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Alternative approaches to hysterectomy: clinical and economic implications for managed care.

Hysterectomy is one of the most frequently performed surgical procedures in the United States. Through advances in pharmacological and surgical technologies, opportunities now exist for converting selected hysterectomies from the traditional abdominal approach to vaginal or laparoscopically-assisted vaginal procedures. Such conversions may lead to diminished operative morbidity, fewer hospital days, a decreased period of convalescence, and the opportunity for cost savings. This paper reviews current clinical thought on the subject and considers the economic effect for providers of care.

California↗

Management of uterine adhesions with 'Massouras Duck's Foot' and 'Butterfly' IUDs.

The Massouras Duck's Foot (MDF) IUD and the Butterfly IUD have been clinically evaluated. The MDF, which is Y-shaped, has 2 or 3 horizontal arms on a vertical stem and 2 triangular wings, in between the 'V'. When inserted after curettage, it prevents intrauterine or intracervical adhesions. The fan-shaped Butterfly IUD has 2 overlapping wings, thereby facilitating adjustment of the IUD to variable uterine cavities. Its wing span occupies the entire uterine cavity when inserted according to the instructions. Both IUDs are made of polyethylene plastic with barium sulfate. Several substitutions for barium sulfate are suggested, e.g., copper, silver, hormones, biodegradable polymers. The high antifertility action of these IUDs is due primarily to their occupancy of the entire uterine cavity.

Chemical Phenomena↗