There are number of steps that can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as the formation of adhesions. Such techniques and principles may include:

• Handling all tissue with absolute care

• Using powder-free surgical gloves

• Controlling bleeding

• Choosing sutures and implants carefully

• Keeping tissue moist

• Preventing infection

However, despite these proactive measures, abdominal or pelvic surgery can result in trauma that can lead to adhesions. In order to prevent adhesions from forming following a pelvic (gynecologic) surgery, such as hysterectomy, myomectomy or caesarean section, adhesion barrier can be placed during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis.

Adhesions can cause complications, such as:

• Infertility, which may result when adhesions twist the tissues of the ovaries and tubes, blocking the normal passage of the egg (ovum) from the ovary to the uterus. One in five infertility cases is estimated to be adhesion related (stoval)

• Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50 percent of chronic pelvic pain cases are estimated to be adhesion related (stoval)

• Small bowel obstruction – the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel. 75% of small bowel obstructions are directly related to adhesions. (Scovill)

All the above complications have been associated with adhesions in clinical studies. [Source needed]

Adapted from the Wikipedia article Elective caesarean section, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Catherine Birnie (nee Harrison) was also born in 1951. She was 2 years old when her mother, Doreen, died giving birth to her brother, who died two days later. Unable to cope with her, her father Harold had sent her away to live with her maternal grandparents. At the age of ten, there was a custody dispute where Catherine’s father gained sole custody of Catherine again.

At the age of 12, she met David Birnie, and by the age of 14 she was in a relationship with David. Harold had begged Catherine on several occasions to leave David due to the fact that she was getting in trouble with the local police all the time. But the disapproval of their relationship only strengthened their union.

Her time in prison throughout her adolescent years offered Catherine the chance to break away from David Birnie. Encouraged by a parole officer, Catherine began working for the McLaughlin family as a house keeper. She married Donald McLaughlin on her 21st birthday.

She and McLaughlin had seven children; their firstborn, a son, was struck and killed by a car in infancy.

Four weeks after the birth of her seventh child, she abandoned McLaughlin and began cohabiting with Birnie, who had tracked her down in hospital after she had had a hysterectomy. She had her surname legally changed by deed poll to match his, and reportedly was emotionally dependent on him.

Adapted from the Wikipedia article David and Catherine Birnie, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Born to a middle class Jewish family in Washington Heights, New York, Cowen wrote poetry from a young age, enjoying the works of T. S. Eliot, Ezra Pound, and Dylan Thomas.

While attending Barnard College in the early 1950s, she became friends with Joyce Johnson (at the time, Joyce Glassman). It was during this period that she was first introduced to Ginsberg by psychology professor Donald Cook. The two discovered a mutual acquaintance in Carl Solomon, whom they had both met while spending time separately in a mental hospital. A romantic involvement followed in the spring and summer of 1953. However, it was during this time that Ginsberg began to embrace his homosexuality, and the relationship gradually dissolved. Despite this, Cowen remained emotionally attached to Ginsberg for the rest of her life.

In February 1956, she and her lover Sheila moved into an apartment with Ginsberg and Peter Orlovsky. At the time Cowen had a job as a typist. She was fired and was removed from the office by police officers who beat her. When her father came to pick her up at the police station, he warned her, “If your mother ever hears of this it will kill her.” She then moved to San Francisco, attracted by its growing Beat scene. While in San Francisco, Cowen became pregnant and was forced to undergo a hysterectomy during a late-stage abortion. She returned to New York, and after another trip to California, she relocated to live in Manhattan.

Adapted from the Wikipedia article Elise Cowen, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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The ”da Vinci” Surgical System has been cleared by the U.S. Food and Drug Administration (FDA) for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, and thoracoscopically assisted cardiotomy procedures. It may also be used with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization.

The most common procedure performed with the ”da Vinci” Surgical System is radical prostatectomy (removal of the prostate gland), normally performed as a treatment for prostate cancer. In addition, ”da Vinci” has been used in the following procedures, among others:

Urology

* Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy, ureteral reimplantation

* da Vinci Pyeloplasty

* da Vinci Cystectomy

* da Vinci Nephrectomy

* da Vinci Partial Nephrectomy

* da Vinci Ureteral Reimplantation

Gynecology

* Hysterectomy, myomectomy, sacrocolpopexy

Cardiac

* Mitral valve repair, atrial septal defect closure, cardiac bypass, ablation

General Surgery

* Cholecystectomy, Nissen fundoplication, Heller myotomy, gastric bypass, donor nephrectomy, adrenalectomy, splenectomy, bowel resection

Pediatric Surgery

* Pyeloplasty

* Ureteral reimplantation

* Cholecystectomy

* Nissen fundoplication

* Aortic ring ligation

* Patent ductus ateriosus ligation (PDA)

* Atrial septal defect closure

Thoracic Surgery

* da Vinci Thymectomy

* da Vinci Lobectomy

* da Vinci Esophagectomy

* da Vinci Mediastinal Tumor Resection

Adapted from the Wikipedia article Intuitive Surgical, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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The surgery is performed with the patient under general anesthesia. The surgeon makes an incision in the side of the abdomen to reach the kidney. Depending on circumstances, the incision can also be made midline. The ureter and blood vessels are disconnected, and the kidney is then removed. The surgery can be done as open surgery, with one incision, or as a laparoscopic procedure, with three or four small cuts in the abdominal and flank area. Recently, this procedure is performed through a single incision in the patient’s belly-button. This advanced technique is called as Single Port Access Surgery.

In January 2009, a woman who had previously had a hysterectomy was able to donate a kidney and have it removed through her vagina. The operation took place at Johns Hopkins Medical Center. This is the first time a healthy kidney has been removed via this method, though it has been done in the past for nephrectomies carried out due to pathology. Removing organs through orifices prevents some of the pain of an incision and the need for a cosmetically unappealing larger scar. Any advance which leads to a decrease in pain and scarring has the potential to boost donor numbers. This operation also has taken place at the Cleveland Clinic. The first transvaginal Nephrectomy actually took place at the Cleveland Clinic in Cleveland Ohio.

For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternatives include renal embolization for those who are poor candidates for surgery, or partial nephrectomy if possible.

More rarely, renal cell cancers can involve adjacent organs, yet may be safely and completely removed surgically via open or laparoscopic techniques.

Adapted from the Wikipedia article Nephrectomy, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Michael Neary’s actions caused national outrage, shock and even horror. The idea that a well-known and liked (as he was at the time) consultant obstetrician could needlessly remove women’s wombs, and get away with it for so long, was shocking in itself, but the delay in discovery and investigation, and numerous other incidents that emerged following the publication of the Lourdes Inquiry, created a media storm and resulted in pages of coverage in newspapers. The women harmed by Dr Neary came forward and spoke of their distress and how they still wonder why he did it. Represented by the group Patient Focus, they may receive compensation from the State for what happened to them, a matter that is being discussed in the Department of Health.

Although much of what is in the Lourdes Inquiry report was already known, the Inquiry brought it to a much wider audience. As a result of the outcry following the publication of the report, the Medical Council pressed to introduce new legislation that would allow them more power to find and stop any doctor who is performing poorly. They also introduced stricter Competence Assurance rules for doctors. The biggest thing to come out of the inquiry, however, was the complaints made against three well respected Dublin obstetricians who in 1998 wrote two reports appearing to clear Dr Neary of any wrong-doing and defending his treatment of nine women whose wombs he removed.

On Sunday, 31 August 2008, RTÉ 1 aired part one of the two part series ”Whistleblower” based on real events, it outlined one Midwife’s concerns with Dr Neary’s practices and ultimately blowing the whistle on his unnecessary hysterectomy procedures.

Adapted from the Wikipedia article Michael Neary (surgeon), under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Although different writers state and employ double effect differently, they share the position that consequentially similar acts having different intentional structures make for ethically different acts. So, for example, advocates of double effect typically consider the intentional terror bombing of non-combatants having as its goal victory in a legitimate war morally out of bounds while holding as ethically in bounds an act of strategic bombing that similarly harms non-combatants with foresight but without intent as a side effect of destroying a legitimate military target. Because advocates of double effect propose that consequentially similar acts can be morally different, double effect is most often criticized by consequentialists who consider the consequences of actions entirely determinative of the action’s morality.

In their use of the distinction between intent and foresight without intent, advocates of double effect make three arguments. First, that intent differs from foresight, even in cases in which one foresees an effect as inevitable. Second, that one can apply the distinction to specific sets of cases found in military ethics (terror bombing/strategic bombing), medical ethics (craniotomy/hysterectomy), and social ethics (euthanasia). Third, that the distinction has moral relevance, importance, or significance.

The Doctrine consists of four conditions that must be satisfied before an act is morally permissible:

# The ”nature-of-the-act condition.” The action must be either morally good or indifferent.

# The ”means-end condition.” The bad effect must not be the means by which one achieves the good effect.

# The ”right-intention condition.” The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect.

# The ”proportionality condition” The good effect must be at least equivalent in importance to the bad effect.

Adapted from the Wikipedia article Principle of double effect, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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In 1972, Vera Katz was elected to the Oregon House of Representatives as a Democrat representing Portland and Multnomah County for the 1973 session. She won re-election to additional two-year terms through 1990. In 1985, she became the first woman to serve as Speaker of the Oregon House, replacing Grattan Kerans. While in the Oregon House, she sponsored the Oregon Educational Act for the 21st Century, a landmark school reform bill. She also helped pass measures on gun control as well as legislation prohibiting discrimination based on gender in places of public accommodation and credit. Katz was the first person in Oregon history to hold the position of Speaker for three straight sessions.

In 1992, Katz ran for mayor of Portland, promoting her candidacy by using public transportation to commute to her office. As of March 2000, Katz had never obtained a valid Oregon driver’s license. Running against then city commissioner Earl Blumenauer, she campaigned on a platform that included reducing crime rates.

She won the election and served from January 1993 until January 2005, winning re-election in 1996 and 2000. During her first term, Mayor Katz endorsed The Yellow Bike Project which drew national attention to Portland’s artistic & bike-friendly civic engagement culture. In 2004, she did not stand for re-election and Tom Potter was elected as mayor in November 2004, assuming office in January 2005. During her administration, Katz pursued a policy of revitalization of the city’s neighborhoods.

Katz fought off the early stages of breast cancer in early 2000, with surgery and radiation treatment. Katz was subsequently diagnosed with a rare form of uterine cancer called adenosarcoma in June 2004, following a routine hysterectomy.

Adapted from the Wikipedia article Vera Katz, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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*”The Infertile Couple”, By Roger J. Pepperell, Bryan Hudson, Carl Wood, 1980, ISBN 0443-0172-71

*”Artificial Insemination by Donor”, By Carl Wood, Monash University, 1980, ISBN 0867-4603-0X

*”In Vitro Fertilization and Embryo Transfer” By Alan O. Trounson, Carl Wood, Published 1984, ISBN 0443026750

*”Atlas of Fine Structure of Human Sperm Penetration, Eggs, and Embryos Cultured In Vitro”, by A. Henry Sathananthan (Author), Alan O. Trounson (Author), Carl Wood (Author), November 1985, ISBN 0275-9130-82

*”In Vitro Fertilization”: By Carl Wood, Ann Westmore, 1987, ISBN 0855-7217-74

*”Prematurity”,By E. Carl Wood, Victor Y. H. Yu, 1987, ISBN 0443-0348-0X

*”The A-Z of Pregnancy & Birth”, By Michael D. Humphrey, Susan Gumley, Carl Wood, 1989, ISBN 0140-1219-51

*”Clinical in Vitro Fertilization”,by Carl Wood (Author), Alan O. Trounson (Editor), 1989, ISBN 0387-1953-43

*”I.V.F. In Vitro Fertilisation”, by Professor Carl Wood and Robyn Riley,First published in 1983, New Edition, 1992, ISBN 0-85575-2126

*”Illustrated Textbook of Gynaecology”,By Eric Vincent Mackay, Norman A. Beischer, Roger J. He is very old and ugley. Pepperell, Carl Wood, 1992, ISBN 0729-5121-18

*”Gynaecological Operative Laparoscopy: Current Status and Future Development”, By Carl Wood, David J. Hill, Peter J. Maher, 1994, ISBN 0702-0186-94

*”Infertility: All Your Questions Answered”, By Gab Kovacs, Carl Wood, 1996, ISBN 0855-7226-30

*”Hysterectomy” By Carl Wood, Published 1997, ISBN 0702-0226-24

*”The Treatment of Fibroids”, By Carl Wood, 2000, ISBN 0855-7230-5X

*”Sexual Positions: An Australian View”, By Carl Wood, 2001, ISBN 0855-7231-49a

cool doodle

Adapted from the Wikipedia article Carl Wood, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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1985–98

Initially portrayed as quiet and caring, Ian Beale was too sensitive for his father Pete’s (Peter Dean) liking. Ian’s penchant for cooking displeased Pete so much that Ian took up boxing briefly in 1985, just to prove his masculinity.

From an early age, Ian got a keen interest in business. He began a short-lived knitting company (“Loftelian”) with his friends Kelvin Carpenter (Paul J. Medford) and Lofty Holloway (Tom Watt) in 1985, and in 1988, became partners with Barry Clark (Gary Hailes), running a mobile disco. After successfully graduating from catering college, Ian began working for Ali Osman (Nejdet Salih) in his café on Bridge Street, whilst hiring himself out as a private caterer on the side. He began to show signs of becoming a ruthless businessman when he lent his café bosses, Ali and Mehmet (Haluk Bilginer), money at interest to finance their gambling. When Ali could no longer afford the repayments, Ian secured ownership. Ian transformed the café from a “greasy spoon” to a slightly more upmarket establishment.

After several unsuccessful relationships in his teens – Sharon Watts (Letitia Dean), Tina Hopkins and his cousin, Elizabeth – Ian began dating Cindy Williams (Michelle Collins) in 1988. Cindy was attracted to Ian’s money-making capabilities. They got engaged in February 1989; however, Cindy then had a one-night-stand with her former lover Simon Wicks (Nick Berry) and their tryst left her pregnant. The prospect of fatherhood frightened Simon, so Cindy begrudgingly married Ian in October 1989 and pretended her baby was his.

The baby was born on Boxing Day 1989 – a boy named Steven. Simon developed paternal instincts for the child. Whilst Ian was busy building a successful business, Cindy and Simon rekindled their romance, and in August 1990, Cindy told Ian that Steven wasn’t his son. In a fury, Ian drove off and deliberately crashed his van in a suicide bid. While he lay in hospital, Cindy and Simon went to her mother’s house in Devon. Ian followed them and was unhinged to discover Cindy with Simon. A feud erupted between the Beales and the Wickses. Ian started a campaign for revenge. He employed Simon as a driver and tampered with his van’s brakes. This backfired when Ian discovered Simon was about to take Steven in the van with him. After the inevitable accident, it became clear that Ian was responsible, so Simon, Cindy and Steven left Walford in December 1990.

Ian immersed himself in his catering business, “The Meal Machine”, aided by Hattie Tavernier (Michelle Gayle), though his exploitative working practices alienated his friends, employees and family. An affair with his older employer, Ronnie Bains, did not last long, as he missed Cindy and Steven. Ian traced Cindy in 1992 and discovered she had been abandoned by Simon. Ian began wooing her and, despite hostilities from Ian’s mother Kathy (Gillian Taylforth) , they reconciled in 1993. Things did not go smoothly for the couple. Cindy attracted the attention of market inspector Richard Cole (Ian Reddington), who took her rejection badly and sought revenge — he got the Meal Machine shut down by environmental health, and later when Cindy fell pregnant, told everyone that he was the father. Ian was ready to believe the worst, but truth prevailed, and Ian was overjoyed when Cindy delivered twins, Peter and Lucy, in December 1993. 1994 saw Ian embark on a new business venture, operating as a loan shark, before deciding that being a usurer wasn’t for him, and opening a fish and chip shop. He became so obsessed with building his business empire and hounding Richard Cole out of the Square that he neglected Cindy. She found distraction elsewhere, embarking on two affairs, firstly with a lifeguard named Matt in 1994 and then with Simon’s brother, David Wicks (Michael French), in 1995.

By 1996, Cindy decided to leave Ian for David. David was uncertain but by now, Ian had become suspicious. He hired a private investigator to follow Cindy and was given a video of Cindy and David together. Ian took Cindy to court and was granted custody of their children – he blackmailed Cindy so she would agree to his terms. Cindy was forced to return to Ian so she could be near her kids. Unfortunately Ian made her life a misery, she decided to hire a hit man, John Valecue, who agreed to kill Ian for £1,500. A car pulled up alongside Ian and he was shot. Ian was only winged and recovered, but Cindy buckled under the pressure from the police and fled. She planned to snatch her children but she was unable to get to Lucy; Cindy was forced to leave without her. Ian was determined to retrieve his sons. He and investigator, Ros Thorne (Clare Grogan) — who Ian also had a fling with — traced Cindy to Italy in 1997 with Phil (Steve McFadden) and Grant Mitchell (Ross Kemp) in tow. Whilst Ian distracted Cindy, Grant and Phil snatched Peter and Steven. Cindy refused to give her children up, returning to Walford with her wealthy boyfriend Nick Holland. She took Ian to court for custody of the children and won. However, with Annie Palmer’s (Nadia Sawalha) help, the imprisoned hitman was persuaded to implicate Cindy in Ian’s attempted murder. Cindy, who was again pregnant, was jailed on remand, but died several months later in childbirth.

1999–2004

In 1998 Ian opened up a new bric-a-brac shop in Walford, employing Melanie Healy (Tamzin Outhwaite) to manage it. Melanie was drawn to Ian when she saw what a loving father he was. Their romance began in 1999 and Mel proposed in August, agreeing to Ian’s plans for a spectacular millennium wedding. However, while on holiday to Brighton, Mel slept with Steve Owen (Martin Kemp) and began to have second thoughts about marrying Ian.

However, Ian’s daughter, Lucy, was ill with suspected lymphoma, so Mel stuck by them. As the countdown to the millennium began, Mel realised that she was marrying Ian for the wrong reasons. Ian, guessing that Mel was trying to leave him, falsely told her that Lucy was dying to emotionally blackmail her into marriage – she had been given the all-clear. The ploy worked and Ian and Mel married in a joint wedding with Barry (Shaun Williamson) and Natalie Evans (Lucy Speed) on New Year’s Eve 1999. However, during their wedding reception, Mel found the letter giving Lucy the all-clear and left Ian as the clock struck midnight.

Ian threw himself into a new business venture: construction and renovation of high-market flats. He hired a new nanny, Laura Dunn (Hannah Waterman), to look after his children. She was attracted to Ian so he took advantage and began using her for sex. After months of a casual relationship, Laura began demanding more commitment. He initially refused but changed his mind after his latest business venture left him bankrupt. Laura stood by him, raising the money to buy back the fish and chip shop and, in April 2001, Ian proposed. Despite initial fears that Ian only wanted her money, Laura accepted and they married in May.

They were happy for a while, but their marriage began to deteriorate after Laura found out that Ian had tried to kiss Mel. With Laura asserting herself as boss of the businesses, Ian felt worthless and belittled. When Laura said she wanted a baby, Ian refused, feeling three children was enough. Regular arguments followed so Ian started visiting local prostitute, Janine Butcher (Charlie Brooks), to escape Laura’s nagging. This backfired when Janine started blackmailing Ian. Laura discovered the truth from Ian’s son, Steven, who saw Ian and Janine together, told Laura, and then moved to New Zealand to live with his biological father, Simon Wicks.

Laura forgave Ian, providing they could have a baby. He agreed but secretly had a vasectomy, telling the doctor that he was a widower. However, when Laura fell pregnant, later that year, Ian threw her out on Christmas Day 2002. He was so sure that her child wasn’t his that he conned her into signing over control of their businesses. Laura had no choice but to turn to the man she thought was the father, Garry Hobbs (Garry Hobbs). In 2003, Laura gave birth to a son, Bobby. Baby Bobby was sickly and needed a blood transfusion. Laura’s blood was incompatible so she asked Garry but his blood was incompatible too, meaning he wasn’t Bobby’s father. Laura realised then that Ian had to be but kept this information to herself. Laura and Ian’s feud continued until Laura’s death in 2004 — she broke her neck after falling down the stairs. Pat Evans (Pam St. Clement) found Bobby’s birth certificate which named Ian as the true father — Ian’s vasectomy had worked but he was told not to have sex for six weeks so the procedure would have time to work. Not wanting to make Laura suspicious, he ignored this and Laura got pregnant. Bobby moved in with Ian shortly before his first birthday.

2005—

Ian’s most notable feud has been with Phil Mitchell. Their long-standing rivalry began in 1995, when Phil flushed Ian’s head down the toilet and then married his mother, destroying her life with abuse and alcoholism. Various vengeful tricks were played. Phil delighted in making Ian beg for a loan and then refused, leaving him bankrupt in 2000. Animosity escalated in 2001 after it was revealed that Ian had discovered Phil’s wounded body and left him to die. Later, in April 2005, Ian tricked Phil into thinking he was helping him escape from police, but had him arrested instead. When he was released, Phil got revenge on Ian by bullying him into relinquishing ownership of his auto mechanic business (The Arches) — Ian had bought it off Phil’s sister Sam for a pittance a year earlier.

After Kathy’s death in 2006, Ian brought his half brother Ben to live with him and a custody battle ensued between him and Ben’s father, Phil. Despite continuous meddling from Ian, Ben eventually opted to live with Phil. Following escalation of conflict in April 2007, Ian and Phil were persuaded to call a reluctant truce. They took their children camping, which ended in disaster after Phil crashed their car whilst arguing with Ian. The car rolled down a hill with Ben and Peter inside and crashed into a lake; it was left to Phil to dive in and save the drowning boys. Ian and Phil appeared to make peace after this, though it was short-lived.

Adapted from the Wikipedia article Ian Beale, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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