depression in an already at-risk elderly population is not recognized and treated, great suffering will continue to be endured and life-threatening situations may occur. Depression often is manifested differently in older persons than in younger ones. Nurses can improve the quality of care provided to these depressed elderly clients by allowing them to express their fears and anger (Gomez & Gomez, 1993). Furthermore, the nurse's attitude should be hopeful, positive and consistent with them. This action can help clients develop trust with the nurse and further their own quality care. Estimates are that 70% to 90% of individuals who suffer from severe depression and receive ECT do indeed recover (Valente, 1991). ECT should be undertaken only after the outlined treatment protocols have been considered and with the knowledge and understanding of the following statements issued by the United States Department of Health and Human Services in the 1993 Agency for Health Care Policy and Research (AHCPR). First, ECT has not been adequately tested in milder forms of depression. Because of this gap in the research, the efficacy of ECT across the spectrum of depressive symptomatology is unknown. Second, ECT is costly when it entails hospitalization. This factor has great meaning in the changing, increasingly cost-conscious, health care arena. Third, ECT has specific and significant side effects, e.g., short-term retrograde and anterograde amnesia. Not only are these side effects troublesome for inpatient recipients of ECT, but the side effects can be quite dangerous for persons receiving treatment on an outpatient basis. The potential for injury is grave for persons who have memory deficit. Given the present cost-conscious, cost-cutting atmosphere, an anticipated rise in the number of clients receiving ECT on an outpatient basis is a distinct possibility. Fourth, the risks of general anesthesia are present. Age is a well known risk factor for general anesthesia. Fifth, treatment with ECT still carries substantial social stigma for clients. In spite of the increasing acceptance of ECT as a treatment for depression in the elderly, many clients prefer to keep their receipt of treatment secret fearing social repercussions of open discussions with family and friends. Sixth, ECT can be contraindicated when certain other medical conditions are present. Persons suffering from severe cardiac or pulmonary disease are frequently disqualified for treatment due to the risk of receiving anesthesia. Last, people usually require a prophylactic treatment with antidepressant medication, even if a complete, acute phase response to ECT is attained (pp. 26-27).
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PMID:Electroconvulsive therapy and the elderly client. 906 Mar 42

Percutaneous endoscopically controlled gastrostomy (PEG) enables patients suffering from a tumor of the upper aerodigestive tract to receive direct gastric feedings. The procedure also avoids the social stigma of a nasal feeding tube. The results of 630 PEG procedures used in 555 patients suffering from various head and neck cancers are reported. The mean age of the patients was 58.0 years with a range from 11 to 92 years. The PEG procedure was carried out under local anesthesia in 60% of the cases and with general anesthesia in 40%. In 512 patients the initial PEG procedure was successful while 43 of the patients require a second PEG procedure after loss of the PEG. In 19 patients the PEG procedure was not successful because of tumor obstruction or it was not possible to perform endoscopy. Twenty-four patients were successfully treated in a second or third session. Although 97% (n = 563) of all 555 patients and 92% (n = 579) of all PEG procedures were successful. The mean duration of PEG use was 243 (range: 0-2271 days). In 66 patients (10.5%) complications occurred but severe complications developed in only 8 patients (1.3%). Operative interventions were necessary in two cases. No deaths resulted from the PEG. These findings show that the PEG technique is safe to do with only few complications when performed by a skilled team.
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PMID:[Long-term experience with percutaneous endoscopic controlled gastrostomy (PEG) in ENT tumor patients]. 973 33

We present an instructive case of a 47-year-old female patient with tethered cord syndrome, discovered before arthroscopy was to be performed under routine spinal anesthesia for right knee arthritis. The patient had no symptoms except for right knee-joint pain, but weakness in the left dorsiflexors and decreased range of motion in the left ankle and toe joints were found on preoperative physical examination. In addition, clawfoot deformity was discovered in the left foot. A small stigma was observed on the skin in the sacral region. A magnetic resonance imaging scan showed the spinal cord tethered to an intrathecal mass in the sacral region. Therefore, we avoided spinal anesthesia. The arthroscopy proceeded uneventfully with the patient under general anesthesia.
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PMID:Tethered cord syndrome discovered in preoperative examination. 1745 59

Substance abuse among healthcare providers is a serious issue affecting patient care and patient outcomes. Substance abuse among anesthesia providers is of extreme concern because of the type of drugs and easy access providers are granted. Impaired anesthesia providers jeopardize not only their own safety but also the safety of their patients. Accidental death of either the healthcare provider or the patient is often the unfortunate first sign of addiction among anesthesia providers. Most states, in the United States offer treatment programs for anesthesia providers as an option to disciplinary action, and on completion of the Substance abuse is the primary occupational program, the provider is allowed to reenter practice. Successful reentry is sometimes rare, and providers are plagued with the stigma of abuse, shame, and a high incidence of relapse. This article is an analysis of the concept of reentry into anesthesia practice, using Walker and Avant's model of concept analysis. Tenets of successful reentry are discussed. Implications for further concept analysis, practice, and research are presented.
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PMID:The concept of reentry in the addicted anesthesia provider. 2490 50

Stigma, isoIation and discrimination are typically associated with diagnosis of leprosy and its disclosure. Health care providers (HCPs) find it challenging to disclose the diagnosis of leprosy to patients and their family members. A qualitative study was done in a rural community near Chennai in Tamil Nadu, from August 2011 to March 2012, covering 155 out of 648 (23.9%) purposively selected leprosy patients from 53 out of 148 panchayats, representing 264 villages in the study area; Out of these 155 patients, 59% were males; 30% were illiterates; 70% were married; 56% were living in nuclear families; half the leprosy patients were either agricultural labourers or skilled workers (50%).Thirty two percent were multibacillary (MB) cases and 68% were pauci bacillary (PB) cases; 77% were old patients and 23% were new patients; 22% had leprosy deformity 12% had disfiguration; 23% had anaesthesia and 3% were with lagophthalmous. Of the 155 patients, 31 (20%) reported that they were not informed about diagnosis of their disease by the concerned HCPs. They were informed to be having a skin disease or a skin patch. Of these 31 patients, 22 (71%) were women; all except one with PB leprosy. Seven patients (23%) had not yet started on treatment 3 patients (10%) were given treatment when they were young and neither, them nor their parents were informed about this disease. Seven (33%) of the married patients who had the disease during their child had or when they were young, were not informed of the diagnosis by the HCPs. Ten respondents (32%) were neither bothered nor concerned about non disclosure of the disease by HCPs. Now, after knowing the diagnosis of the disease 4 females (13%) mentioned that they were having some fear, worry or stigma. As non-disclosure of leprosy by HCPs may adversely affect acceptance and adherence, to treatment by the patients, appropriate communication strategies should be developed and implemented.
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PMID:Disclosure of Leprosy by Health Care Providers in South-India: Patients' Perception and Relevance to Leprosy Control, Tamil Nadu. 2699 87

Vitiligo is a common pigmentary disorder of the skin with a great amount of social stigma attached to it. Though various medical modalities are available for the treatment of stable vitiligo, surgical modality remains the treatment of choice for stable and localized vitiligo. The surgical options range from simple punch grafting to the recent epidermal harvesting methods using a negative pressure unit. Although successful use of multiple methods of epidermal grafting has been reported, most of them are cumbersome and time-consuming. The new automated epidermal harvesting system now commercially available involves a tool that applies both heat and suction concurrently to normal skin to induce epidermal micrografts. Hence it serves as a safe, quick and cost-effective method without anesthesia, with a very minimal downtime for healing and requires an optimal expertise. The duration of repigmentation seems to be faster and more uniform compared to other procedures. We would like to share our experience with the negative pressure epidermal harvesting method in a patient with stable vitiligo.
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PMID:Autologous Epidermal Grafting Using a Novel Negative Pressure Epidermal Harvesting System in a Case of Stable Vitiligo. 2800 45


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