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Forrest, Mike
Name: J. Michael Forrest
Title: Associate Professor, Electrical/Electronics
Department: Industrial Technology
Campus: Franklin
Office Location: Room 137
Phone: 757.569.6745
Email: firstname.lastname@example.com
Mike Forrest is a faculty member in the Industrial Technology program at the Franklin and Suffolk Campus. He holds a Bachelor of Science in Electronics Engineering Technology from Norfolk State University and a Master of Science in Occupational and Technical Education degree from Old Dominion University. Before coming to PDCCC he was practicing electronics engineering in Marine architecture, Industrial Engineering Technology and Avionics. Additionally, he is certified in General Purpose Data (GPD), Elemental Standard Data, Method-Time-Measurement (MTM) and Primavera Systems.

subset: commoncrawl


text:
Cary Gabriel Costello
Associate Professor of Sociology
Coordinator, LGBT Studies
Office: Bolton Hall, Room 738Phone: 414/229-6942
E-mail: email@example.com
Vita (pdf)
Winter Break Office Hours (Dec. 12, 2014 - Jan. 25, 2015): By appointment
Ph.D., University of California, Berkeley 1999
M.A., University of California, Berkeley 1994
J.D., Harvard Law School 1990
B.A., Yale College 1986
Areas of Specialization:
Teaching Schedule
Spring 2015
Sociol 255-001: Sociology of Sexuality
Sociol 444-001: Sociology of the Body
Summer 2014
Sociol 250-201: Sex and Gender
Spring 2014
Sociol 102-401: Social Problems in American Society (pdf)
Sociol 255-001: Sociology of Sexuality (pdf)
Syllabus from Recently Taught Course
Sociol 444-001: Sociology of the Body Summer 2012 (pdf)
Research Interests:
Prof. Costello is currently engaged in research on virtual embodiment and identity in Second Life®. He runs the Avatar Identity Research Center, which presents a seminar series on avatar embodiment, and through the Editing Appearances project has interviewed over 90 individuals in a variety of communities about selfhood and the virtual body.
Selected Publications:
Costello, Cary G. "Sexuality in a Virtual World" 2013. Pp. 178-188 in Mindy Stombler et al., eds., Sex Matters, 4 th Ed . NY, NY: W.W. Norton & Co.
Older Publications:
Carrie Yang Costello. "Changing Clothes: Gender Inequality and Professional Socialization." 2004. National Women's Studies Association Journal, 16(2): pp. 138-155.
Carrie Yang Costello. "Cosmetic Genital Surgery Performed upon Children." 2004. Robert Perrucci, Kathleen Ferraro, JoAnn Miller, Paula C. Rodriguez Rust, eds., Solutions: Agenda for Social Justice 2004. Tenn.: Society for the Study of Social Problems: pp. 81-86.
Carrie Yang Costello. The Sociology of Gender and Work: Syllabi and Teaching Materials. (editor) 2002. Washington, D.C.: American Sociological Association.
Carrie Yang Costello. "Comment: Limits of Biological Determinism." Coauthored with Eleanor M. Miller. 2001. American Sociological Review, 66(4): pp. 592-8.
Carrie Yang Costello. "Schooled by the Classroom: The (Re)Production of Social Stratification and Professional School Settings," 2001. Eric Margolis, ed., The Hidden Curriculum in Higher Education, Routledge: pp. 43-59.
Carrie Yang Costello. "Conceiving Identity: Lesbian, Gay and Bisexual Parents Consider their Children's Sexual Identities," 1997. Journal of Sociology and Social Welfare, 24(3): pp. 63-89.


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Edited by Dynamic Dave on 13/06/2008 at 12:49
Tags: technical issues maintenance and servicing head gasket legal advice
Edited by defender on 13/06/2008 at 21:50
Is there a reason why these studs are so long?
>>the long studs that go through to the bottom of the block had now snapped.
Edited by Pugugly on 21/06/2009 at 10:23


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Holiday season dinners with Hawaii flavor! Recipes from Chef Peter Merriman
by: Derek Paivaposted: Mon Nov 22, 2010 at 05:54 PM
Recently, Peter Merriman rang us asking if our Mainland HAWAII Magazine readers might appreciate a few recipes that would add a bit of Hawaii flavor to their holiday season meals. We were all ears.
Merriman is one of Hawaii's most successful and celebrated chef/restaurateurs, and a longtime champion of using fresh, locally procured ingredients from Island farmers, ranchers and fishermen. Peruse the menus of all four of his Merriman's restaurants and cafes—two on the Big Island, and one each on Maui and Kauai—and you'll find dishes proudly boasting their locavore credentials.
"When I'm creating our restaurants' Thanksgiving menus, I begin thinking about traditional dishes, and then which locally sourced items are in season and how those ingredients highlight, not disguise, the traditional hand-crafted Thanksgiving dinner," says Merriman (pictured). "If you eat in a Merriman's restaurant for Thanksgiving, you'll enjoy a traditional Thanksgiving menu with a touch of Hawaii."
The ethos Merriman followed in compiling the Hawaii-inspired holiday season recipes shared here was making sure ingredients could be found wherever HAWAII Magazine readers were in the world.
"Bringing a touch of Hawaii to your Thanksgiving Day menu is easy," says Merriman. "The basic flavors of Hawaii—coconut, macadamia nuts, and pineapple—all go great with traditional Thanksgiving favorites. You can keep your family recipes and add these for a fun, tropical twist."
On the following pages, you'll find Chef Peter Merriman's recipes for Molokai Sweet Potato Palau, Cranberry Pineapple Relish, Macadamia Nut Stuffing and Kalua Turkey.
Mahalo for the recipes Chef Peter! And Happy Holidays to our entire HAWAII Magazine reader ohana!
Check out these related HawaiiMagazine.com posts:
New Maui restaurant from Hawaii Regional Cuisine pioneer
Hawaii restaurant serving up "sustainable seafood" initiative in support of conservation
Hawaii's Thanksgiving means much more than turkey


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Last week, I chatted about the coming Internet 2 and what it would take to switch users to the new infrastructure.
Well, here's something that will help: Researchers announced yesterday they sent data over the Internet2 network at 7.67 gigabits per second. I don't know why we're just now finding out about it, since they did it in December, but whatever. They reached that speed with the standard protocols. It isn't quite so impressive when you consider the IPv4's record stands at 8.8 gigabits, delivered in 2006.
But the next day, by using modified protocols, they sent the same data at 9.08 gigabits per second.
Theoretically, Internet2 can only reach 10 Gbps. So, of course, the Internet2 consortium plans to build a new network that could deliver 100 Gbps. My guess is, a lot of organizations would upgrade for that kind of speed.
Just to give you an idea of what all this means in a more substantial way, here's how fast you could deliver a high-quality copy of The Matrix over each:
Now if they can deliver those speeds with about 1 billion people using it, then that would be a good reason to convert.
Post a comment
Business performance information for strategic and operational decision-making
SOA uses interoperable services grouped around business processes to ease data integration
Data warehousing helps companies make sense of their operational data


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Search / LoginQuick Links:
SubscribeSign up for our email newsletters for updates on new releases, events, special deals and more. |
Fantagraphics sponsors a variety of events at the Fantagraphics Bookstore & Gallery in Seattle and elsewhere. You can also find us at various conventions and festivals around the United States. Our up-to-date event listings will keep you informed of the wheres and whens. See you soon!


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Uterine fibroids and hysterectomy
This content will no longer be available as of 10/11
Stay tuned for improvements we're making to our Health Information section.
Uterine fibroids and hysterectomy
Uterine Fibroids
Uterine fibroids, also called leimyomas or myomas, are non-cancerous growths that originate in the muscular wall of the uterus. Fibroids are the most common type of tumor found in female reproductive organs. Uterine fibroids are very common, especially among African-American women.
Symptoms of Uterine Fibroids
Common symptoms of uterine fibroids may include:
- Heavy and prolonged menstrual bleeding
- Pressure and pain in the abdomen and lower back
- Frequent urination
- Constipation
- Pain during intercourse
- Some women with fibroids do not have any symptoms
Complications of Uterine Fibroids
- Fibroids can increase pregnancy complications and delivery risks.
- Anemia due to iron deficiency may result from heavy menstrual bleeding.
- Large fibroids may reduce fertility, although this is not very common.
Many women with fibroids choose not to have treatment, especially if they are approaching the age of menopause. Fibroids grow slowly and usually shrink after menopause. Treatment includes various drug and surgical options.
Medications for Fibroids
- Continuous-dosing oral contraceptives can reduce or eliminate menstrual periods.
- Progestin-releasing intrauterine devices can help control excessive menstrual bleeding (menorrhagia). The levonorgestrel-releasing intrauterine system (Mirena) is approved by the Food and Drug Administration (FDA) for treatment of menorrhagia.
- Gonadotropin-releasing hormone (GnRH) agonists reduce estrogen and progesterone levels, which diminishes the size of fibroids.
Surgical Options
Invasive and less-invasive surgical methods include:
- Myomectomy
- Uterine artery embolization
- Endometrial ablation
- Magnetic resonance-guided focused ultrasound (still not commonly available)
- Hysterectomy
A uterine fibroid (known medically as a leiomyoma or myoma) is a noncancerous (benign) growth of smooth muscle and connective tissue. Fibroids can range in size from as small as a pinhead to larger than a melon. Fibroids have been reported weighing more than 20 pounds.
Fibroids originate from the thick wall of the uterus and are categorized by where they grow:
- Intramural fibroids grow within the middle and thickest layer of the uterus (called the myometrium).
- Subserosal fibroids grow out from the thin outer fibrous layer of the uterus (called the serosa). Subserosal can be either stalk-like (pedunculated) or broad-based (sessile).
- Submucosal fibroids grow from the uterine wall toward and into the inner lining of the uterus (the endometrium). Submucosal fibroids can also be stalk-like or broad-based.
The primary structures in the reproductive system are as follows:
- The uterus is a pear-shaped organ located between the bladder and lower intestine. It consists of two parts, the body and the cervix.
- When a woman is not pregnant the body of the uterus is about the size of a fist, with its walls pressed against each other. During pregnancy the walls of the uterus are pushed apart as the fetus grows.
- The cervix is the lower portion of the uterus. It has a canal opening into the vagina with an opening called the os, which allows menstrual blood to flow out of the uterus into the vagina.
- Leading off each side of the body of the uterus are two tubes known as the fallopian tubes. Near the end of each tube is an ovary.
- Ovaries are egg-producing organs that hold 200,000 - 400,000 follicles (from folliculus, meaning "sack" in Latin). These cellular sacks contain the materials needed to produce ripened eggs, or ova.
The inner lining of the uterus is called the endometrium. During pregnancy this inner lining thickens and becomes enriched with blood vessels to house and support the growing fetus. If pregnancy does not occur, the endometrium is shed as part of the menstrual flow. Menstrual flow also consists of blood and mucus from the cervix and vagina.
Reproductive Hormones. The hypothalamus (an area in the brain) and the pituitary gland regulate the reproductive hormones. The pituitary gland is often referred to as the master gland because of its important role in many vital functions, many of which require hormones.
In women, six key hormones serve as chemical messengers that regulate the reproductive system:
- The hypothalamus first releases the gonadotropin-releasing hormone (GnRH).
- This chemical, in turn, stimulates the pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
- Estrogen, progesterone, and the male hormone testosterone are secreted by the ovaries at the command of FSH and LH and complete the hormonal group necessary for reproductive health.
It is not clear what causes fibroids, but estrogen and progesterone appear to play a role in their growth. Fibroids tend to shrink after menopause, when estrogen levels decline.
Risk Factors
Uterine fibroids are the most common tumor found in female reproductive organs.
AgeFibroids are most common in women from their 30s through early 50s. (After menopause, fibroids tend to shrink.) About 20 - 40% of women age 35 and older have fibroids of significant enough size to cause symptoms.
Race and EthnicityUterine fibroids are particularly common in African-American women, and these women tend to develop them at a younger age than white women.
Family HistoryFamily history (having a mother or sister who had fibroids) may increase risk.
Other Possible Risk FactorsObesity and high blood pressure may possibly be associated with increased fibroid risk
Effect on FertilityMost fibroids appear to have only a small effect on a woman's fertility. Female infertility is usually due to other factors than fibroids.
Effect on PregnancyFibroids may increase pregnancy complications and delivery risks. These may include:
- Cesarean section delivery
- Breech presentation (baby enters the birth canal upside down with feet or buttocks emerging first)
- Preterm birth
- Placenta previa (placenta covers the cervix)
- Excessive bleeding after giving birth (postpartum hemorrhage)
Anemia due to iron deficiency can develop if fibroids cause excessive bleeding. Oddly enough, smaller fibroids, usually submucosal, are more likely to cause abnormally heavy bleeding than larger ones.
Most cases of anemia are mild and can be treated with dietary changes and iron supplements. However, prolonged and severe anemia that is not treated can cause heart problems.
Urinary Tract InfectionLarge fibroids that press against the bladder occasionally result in urinary tract infections. Pressure on the ureters may cause urinary obstruction and kidney damage.
Fibroids are nearly always noncancerous, even if they contain cells with abnormal shapes. Cancer of the uterus usually develops in the lining of the uterus (endometrial cancer). Only in rare cases (less than 0.1%) does cancer develop from a malignant change in a fibroid (called leiomyosarcoma). Nevertheless, rapidly enlarging fibroids in a premenopausal woman or even slowly enlarging fibroids in a postmenopausal woman need evaluation to rule out cancer.
Many patients with fibroids do not have symptoms. When they do, symptoms may include:
- Heavy Menstrual Bleeding. The most common symptom is prolonged and heavy bleeding during menstruation. This is caused by fibroid growth bordering the uterine cavity. Menstrual periods may also last longer than normal.
- Menstrual Pain. Heavy bleeding and clots can cause severe cramping and pain during menstrual periods.
- Abdominal Pressure and Pain. Large fibroids can cause pressure and pain in the abdomen or lower back that sometimes feels like menstrual cramps
- Abdominal and Uterine Enlargement. As the fibroids grow larger, some women feel them as hard lumps in the lower abdomen. Very large fibroids may give the abdomen the appearance of pregnancy and cause a feeling of heaviness and pressure. In fact, large fibroids are defined by comparing the size of the uterus to the size it would be at specific months during gestation.
- Pain During Intercourse. Fibroids can cause pain during sexual intercourse (dyspareunia).
- Urinary Problems. Large fibroids may press against the bladder and urinary tract and cause frequent urination or the urge to urinate, particularly when a woman is lying down at night. Fibroids pressing on the ureters (the tubes going from the kidneys to the bladder) may obstruct or block the flow of urine.
- Constipation. Fibroid pressure against the rectum can cause constipation.
Doctors can detect some fibroids as masses (lumps) during a pelvic exam. During a pelvic exam, the doctor will check for pregnancy-related conditions and other conditions, such as ovarian cysts. The doctor will ask you about your medical history, particularly as it relates to menstrual bleeding patterns. Other causes of abnormal uterine bleeding must also be considered.
UltrasoundUltrasound is the standard imaging technique for detecting uterine fibroids. The doctor will order transabdominal and transvaginal ultrasounds. Ultrasound is a painless technique that uses sound waves to image the uterus and ovaries. In transabdominal ultrasound, the ultrasound probe is moved over the abdominal area. In transvaginal ultrasound, the probe is inserted into the vagina.
A variation of ultrasound, called hysterosonography, uses ultrasound along with saline (salt water) infused into the uterus to enhance the visualization of the uterus.
HysteroscopyHysteroscopy is a procedure that may be used to detect the presence of fibroids, polyps, or other causes of bleeding. (It may also be used during surgical procedures to remove fibroids.)
Hysteroscopy can be performed in a doctor's office or in a hospital setting. The procedure uses a long flexible tube called a hysteroscope, which is inserted into the vagina and through the cervix to reach the uterus. A fiber-optic light source and a tiny camera in the tube allow the doctor to view the cavity. The uterus is filled with saline or carbon dioxide to inflate the cavity and provide better viewing. This can cause cramping.
Hysteroscopy is non-invasive and does not require incisions; however, some women report severe pain with the procedure. Local, regional, or general anesthesia may be given.
LaparoscopyIn some cases, laparoscopic surgery may be performed as a diagnostic procedure. Laparoscopy involves inserting a fiber-optic scope into a small incision made near the navel. Whereas hysteroscopy allows the doctor to view inside the uterus, laparoscopy provides a view of the outside of the uterus, including the ovaries, fallopian tubes, and general pelvic area.
Other TestsIn certain cases, the doctor may perform an endometrial biopsy to determine if there are abnormal cells in the lining of the uterus that suggest cancer. Endometrial biopsy can be performed in a doctor's office, with or without anesthesia. Dilation & curettage (D&C) is a more invasive procedure that involves scraping the inside lining of the uterus. It can be used to take tissue samples and also as a procedure to help temporarily reduce heavy menstrual bleeding.
The doctor may also order a complete blood count (CBC) to check for signs of anemia.
Ruling out Other Conditions that Cause Heavy BleedingAlmost all women, at some time in their reproductive life, experience heavy bleeding during menstrual periods.
A number of conditions can cause or contribute to the risk:
- Menstrual disorders
- Miscarriage
- Having late periods or approaching menopause
- Uterine polyps (small benign growths in the uterus)
- Intrauterine device (IUD)
- Bleeding disorders that impair blood clotting, Von Willebrand disease
- Uterine cancer
- Pelvic infections
- Adenomyosis. This condition occurs when glands from the uterine lining become embedded in the uterine muscle. Its symptoms are nearly identical to fibroids (heavy bleeding and pain).
- Medical conditions, including thyroid problems and systemic lupus erythematosus
- Certain drugs, including anticoagulants and anti-inflammatory medications.
- Often, the cause of heavy bleeding is unknown.
Many women with uterine fibroids do not require treatment. A woman's age and the severity of her symptoms are important factors in considering treatment options.
The three treatment options are:
- Watchful Waiting. A woman may choose to delay having any treatment, particularly if she is close to reaching menopause. Periodic pelvic exams and ultrasounds can help track the progression of her fibroid condition.
- Drug Therapy. Hormonal treatments such as oral contraceptives or a progestin-releasing IUD can help reduce heavy bleeding and pain. Gonadotropin releasing hormone (GnRH) agonists stop ovulation and the production of estrogen, and can reduce fibroid size.
- Surgery. There are many surgical options ranging from less invasive to very invasive. They include removal of the fibroid (myomectomy), removal of the endometrial lining (endometrial ablation), shrinking the blood supply to the fibroid (uterine artery embolization), and removal of the uterus (hysterectomy).
Women should discuss each option with their doctor. Deciding on a particular surgical procedure depends on the location, size, and number of fibroids. Certain procedures affect a woman's fertility and are recommended only for women who are past childbearing age or who do not want to become pregnant. In terms of surgical options, myomectomy is generally the only commonly performed procedure that preserves fertility.
For fibroid pain relief, women can use acetaminophen (Tylenol, generic) or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil, generic) or naproxen (Aleve, generic).
Prescription drug treatment of fibroids uses medicines that block or suppress estrogen, progesterone, or both hormones.
Hormonal ContraceptivesOral contraceptives (OCs) are sometimes used to control the heavy menstrual bleeding associated with fibroids, but they do not reduce fibroid growth. Newer types of continuous-dosing OCs reduce or eliminate the number of periods a woman has per year.
Intrauterine devices (IUDs) that release progestin can be very beneficial for reducing heavy bleeding. Specifically, the levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena), has shown excellent results. It is approved by the FDA to treat heavy menstrual bleeding. Many doctors now recommend the LNG-IUS as a first-line treatment for heavy menstrual bleeding, particularly for women who may face hysterectomy (removal of uterus).
GnRH AgonistsGonadotropin-releasing hormone (GnRH) agonists include the implant goserelin (Zoladex), a monthly injection of leuprolide (Lupron Depot, generic), and the nasal spray nafarelin (Synarel). GnRH agonists block the release of the reproductive hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone). As a result, the ovaries stop ovulating and producing estrogen. Basically, GnRH agonists induce a temporary menopause.
GnRH agonists may be used as drug treatment to shrink fibroids in women who are approaching the age of menopause. They may also be used as a preoperative treatment 3 - 4 months before fibroid surgery to reduce fibroid size so that a more minimally invasive surgical procedure can be performed.
Before using these drugs, the doctor should be certain that no other complicating conditions are present, particularly leiomyosarcoma (cancer). The use of these drugs can delay treatment of the malignancy and cause severe complications.
Commonly reported side effects, which can be severe in some women, include menopausal-like symptoms. These symptoms include hot flashes, night sweats, vaginal dryness, weight gain, and depression. The side effects vary in intensity, depending on the GnRH agonist. They may be more intense with leuprolide and persist after the drug has been stopped.
The most important concern is possible osteoporosis from estrogen loss. Women should not take these drugs for more than 6 months.
GnRH treatments used alone do not prevent pregnancy. Furthermore, if a woman becomes pregnant during their use, there is some risk for birth defects.
Surgical Alternatives to Hysterectomy
A myomectomy surgically removes only the fibroids and leaves the uterus intact, often preserving fertility. Myomectomy may also help regulate abnormal uterine bleeding caused by fibroids. Not all women are candidates for myomectomy. If the fibroids are numerous or large, myomectomy can become complicated, resulting in increased blood loss. If cancer is found, conversion to a full hysterectomy may be necessary.
To perform a myomectomy, the surgeon may use a standard "open" surgical approach (laparotomy) or less invasive ones (hysteroscopy or laparoscopy).
- Laparotomy. Laparotomy uses a normal abdominal incision and conventional "open" surgery. It is used for subserosal or intramural fibroids that are very large (usually more than 4 inches), that are numerous, or when cancer is suspected. While complete recovery takes less than a week with laparoscopy and hysteroscopy, recovery from a standard abdominal myomectomy takes as long as 6 - 8 weeks. Open laparotomy poses a higher risk for scarring and blood loss than with the less invasive procedures, a concern for women who want to retain fertility.
- Hysteroscopy. A hysteroscopic myomectomy may be used for submucosal fibroids found in the uterine cavity. With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal. The doctor then uses an electrosurgical wire loop to surgically remove (resect) the fibroid.
- Laparoscopy. Women whose uterus is no larger than it would be at a 6-week pregnancy and who have a small number of subserosal fibroids may be eligible for treatment with laparoscopy. As with hysteroscopy, thin scopes are used that contain surgical and viewing instruments. Laparoscopy requires only tiny incisions, and has a much faster recovery time than laparotomy.
Complications. The risks for myomectomy are generally the same of those for other surgical procedures, including bleeding and infection.
Recurrence of Fibroids. Myomectomy is not necessarily a permanent solution for fibroids. They can recur after these procedures.
Uterine Artery EmbolizationUterine artery embolization (UAE), also called uterine fibroid embolization (UFE), is a relatively new way of treating fibroids. UAE deprives fibroids of their blood supply, causing them to shrink. UAE is a minimally invasive radiology treatment and is technically a nonsurgical therapy. It is much less invasive than hysterectomy and myomectomy, and involves a shorter recovery time than the other procedures. The patient remains conscious, although sedated, during the procedure, which takes around 60 - 90 minutes.
The procedure is typically performed in the following manner:
- The patient receives a sedative to cause drowsiness, and a local anesthetic is applied to the skin around the groin.
- An interventional radiologist makes a small quarter-inch incision in the skin and inserts a catheter (a thin tube) into the femoral artery. The femoral artery is a large artery that begins in the lower abdomen and extends down to the thigh. The radiologist then threads the catheter into the uterine artery.
- Small plastic particles are injected into the artery. These particles block the blood supply to the tiny arteries that feed fibroid cells, and the tissue eventually dies.
- Patients usually stay in the hospital overnight after UAE and are given pain medication. Pelvic cramps are common for the first 24 hours after the procedure.
- It takes 1 - 2 weeks for the patient to recover from the procedure and return to work. It may take several months to several years for the fibroids to completely shrink.
- Most patients have a light, brownish color vaginal discharge for several days following UAE, which may last until the next menstrual cycle. Most women resume regular menstrual cycles within 2 - 3 months of the procedure. Heavy menstrual bleeding reduced by the second or third cycle.
Effect on Fertility. In general, UAE is considered an option for only those who have completed childbearing. The American College of Obstetricians and Gynecologists advises women who wish to have children that it is not yet known how this procedure affects their potential for becoming pregnant. Some evidence indicates UAE may increase the risk for miscarriage in women who do become pregnant.
Complications. UAE has a lower rate of complication than hysterectomy and laparotic myomectomy and a shorter hospital stay. Compared to other procedures, women who have UAE miss fewer days of work. Serious complications occur in fewer than 0.5% of cases. In addition to potential impact on fertility, other postoperative effects may include.
- Pain. Abdominal cramps and pelvic pain after the procedure are nearly universal and may be intense. Pain usually begins soon after the procedure and typically plateaus by 6 hours. The pain usually improves each day over the next several days. A low-grade fever and general malaise are also common in the first week after the procedure.
- Early menopause. Most women who have UAE will continue to have normal menstrual periods. Some women, however, go through menopause after the procedure. Menopause is more likely to occur in women over age 45 who have UAE.
Success Rates. Studies on uterine artery embolization show high patient satisfaction (over 90%) and low complication rates. Menorrhagia symptoms, as well as pelvic pain and urinary symptoms, improve in 85 - 95% of patients within 3 months after treatment. Uterine artery embolization is effective for most patients. However, some women may have fibroid recurrence and may need future procedures (repeat embolization or hysterectomy).
Some studies suggest that women with larger single fibroids or larger uteruses are not good candidates for UAE.
Endometrial AblationEndometrial ablation destroys the lining of the uterus (the endometrium) and is usually performed to stop heavy menstrual bleeding. It may also be used to treat women with small fibroids. It is not helpful for large fibroids or for fibroids that have grown outside of the interior uterine lining. For most women, this procedure stops the monthly menstrual flow. In some women, menstrual flow is not stopped but is significantly reduced.
Endometrial ablation procedures use some form of heat (radiofrequency, heated fluid, microwave) to destroy the uterine lining. The procedure is typically done on an outpatient basis and can take as few as 10 minutes to perform. Recovery generally takes a few days, although watery or bloody discharge can last for several weeks.
Endometrial ablation significantly decreases the likelihood a woman will become pregnant. However, pregnancy can still occur and this procedure increases the risks of complications, including miscarriage. Women who have this procedure must be committed to not becoming pregnant and to using birth control. A main concern of endometrial ablation is that it may delay or make it more difficult to diagnose uterine cancer in the future.
Magnetic Resonance Guided Focused Ultrasound (MRgFUS)MRgFUS is a non-invasive procedure that uses high-intensity ultrasound waves to heat and destroy (ablate) uterine fibroids. This "thermal ablation" procedure is performed with a device, the ExAblate, which combines magnetic resonance imaging (MRI) with ultrasound.
During the 3-hour procedure, the patient lies inside an MRI machine. The patient receives a mild sedative to help relax but remains conscious throughout the procedure. The radiologist uses the MRI to target the fibroid tissue and direct the ultrasound beam. The MRI also helps the radiologist monitor the temperature generated by the ultrasound.
MRgFUS is appropriate only for women who have completed childbearing or who do not intend to become pregnant. The procedure cannot treat all types of fibroids. Fibroids that are located near the bowel and bladder, or outside of the imaging area, cannot be treated.
This procedure was approved in 2004, and long-term results are not yet available. Likewise, it requires an extensive period of time involving MRI equipment. Many insurance companies do not pay for this treatment.
Hysterectomy is the surgical removal of the uterus. The ovaries may also be removed, although this is not necessary for fibroid treatment. Hysterectomy is a permanent solution for fibroids, and is an option if other treatments have not worked or are not appropriate.
A woman cannot become pregnant after having a hysterectomy. If the ovaries are removed along with the uterus, hysterectomy causes immediate menopause.
Types of HysterectomiesOnce a decision for a hysterectomy has been made, the patient should discuss with her doctor what will be removed. The common choices are:
- Total hysterectomy (removal of uterus and cervix).
- Subototal, also called supracervical hysterectomy (removal of uterus and preservation of the cervix).
- Oophorectomy (removal of an ovary). Bilateral oopherectomy is the removal of both ovaries. Bilateral salpingo-oophorectomy is the removal of the fallopian tubes and ovaries). These procedures can be performed with either total or supracervical hysterectomy.
Hysterectomy procedures include:
- Abdominal hysterectomy
- Vaginal hysterectomy
- Laparoscopically assisted vaginal hysterectomy (LAVH)
- Laparoscopic hysterectomy
- Robotic hysterectomy
Abdominal Hysterectomy. Abdominal hysterectomy is the standard procedure. It is best suited for women with large fibroids, when the ovaries need to be removed, or when cancer or pelvic disease is present. The surgeon makes a 5-inch to 7-inch incision in the lower part of the belly. The cut may either be vertical, or it may go horizontally across the abdomen, just above the pubic hair (a bikini cut). The bikini cut incision heals faster and is less noticeable than a vertical incision, which is used in more complicated cases. The patient may need to remain in the hospital for 3 - 4 days, and recuperation at home takes about 4 - 6 weeks.
Vaginal Hysterectomy, LAVH, and Laparoscopic Hysterectomy. Vaginal hysterectomy requires only a vaginal incision through which the uterus is removed. The vaginal incision is closed with stitches.
A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy (LAVH). It uses several small abdominal incisions through which the surgeon severs the attachments to the uterus and, if needed, ovaries. In LAVH, the uterus (and ovaries) are then removed through the vaginal incision, as in the standard vaginal approach. In laparoscopic hysterectomy, they are removed in small pieces through the abdomen.
Recovery times for vaginal hysterectomy and LAVH are shorter than those for abdominal hysterectomy. However, hospital stays may be longer, and costs are greater with LAVH than with standard vaginal hysterectomy. Some doctors question whether LAVH adds any significant benefits compared to the standard vaginal procedure.
Robotic Hysterectomy. Robotic hysterectomy is like laparoscopic hysterectomy, but a special machine is used. This approach is most often used when a patient has cancer or is very overweight and vaginal surgery is not safe.
ComplicationsMinor complications after hysterectomy are very common. About half of women develop minor and treatable urinary tract infections. There is usually mild pain and light vaginal bleeding post operation. More serious complications are uncommon but can include infection and blood clots.
Postoperative CareThe patient should ask a family member or friend to help out for the first few days at home. The following are some of the precautions and tips for postoperative care:
- For 1 - 2 days after surgery, the patient is given medications to prevent nausea and painkillers to relieve pain at the incision site.
- As soon as the doctor recommends it, usually within a day of the operation, the patient should get up and walk in order to help prevent pneumonia, reduce the risk of blood-clot formation, and speed recovery.
- Walking and slow, deep breathing exercises may help to relieve gas pains, which can cause major distress for the first few days.
- Coughing can cause pain, which may be reduced by holding a pillow over a surgical abdominal wound or by crossing the legs after vaginal surgery.
- Patients are advised not to lift heavy objects, not to douche or take baths, and not to climb stairs or drive for several weeks.
- For the first few days after surgery, many women weep frequently and unexpectedly. These mood swings may be due to depression from the loss of reproductive capabilities and from abrupt changes in hormones, particularly if the ovaries have been removed.
Patients who have had abdominal hysterectomies should discuss with their doctors when exercise programs more intense than walking can be started. The abdominal muscles are important for supporting the upper body, and recovering strength may take a long time. Even after the wound has healed, the patient may have an on-going feeling of overall weakness, for some time. Some women do not feel completely well for as long as a year while others may recover in only a few weeks.
If a woman has had her cervix removed, she no longer needs annual Pap smears. However, women who have had any type of hysterectomy should continue to receive routine pelvic and breast exams, and mammograms.
Menopausal Symptoms and Premature Menopause after HysterectomyThe ovaries are the main source of production of estrogen. In premenopausal woman, the removal of ovaries causes premature menopause. After hysterectomy with bilateral oopherectomy, women may have hot flashes and other symptoms of menopause, including vaginal dryness, insomnia, and weight gain.
Women who have surgical removal of both ovaries, and who do not receive hormone replacement therapy, tend to have more severe hot flashes than women who enter menopause naturally. If hormone replacement therapy (HRT) is recommended after hysterectomy and ovary removal, it is given as estrogen-only replacement therapy (ERT). (Women without ovaries do not need to take combination estrogen-progesterone HRT.)
In premenopausal women who have had their ovaries retained, the ovaries will usually continue to function and secrete hormones even after the uterus is removed, but the lifespan of the ovaries is reduced by an average of 3 - 5 years. In rare cases, complete ovarian failure occurs right after hysterectomy, presumably because the surgery has permanently cut off the ovaries' blood supply.
The most important complications occur in women who have had their ovaries removed. This causes estrogen loss, which places women at risk for osteoporosis (loss of bone density) and a possible increase in risks for heart disease and stroke. Several drugs are available that can help protect both bones and heart.
Sexuality after HysterectomySexual intercourse may resume 4 - 6 weeks following surgery. The effect of hysterectomy on sexuality varies among women. Some women notice a change in their orgasmic response because they no longer experience uterine contractions. Other women report increased sexual drive and pleasure because they are free from the problems that prompted hysterectomy.
Patients who have both ovaries removed may be at higher risk for loss of sexuality and experience sexual problems such as vaginal dryness. A vaginal gel or lubricant can help reduce vaginal dryness.
- www.asrm.org -- American Society for Reproductive Medicine
- www.acog.org -- American College of Obstetricians and Gynecologists
- www.sirweb.org -- Society of Interventional Radiology
- www.nuff.org -- National Uterine Fibroids Foundation
- www.rsna.org -- Radiological Society of North America
- www.radiologyinfo.org -- Radiology info from the American College of Radiology and the Radiological Society of North America
- www.womenshealth.gov -- National Women's Health Information Center
American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008 Aug;112(2 Pt 1):387-400.
Bradley LD. Uterine fibroid embolization: a viable alternative to hysterectomy. Am J Obstet Gynecol. 2009 Aug;201(2):127-35.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Centers for Disease Control and Prevention (CDC), Farr S, Folger SG, Paulen M, et al. U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. MMWR Recomm Rep. 2010 Jun 18;59(RR-4):1-86.
Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007 Jan 25;356(4):360-70.
Evans P, Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician. 2007 May 15;75(10):1503-8.
Goodwin SC, Spies JB. Uterine fibroid embolization. N Engl J Med. 2009 Aug 13;361(7):690-7.
Griffiths A, D'Angelo A, Amso N. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2006 Jul 19;3:CD003857.
Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril. 2010 Jun;94(1):324-30. Epub 2009 Apr 9.
Jacoby VL, Grady D, Sawaya GF. Oophorectomy as a risk factor for coronary heart disease. Am J Obstet Gynecol. 2009 Feb;200(2):140.e1-9. Epub 2008 Nov 18.
Kaunitz AM. Progestin-releasing intrauterine systems and leiomyoma. Contraception. 2007 Jun;75(6 Suppl):S130-3. Epub 2007 Mar 9.
Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009 May;113(5):1104-16.
Lethaby A, Hickey M, Garry R, Penninx J. Endometrial resection / ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001501.
Moss J, Cooper K, Khaund A, Murray L, Murray G, Wu O, et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 2011 Jul;118(8):936-944. doi: 10.1111/j.1471-0528.2011.02952.x. Epub 2011 Apr 12.
Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD003677.
[No authors listed] ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18.
Olive DL, Lindheim SR, Pritts EA. Conservative surgical management of uterine myomas. Obstet Gynecol Clin North Am. 2006 Mar;33(1):115-24.
Parker WH, Broder MS, Chang E, Feskanich D, Farquhar C, Liu Z, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study. Obstet Gynecol. 2009 May;113(5):1027-37.
Smart OC, Hindley JT, Regan L, Gedroyc WG. Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol. 2006 Jul;108(1):49-54.
Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF;Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomas. J Vasc Interv Radiol. 2010 Aug;21(8):1153-63. Epub 2010 Jun 16.
Stout MJ, Odibo AO, Graseck AS, Macones GA, Crane JP, Cahill AG. Leiomyomas at routine second-trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol. 2010 Nov;116(5):1056-63.
Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009 Jan 7;301(1):82-93. Epub 2008 Dec 2.
van der Kooij SM, Bipat S, Hehenkamp WJ, Ankum WM, Reekers JA. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011 Oct;205(4):317.e1-18. Epub 2011 Mar 16.
Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007 Jun;196(6):519.e1-11.
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I am a novice gardener. Up until this year I have only grown flowers in my garden. I did have a few tomato plants and strawberries last year and did okay with them. I have just acquired some large apple bins from the east side and plan to grow some veggies in them this year. The bins came with some spray paint markings on the outside and I was wondering if there is a "safe" paint I could use on the outside of them to make them less of an eyesore . Any advice? |
Follow-Up Postings:
- Posted by larry_gene USDA8b-OregonPDX (My Page) on Mon, Apr 29, 13 at 22:59
Orchard tote-bins are awfully deep for homeowner raised beds, unless you are referring to bushel boxes. Veggies will do fine in 12 to 16" of soil. Not sure what an unsafe paint would be as it is going on the outside of the bins. Use a paint intended as the primer layer as bin wood would not be suitable for a finish coat only. Primer paint can be tinted to many colors. |
This post was edited by larry_gene on Mon, Apr 29, 13 at 23:01
Perhaps, instead of painting over the paint just try to sand it off with an electric sander. The random type makes it smooth without taking off too much. You could also try higher grit paper or a wire brush if the paint is persistent and the wood strong enough. Just know that the paint might contain lead, so take precautions. Our scrap lumber raised beds had stray markings, but once plants grew up & the sunshine grayed the wood I didn't notice it anymore. It's only in early spring or just after harvest that you'd notice. Another idea might be to disguise the most visible sides of the boxes with bamboo mats like what you'd take to the beach in Hawaii or roll up bamboo screening shades. I've been patching drywall, sanding & painting lately prior to a move, so am aware of the fussiness of getting paint applied straight & smooth on irregular surfaces or trying to not get it on some things like popcorn ceiling. If you do paint you might not want to spend a lot of time on it because it will get dinged up with garden tools, shoes, etc. -- no matter how well you paint it. On the weekend I brushed some paint on the outsides of 2 old plywood doors of a chicken coop. After a few passes with the sander it was smooth enough to brush on exterior latex sample paint in sage green as a primer. The 2nd coat was a bit lighter green exterior latex paint and though still looks like a chicken coop. We wanted a bit more of a finished look positioned near the garage instead of tucked away in the backyard. We might add some trim pieces when we're done with all this house stuff & moving, but the rustic look is what you'd expect of a coop in a rural setting and we're only having it in this spot for awhile with the young chicks this spring. Hope that helps~~ |
I have stained and painted various beds in my yard. I included a link that has photos of all of them. 2x12' bed was painted house color about 2 years ago and still looks fine. 4x8' beds - the bottom layer was stained 4 years ago, the top layer was installed this year and won't be getting stain The remainder of the beds are 1&2 years old and the stain still looks nice on them, but up close you can tell it's starting to degrade. |
Here is a link that might be useful: Home In Disarray - Garden Beds
- Posted by CarmieCarm none (My Page) on Tue, May 7, 13 at 14:24
Thanks for all of the great tips. I am definitely a work smarter not harder type. Don't know if sanding would be my thing. I think maybe I will just leave them as-is for this year and see if I can even grow food :D I am going for the rustic look anyway, so I can make it work. If it still bothers me next year, I will look into painting. There are a few non-lead primers on the market that look good to me. Larry, they are the reg orchard bins. 2.5' deep. I plan to put pallets in the bottoms of them to raise up the inside depth and top with landscape fabric and straw before I put the soil and compost in them. Wow! It's May 7th already. I better get busy. |
- Posted by larry_gene USDA8b-OregonPDX (My Page) on Tue, May 7, 13 at 23:13
In that case I would increase the long-term usage chances by placing a brick or paver at each corner and in the center to keep the tote off the ground. If the bottom and lower sides rot out, it could destabilize the whole structure. Put a few large holes in the bottom to let water escape that percolates through. Partial infill with pallets is a good idea. |
- Posted by Johnnye2145 none (My Page) on Wed, Mar 5, 14 at 11:56
This is my first year at the square foot gardening/raised beds. The frame was made out of untreated pine lumber. I was thinking of painting it with exterior latex paint - both inside and outside - but Mel Bartholomew says don't paint the inside - has anyone had any experience with painting their raised bed? Thanks for the help. |
- Posted by larry_gene USDA8b-OregonPDX (My Page) on Wed, Mar 5, 14 at 23:11
Inside painting as a cosmetic attempt to make the unused area above the soil line a uniform or pretty color may be a wasted effort as it will quickly accumulate tool marks and soil splatters from rainfall or watering. Perhaps there will be more painting experience comments than the ones already posted from last year, above. |
- Posted by Johnnye2145 8 (My Page) on Thu, Mar 6, 14 at 11:31
Thanks Larry for you input... I though perhaps it would protect the wood from deteriorating quite so quickly if the paint was inside also. But the more I read I think it should stay unpainted. |
- Posted by larry_gene USDA8b-OregonPDX (My Page) on Thu, Mar 6, 14 at 23:32
If 3/4" untreated lumber was used for the sides, the lifetime will be limited, perhaps 10 years or less. Lining the inner sides with sheet materials would extend the life. The lower down the side, the more likely the decay. |
my guess is that 3/4" untreated lumber would last 2-4 seasons. all wooden raised beds are temporary, just a question of HOW temporary. this time of year home depot and parr lumber carry raw edge cedar 2x10 stock. i forget the board foot numbers, but if you have some bolts lying around you can get say a 3 by 7 bed together for $80 or so. (two 10 foot sections 2x10). if its just one 10" board, don't bother with the 4x4 corners. cedar stakes should hold it well enough. |
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Attenuation 1 dB Steps 31 dB with High Accuracy Single Positive Control +5 V) for Each Bit Low DC Power Consumption Small Low Cost SSOP-16 Plastic Package
The a 5 bit, single positive control GaAs IC FET digital attenuator in a low cost SSOP-16 package. This attenuator has an LSB 1 dB and a total attenuation of 31 dB. The attenuator requires external DC blocking capacitors, positive supply voltage (VS) and five individual bit control voltages (V1V5). The AA101-80 is particularly suited where high attenuation accuracy, low insertion loss and low intermodulation products are required. Typical applications include base station, wireless data, and wireless local loop gain level control circuits.
Parameter1 Insertion Loss Condition Frequency 0.51.0 GHz 1.02.0 GHz 2.02.5 GHz 0.51.0 GHz 1.02.0 GHz 2.02.5 GHz VSWR (I/O)3 Rise, Fall or 90/10% RF) On, Off (50% CTL to 90/10% RF) Video Feedthru +5 V For Two-tone Input Power +5 dBm V 0.52.5 GHz 0.52.5 GHz 0.52.5 GHz 0.52.5 GHz Min. Typ. of Attenuation Setting in dB) of Attenuation Setting in dB) of Attenuation Setting in dB) ns mV dBm Max. 3.0 3.3 Unit dB
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The UCO Student Counseling Center is a place where students can learn to deal with personal concerns or situations, such as initiating friendships, divorce or a break-up, anxiety, stress, depression, academic difficulties, and adjustment to college life. Services are available to currently enrolled students at the University of Central Oklahoma free of charge. The Counseling Center is located on the fourth floor of the University Center, Room 402. Call (405) 974-2215 for more information or visit them online at www.uco.edu/student_counseling.
The University of Central Oklahoma provides a Student Health Center where health services are available to all students. There are nominal fees assessed for medication, specified services, and to see the nurse practitioner or doctor. For further information, call (405)974-2317 or visit them online at www.ucowellnesscenter.com.
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The UCO Testing Center is a national test center for Education Testing Services, The College Board, and the American College Testing Program. As such, it provides registration forms and administers national testing dates for the Graduate Record Exam (GRE), Scholastic Aptitude Test (SAT), and the Pre-Professional Skills Test (PPST). Regular on-campus (residual) ACT and institutional TOEFL are also offered for prospective UCO students. The Center also administers tests for those students attempting to earn credit through Extra-institutional Examinations such as CLEP, Departmental Challenge Exams, AP, and DANTES. A complete listing of tests is available at the Testing Center. Students and prospective students are invited to visit Thatcher Hall, Room 302, or phone (405) 974-2388 or visit them online at www.uco.edu/testing_services.