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April 5, 1996     Cape Gazette
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April 5, 1996

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CAPE GAZETTE, Friday, April 5 -April 11, 1996 - 35 Health & Fitness Part III: Surgical series Laparoscopes, hys By Kerry Kester Open gynecological surgery, with its history of being traumatic both physically and emotionally, has undergone a change that eases women' s suffering. Now, because of technological develop- ments, women may have less invasive operations that not only ease the trauma, but provide sur- geons with more accurate data with which to assess their patients' conditions. Surgery through scopes allows physicians to examine the abdom- inal cavity. "It's a way to get inside and look inside without opening them up," said Steven Berlin, M.D., an obstetrician /gynecologist with Bayside Health Association. Actual pro- cedures can also be performed through the scopes. Berlin compared performing a surgery without the scopes to mowing a lawn blindfolded. "If you mowed a parcel of land while wearing a blindfold, the chances are that when you took the blind- fold off, you would see that you missed a lot of the grass," said Berlin. "If you mowed another parcel without the blindfold, you probably wouldn't miss much." The camera [of a scope] allows a physician to see much more than with only the naked eye, he explained. Gynecologists use both laparo- scopes and hysteroscopes. A laparoscope is a small lighted tube equipped with a magnifying device. Like with scopes used in other surgeries, only small inci- sions are required to insert the scope through the small punctures in the abdomen. teroscopes provide new medical A hysteroscope, similar in that it allows the physician a closer look at the inside of a patient, requires no external incisions. The hys- teroscope is inserted through the vagina, past the cervix and into the uterus. Both scopes project images onto television monitors on which surgeons rely for their visuals. Scopes used in diagnosis In the early morning of a Thurs- day in March, Berlin stood masked and gowned over a 24-year-old anesthetized patient who had been experiencing pelvic pain and abnormal uterine bleeding. Berlin, scope in hand, was ready to solve the mystery of why she was having problems. Poised with the hysteroscope, Berlin searched through the woman's uterus until he located one of the sources of her problems. Small polyps were growing in the uterus. While watching his move- ments on the television monitor stationed above the patient, Berlin carefully removed the small growths that were causing his patient bleeding and discomfort. Armed next with the laparo- scope - which allowed Berlin to approach the uterus through the abdomen, he began searching for signs of endometriosis, or some growth of uterine tissue outside of the uterus. What he found was some scar tissue that was the result of her previous cesarean sections. He also found an ovary bound by scar tissue and was able to cut the tissue and free the ovary. "That should help with the pain," he explained as he carefully snipped away. "At one time, someone would have just removed the ovary," said Berlin, explaining that an important advantage of surgery through scopes is that there is a greaterflkelihood of sav- ing reproductive organs. As he continued exploring and searching for other problems, he paused when he found some' indi- rect indications that his patient might have endometriosis. "Endometriosis has often been called the big masquerader, because is presents in so many ways," said Berlin. "At one time, women would have had to have major surgery for this," said Berlin, who was clearly enthused that his patient was benefiting from Beebe Medical Center's state-of-the-art operating room. Berlin carefully delivered differ- ent tissue samples to his operating room assistants, who later sent them for pathological testing. (He later learned that his patient did not have cancer.) "We'll follow her and see how she does, and we'll offer her some alternative treatments," said Berlin as he deft- ly began closing the operation. Hysterectomy alternatives One of the things Berlin most likes about doing procedures with scopes, he said, is that they allow physicians "to conserve reproduc- tive organs." Endometrial ablation is a procedure that was first intro- duced to the Cape Region when it was performed at Beebe Medical Center on October 12, 1994. Doc- tors Berlin, Vincent Killeen and Newell Washburn were the first to bring the procedure to Sussex County, and for many women it is an alternative to a hysterectomy. vistas Kerry Kester photo Using scopes during operations has revolutionized many dif- ferent types of surgery. Steven Berlin, M.D., a gynecologist/obstetrician with Bayside Health Association, performs a laparoscopic diagnostic procedure on a 24-year-old patient who suffered from pain and abnormal bleeding prior to her surgery. Berlin learned that one of his patient's prob- lems was that her ovary was "trapped" by some scar tissue. He was able to snip the tissue away to free the ovary. A hysterectomy is the complete removal of the uterus. Having the uterus removed - especially if the operation removes the cervix, ovaries, and fallopian tubes (reproductive organs) - can create severe problems for women. Hor- mone levels are disrupted, recov- ery time is lengthy, and women may experience discomfort or pain for a relatively long time. An endometrial ablation involves removing the uterine lin- ing through a hysteroscope. The women who need the procedure are usually those for whom other treatments to cure bleeding dys- function have failed, but who are not being treated for cancer and are past the child bearing stage of life. It is a procedure that Berlin said cannot be performed at all without scopes. "It's too dangerous," said Berlin, who explained that without the magnification and increased visual field, there would be a risk of puncturing the uterus. Prior to the option of the procedure, a woman's only choice was for the hysterectomy. Scopes increase accuracy When women experience dys- functional menstrual bleeding, pelvic pain, or when they need a uterine disease diagnosed, physi- cians may need to scrape the lining of the uterus. Prior to the use of scopes, if a woman needed the uterus scraped, Continued on page 36 Cellex-C: A new skin rejuvenating agent There is little we can do to stop the process of aging; however, with the use of antioxidants we can slow aging down and even reverse the aging process of the skin. Antioxidants are a group of chemicals that neutralize free rad- icals. Free radicals are a group of chemicals that over our lifetime will damage cells, the building blocks we are all made of. Several vitamins have antioxi- dant properties including vitamins A, E and C. When applied to the skin in their regular form, these vitamins do not penetrate the skin. The vitamins just sit on the sur- face and can do little if any good. Many cosmetic companies add Vitamin E to their products but limited benefit is derived because the vitamin does not penetrate the skin's surface. In fact, many HEALTH TOPICS Dr. Mitchell Stickler patients will present to the derma- tology office with allergic reac- tions to Vitamin.E containing creams. Cellex-C is a new formulation of Vitamin C, developed by a derma- tologist at Duke University. What makes Cellex-C different is that Vitamin C has been coupled to an enzyme that allows it to penetrate the skin providing levels of the vit- amin 20 times what is normally found in the skin. .Cellex-C becomes incorporated into the skin; it cannot be washed or rubbed off. The vitamin lasts for up to three days after it is applied. Like other vitamins, Vit- amin C is not made by the body; it is only available through the diet. Aside from being an antioxidant, Vitamin C is also known to be important in the body's manufac- turing of collagen, which gives the skin strength and flexibility. Cellex-C has been shown to have several positive effects when applied to the skin. First, if the skin gets an overdose of sunlight, applying Cellex-C as soon as pos- sible can decrease the severity of the sunburn and will shorten the time required for healing. Cellex- C provides a broad spectrum of photoprotection against UVA and UVB type sunlight. However, it is not a sunscreen because it does not absorb ultravi- olet light. Cellex-C should be used with a sunscreen because it does not absorb ultraviolet light. Cellex-C should be used with a sunscreen to give added protec- tion. Several leading dermatolo- gists think Cellex-C will be a com- mon ingredient in sunscreens within the next few years. If used daily for a three to six month peri- od, Cellex-C can also improve Bateman's purpura (bruising on the arms of people over fifty years of age) and will lighten brown sun spots on the skin. The best way to keep the skin looking young and healthy is to avoid direct sunlight as much as possible and to use daily sun- screen on sun-exposed skin areas. Until recently, once sun damage occurred, there was no way to reverse this damage. In the past few years, medical researchers have made some small but signifi- cant steps in our ability to reverse sun damage. CeUex-C represents one of these steps. Over the next few months I will discuss some of the other treatments that are now available for the treatment of sun damaged skin, including Renova and alpha hydroxyacids. Editor's Note: Mitchell Stickler, M.D., is a board certified derma- tologist at Cape Henlopen and Nanticoke Dermatology.