Issues in second trimester induced abortion (medical/surgical methods)

Second trimester abortion remains a common procedure worldwide. Dilatation and evacuation (D&E) is the surgical method of choice, if the surgical expertise and facilities are available. Adequate cervical dilatation preoperatively is a prerequisite for a safe D&E. Medical abortion using misoprostol together with mifepristone is the medical method of choice. The recommended regimen is 200 mg mifepristone followed by 800 μg of vaginal misoprostol 36-48 h later. Subsequent doses of 400 μg of misoprostol can be given orally every 3 h up to a maximum of four more doses. Proper preoperative assessment would not only help to provide safe abortion treatment, but it also guides the choice of method. If the expertise and facilities of both methods are available, both methods should be discussed and offered to the patient so that the patient can make an informed choice. © 2010 Elsevier Ltd. All rights reserved.postprin

Male infertility

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Womens knowledge of and attitudes towards emergency contraception in Hong Kong: questionnaire survey

OBJECTIVE. To study the level of knowledge of and attitude towards emergency contraception in a group of women requesting the termination of pregnancy. DESIGN. Structured questionnaire survey. SETTING. Family Planning Association and university teaching hospital, Hong Kong. PARTICIPANTS. Two hundred women who requested the termination of an unplanned pregnancy between May 1997 and March 1998. MAIN OUTCOME MEASURES. Demographic data, basic knowledge of contraception, reasons for terminating the pregnancy, and knowledge and usage of emergency contraception. RESULTS. A sustantial proportion (33.0%) of women was ignorant of the existence of emergency contraception. Only 10.0% of women had used emergency contraception before and only 2.5% had used it in an attempt to prevent this pregnancy. Of the 134 women who knew about emergency contraception, the main reason (41.8%) for not using it was risk-taking behaviour. More nulliparous women (88.5% versus 57.6%; P<0.001) and women younger than 20 years (84.0% versus 61.3%; P<0.01) had heard of emergency contraception. Women who were educated beyond secondary school level (71.0% versus 37.5%; P<0.01) and unmarried women compared with married, cohabiting, or divorced women (87.1% versus 49.5%; P<0.001) were also more likely to have heard of emergency contraception. Women younger than 20 years were more likely to have used this form of birth control in the past (18.0% versus 7.3%; P<0.05). CONCLUSION. There is a need to improve women's education about emergency contraception in Hong Kong.published_or_final_versio

Olfactomedin1 (Olfm1) in fallopian tube may modulate tubal ectopic pregnancy in humans: evidence from Immunohistochemistry and an in vitro coculture model

Conference Theme: The Intersection Between Genetics, Genomics, and Reproductive BiologyOlfactomedins are secretary glycoprotein constituted in the extracellular matrix (ECM) of various cell types. Recent studies suggested that Olfm-1 is down-regulated during the window of implantation (WOI) in the human endometrium and up-regulated in pathological condition like endometriosis and recurrent spontaneous abortions. Ectopic pregnancy is a gynaecological emergency and fertility threatening phenomenon which occurs in 1-2% of normal pregnancies and shows an increasing trend. Yet, tubal ectopic pregnancy accounts for more than 98% of the cases ...postprintThe 43rd Annual Meeting of the Society for the Study of Preproduction (SSR), Milwaukee, WI., 30 July-3 August 2010. In Biology of Reproduction, 2010, v. 83 n. Meeting abstracts, p. 27-28, abstract no. 13

The efficacy of extracorporeal shock wave lithotripsy in the treatment of ureteric stones

This study was conducted to evaluate the efficacy of in situ extracorporeal shock wave lithotripsy treatment of ureteric stones using the Dornier MFL 5000 lithotripter. From March 1991 to June 1994, 184 patients received in situ extracorporeal shock wave lithotripsy treatment. The overall success rate was 76% (77% for upper; 69% for middle; and 81% for lower ureteric stones, respectively). The level and size of the stones did not affect the final outcome significantly. An average of 1.23 sessions were required for each patient and the rate of major auxiliary intervention was 21%. We conclude that extracorporeal shock wave lithotripsy is an effective treatment for ureteric stones.published_or_final_versio

Pharmacokinetics of repeated doses of misoprostol

BACKGROUNDMisoprostol is widely used in obstetrics and gynaecology for medical abortion, cervical priming and induction of labour. To aid the design of effective and safe regimens, we have investigated the pharmacokinetic parameters after the vaginal or sublingual administration of repeated doses of 400 g of misoprostol.METHODSWomen undergoing termination of pregnancy by suction evacuation were randomized to receive 400 g of sublingual or vaginal misoprostol every 3 h for five doses. Venous blood was taken at 180, 200, 240, 360, 380, 420, 540, 560, 600, 720, 740, 780 and 900 min after the first dose of misoprostol for determination of the plasma level of misoprostol acid (MPA).RESULTSThe peak plasma levels of MPA decreased with successive doses of vaginal misoprostol, whereas the peak plasma levels were similar with successive doses of sublingual misoprostol. After the third dose, the peak plasma levels of MPA after sublingual misoprostol were significantly higher than those after vaginal administration. After the final dose, the area under the MPA concentration-time curve after sublingual administration was significantly higher than that after vaginal misoprostol (P < 0.031). However, subgroup analysis in the vaginal administration group showed that the progressive decline in the peak plasma levels of MPA occurred only in women with significant vaginal bleeding.CONCLUSIONSThe peak plasma level of MPA after each dose of misoprostol is higher and the bioavailability is also greater after sublingual administration, compared with that after vaginal administration, of repeated doses of misoprostol. The difference was probably due to the reduction in absorption of vaginal misoprostol in the presence of significant vaginal bleeding.postprin

Adipocyte fatty acid binding protein potentiates toxic lipids-induced endoplasmic reticulum stress via its inhibition of autophagy

Oral PresentationINTRODUCTION: Chronic inflammation is the key link between obesity and its related cardio-metabolic complications. Endoplasmic reticulum (ER) stress is the potent trigger of inflammation in obese adipose tissue. However, the mechanism that links ER stress with inflammation is unclear. Adipocyte fatty acid binding protein (A-FABP) has been shown to ...published_or_final_versionThe 17th Medicial Research Conference, Department of Medicine, The University of Hong Kong, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 n. 1, suppl. 1, p. 25, abstract no. 2

Management of ureteric calculi: the pendulum swings

Extracorporeal shock wave lithotripsy (ESWL) for treatment of ureteral calculi has gained wide popularity because of its non-invasive and ambulatory nature. The success rate using the Dornier MFL 5000 is about 77%, but retreatment is often required and stone clearance is gradual. Ureteroscopic lithotripsy (URSL) used to be performed as an in-patient procedure. With the introduction of Holmium laser and establishment of day surgery service, out-patient URSL carries a success rate of 93% and offers immediate stone clearance. It is an attractive alternative for low surgical risk patients as a primary treatment modality.published_or_final_versio

Effect of Variable Selection Strategy on the Performance of Prognostic Models When Using Multiple Imputation

BACKGROUND: Variable selection is an important issue when developing prognostic models. Missing data occur frequently in clinical research. Multiple imputation is increasingly used to address the presence of missing data in clinical research. The effect of different variable selection strategies with multiply imputed data on the external performance of derived prognostic models has not been well examined. METHODS AND RESULTS: We used backward variable selection with 9 different ways to handle multiply imputed data in a derivation sample to develop logistic regression models for predicting death within 1 year of hospitalization with an acute myocardial infarction. We assessed the prognostic accuracy of each derived model in a temporally distinct validation sample. The derivation and validation samples consisted of 11524 patients hospitalized between 1999 and 2001 and 7889 patients hospitalized between 2004 and 2005, respectively. We considered 41 candidate predictor variables. Missing data occurred frequently, with only 13% of patients in the derivation sample and 31% of patients in the validation sample having complete data. Regardless of the significance level for variable selection, the prognostic model developed using only the complete cases in the derivation sample had substantially worse performance in the validation sample than did the models for which variables were selected using the multiply imputed versions of the derivation sample. The other 8 approaches to handling multiply imputed data resulted in prognostic models with performance similar to one another. CONCLUSIONS: Ignoring missing data and using only subjects with complete data can result in the derivation of prognostic models with poor performance. Multiple imputation should be used to account for missing data when developing prognostic models

Management and outcome of antenatally diagnosed congenital cystic adenomatoid malformation of the lung

Objective: To review the management and outcome of babies with antenatally diagnosed congenital cystic adenomatoid malformation. Design: Retrospective cohort review. Setting: Tertiary neonatal care unit at Queen Mary Hospital and antenatal diagnostic centre at Tsan Yuk Hospital. Patients: Consecutive patients with antenatally suspected congenital cystic adenomatoid malformation in their concepti among antenatal patients attending Tsan Yuk Hospital from 1994 to 2002. Twenty-four of 33 cases were referred to Queen Mary Hospital for postnatal management and for whom comprehensive records were available for analysis in 23. Interventions: Postnatal interventions in their babies included investigational imaging for congenital cystic adenomatoid malformation and surgery. Main outcome measures: Antenatal and postnatal outcome, as well as pathology of the excised lesions. Results: Antenatal outcome: termination of pregnancy in two cases and spontaneous abortion in one; in-utero regression was documented in nine cases and in one hydropic change was apparent. Postnatal outcome: only eight of 20 babies born alive had symptoms in neonatal period. Two developed serious infective complications in infancy, one with documented in-utero regression. Pulmonary parenchymal abnormalities were detected on computed tomography of the thorax in six of seven cases with normal or non-specific chest radiograph findings. Among nine cases with in-utero regression, congenital cystic adenomatoid malformation was confirmed by operative histology in five and abnormal computed tomography findings in three. Fifteen babies underwent surgical excision, one of whom died because of severe pre-existing pulmonary hypoplasia and nine endured minor postoperative complications. A favourable outcome was documented at a mean follow-up of 22 months (range, 2 months-7 years). Conclusions: In-utero regression of congenital cystic adenomatoid malformation on antenatal ultrasound may not represent genuine resolution. Computed tomographic thorax should be considered in all newborns with antenatally diagnosed congenital cystic adenomatoid malformation, and if confirmed early operation before first hospital discharge is recommended.published_or_final_versio