Background-This study tested the hypothesis that microstructural white matter abnormalities in frontostriatal-limbic tracts are associated with poor response inhibition on the Stroop task in depressed elders.

Primary dysmenorrhea is defined as painful menstruation in the absence of pelvic pathology. Characterized by recurrent, crampy, lower abdominal pain during menstruation, it is the most common reason for gynecologic visits, affecting 50% to 90% of women, half of whom describe their pain as moderate to severe. 1 Secondary dysmenorrhea refers to the same clinical features of pain during menstruation, but is attributable to pelvic pathology, such as endometriosis, fibroids, adenomyosis, and congenital anatomic abnormalities. Management of primary dysmenorrhea is directed toward excluding other causesofsymptomsandidentifying medical therapies that control the patient's symptoms. Despite its high prevalence, dysmenorrhea is often underdiagnosed, inadequately treated, and normalized even by patients themselves, who may accept the symptoms as an inevitable response to menstruation.Primary dysmenorrhea generally begins in adolescence after ovulatory cycles are established. The associated pain arises from release of excess prostaglandins at the time of endometrial sloughing. Higher levels of prostaglandins have been found in endometrial tissue and menstrual fluid of women with dysmenorrhea compared with asymptomatic women. The increased level of prostaglandins at the time of menstruation is theorized to cause myometrial hypercontractility resulting in hypoxia and ischemia of uterine muscle and the perception of pain, as well as the cause of systemic symptoms often associated with dysmenorrhea, such as nausea and diarrhea.In a population-based survey of women older than 18 years with primary dysmenorrhea, more than half of the respondents described symptoms limiting their activities and 17% reported missing school or work as a result. 2 Dysmenorrhea is the most common cause of short-term absence from school in adolescent girls, and about 1 in 8 girls aged 14 to 20 years report missing school or work as a result of dysmenorrhea. 1 Other cross-sectional studies have demonstrated similar findings of dysmenorrhea affecting relationships, functioning and productivity, and contributing to absenteeism. Despite the significant effects on quality of life, the prevalence of primary dysmenorrhea is considered to be underestimated because women frequently do not seek medical treatment because of the commonly held belief that pain is an expected part of menstruation.The evaluation and diagnosis of women with primary dysmenorrhea does not require specialization in women's health or pelvic pain. In many cases, a diagnosis of primary dysmenorrhea can be reached by obtaining a detailed medical, psychosocial, and gynecologic (including menstrual and sexual) history. 1 A complete menstrual history should include age at menarche; duration of bleeding; intervals between menses; assessment of menstrual flow; and history of associated symptoms, such as pain, nausea, diarrhea, and fatigue, that includes timing of onset, severity of pain, and effects on daily activities. The onset of primary dysmenorrhea typically begins 6 to 24 months after menarc...

Preoperative evaluation for elective benign gynecologic procedures is a necessary step in reducing perioperative complications. Although a thorough history and physical examination are the foundation of this assessment, much evidence exists that physicians rely on unnecessary laboratory and diagnostic testing. Our goal was to perform a systematic review of the available literature regarding preoperative evaluation to better inform preoperative test selection and to identify deficiencies in the current literature. There is very limited data specific to preoperative testing for patients undergoing gynecologic surgeries. Abnormal test results are common when routine, unselected testing is applied. Using a protocol to guide preoperative testing improves patient care by eliminating unnecessary tests without compromising the efficacy of predicting adverse perioperative events or case cancellation and modifications.

The preoperative evaluation including thorough history and physical examination should be the cornerstones for eliciting underlying disease, which may alter a surgical strategy. Devising a protocol to direct preoperative testing has been shown to decrease unnecessary tests without compromising prediction of perioperative morbidity/mortality or case cancellation and changes. Avoidance of 'routine preoperative testing' and instead, thoughtful risk stratification of individual patients, should be a goal of providing value-based care.

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Purpose of reviewTo evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery.Recent findingsFactors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics.SummaryConsidering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.

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