Vaginal hysterectomy for the large uterus

Objective To assess the feasibility and safety of performing vaginal hysterectomy on enlarged uteri the equivalent of 14 to 20 weeks of gestation in size.
Design A prospective observational study.
Setting The Royal Free Hospital, London.
Participants Fourteen consecutive women undergoing vaginal hysterectomy for uterine fibroids up to 20 weeks in size.
Interventions Vaginal hysterectomy with or without bilateral salpingo-oophorectomy or oophorectomy.
Main outcome measures Uterine size and weight, techniques used to reduce uterine size, surgical outcome, operative time, estimated operative blood loss, intra-and post-operative complications, duration of hospitalisation.
Results The mean uterine size was 16.3 weeks (range 14 to 20 weeks). All hysterectomies were completed successfully by the vaginal route. The uteri weighed 380 to 1100 g, with a mean of 638.7 g. Bisection combined with myomectomy and morcellation were used in most cases to obtain reduction in uterine size, whereas coring was only utilised in two cases. The mean operating time was 84.3 min with a range of 30 to 150 min. The only complications were transient haematuria (   n = 6  ) and superficial vaginal grazes (   n = 5  ). One of the women required a blood transfusion. The mean post-operative hospital stay was 3.7 days (range 2 to 9 days).
Conclusion Enlargement of the uterus to a size equivalent to 20 weeks of gestation should no longer be considered a contraindication to vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic surgery.     

Transthoracic impedance to defibrillator discharge. Effect of electrode size and electrode-chest wall interface

Transthoracic impedance of man to direct current defibrillator discharge has been reported to vary from 27 to 110 ohms. This study was designed to determine the effect of paddle electrode size and paddle electrode-chest wall interface on transthoracic impedance. Paddle electrode diameters studied were 4.5, 8.0, and 12.8 cm. There was a progressive decrease in impedance with increasing paddle electrode size. Paddle electrode-chest wall interfaces used were none, electrode cream, saline-soaked gauze pads, and electrode paste. The transthoracic impedance was progressively decreased with these interfaces regardless of paddle electrode size.This study suggests that when using direct current defibrillators or cardioverters, large paddle electrodes should be used with electrode paste as interface to accomplish maximum reduction in transthoracic impedance.     

Medical planning for disaster in Israel: Evaluation of the military surgical experience in the October 1973 War, and implications for the organization of the civilian disaster services

During its 27 years of existence, Israel has experienced four wars and dozens of mass casualty situations from various causes. This experience has led to the development of a plan for the management of mass casualties. This plan was put to the test in the October War of 1973 and proved successful. Although disasters and procedures vary widely in time and location certain principles of organization and management apply to most of them. In this paper the organization of the evacuation and management of the casualties in the October War is evaluated and its implications in the organization of civilian disaster services discussed.