The VALUE national hysterectomy study: description of the patients and their surgery.

OBJECTIVES: To describe hysterectomies practised in 1994 and 1995: the patients, their surgery and short term outcomes. DESIGN: One of two large cohorts, with prospective follow up, recruited to compare the outcomes of endometrial destruction with those of hysterectomy. SETTING: England, Wales and Northern Ireland. POPULATION: All women who had hysterectomies for non-malignant indications carried out during a 12-month period. METHODS: Gynaecologists in NHS and independent hospitals were asked to report cases. Follow up data were obtained at outpatient follow up approximately six weeks post-surgery. MAIN OUTCOME MEASURES: Indication for surgery, method of hysterectomy, ovarian status post-surgery, surgical complications. RESULTS: 37,298 cases were reported which is estimated to reflect about 45% of hysterectomies performed during the period studied. The median age was 45 years, and the most common indication for surgery was dysfunctional uterine bleeding (46%). Most hysterectomies were carried out by consultants (55%). The proportions of women having abdominal, vaginal or laparoscopically-assisted hysterectomy were 67%, 30% and 3%, respectively. Forty-three percent of women had no ovaries conserved after surgery. The median length of stay was five days. The overall operative complication rate was 3.5%, and highest for the laparoscopic techniques. The overall post-operative complication rate was 9%. One percent of these was regarded as severe, with the highest rate for severe in the laparoscopic group (2%). There were no operative deaths; 14 deaths were reported within the six-week post-operative period: a crude mortality rate soon after surgery of 0.38 per thousand (95% CI 0.25-0.64). CONCLUSIONS: This large study describes women who undergo hysterectomy in the UK, and presents results on early complications associated with the surgery. Operative complications occurred in one in 30 women, and post-operative complications in at least one in 10. Laparoscopic techniques tend to be associated with higher complication rates than other methods

Early child health in Lahore, Pakistan: II. Inbreeding

The prevalence of consanguineous marriages was studied in 940 families belonging to four different socio-economic groups in and around Lahore, Pakistan. The births occurring in these families from September 1984 to March 1987 were also investigated for birth defects. The overall prevalence of consanguineous marriages was 46%. The first cousin marriages were most common (67%), followed by the marriages between second cousins, 19%. The prevalence of consanguineous marriages was clearly associated with the socio-economic status of the study groups; 50% of the marriages was related in the periurban slum, 49% in the village, 44% in the urban slum and 31% in the upper middle class. The birth defects were also more prevalent in the poorer areas, being highest in the periurban slum (17.7%) followed by the urban slum (15.6%) and then the village (14.8%) and lowest in the upper middle class (12.3%). Although, the frequency of both consanguinity and birth defects were related with the socio-economic levels of the study groups, there was no association between inbreeding and birth defects. Perhaps, deleterious recessive genes for birth defects have been 'bred out', because of continuous inbreeding over generations in this population. There was a significant predilection of major birth defects in boys without clear sex linkage. The conclusion is that the rate of consanguineous marriages was high, especially in the poorer areas, but the relationship between consanguineous marriages and birth defects was little or none. However, other child health indicators may be affected by consanguineous marriages.link_to_subscribed_fulltex

Achados audiológicos em crianças com fenilcetonúria Audiologic findings in children with phenylketonuria

OBJETIVO: Investigar a existência de alterações na audição de crianças com fenilcetonúria diagnosticadas e tratadas precocemente e comparar os resultados com os encontrados nas avaliações auditivas de crianças normais de mesma idade. MÉTODOS: Foram realizadas imitanciometria e audiometria tonal e vocal em 63 crianças, sendo 30 no grupo controle, com média de idade de 8,1 anos, e 33 com fenilcetonúria no grupo de estudo, com média de idade de 7,7 anos. O grupo de estudo foi subdividido em 15 crianças com controle adequado da dieta e 18 crianças com controle inadequado da dieta, com médias de idade 8,1 e 7,2, respectivamente. A análise estatística utilizou o Teste t ou ANOVA. RESULTADOS: A audiometria revelou 83,3% de crianças com audição normal no grupo controle e 16,7% de perdas auditivas condutivas uni ou bilaterais. No grupo com fenilcetonúria, 66,7% das crianças apresentaram audição normal e 33,3% com perdas auditivas condutivas. Na imitanciometria, observou-se curvas normais em 91,7% das crianças do grupo controle e em 72,7% das crianças do grupo com fenilcetonúria. Houve diferença na comparação entre grupos para limiares aéreos, reflexos estapedianos, limiares de recepção da fala e índice de reconhecimento de fala. Não foi observada diferença entre os resultados das avaliações auditivas de crianças fenilcetonúricas com dieta adequada e inadequada. CONCLUSÃO: As crianças com fenilcetonúria diagnosticadas e tratadas precocemente apresentaram piores limiares de audibilidade por via aérea, limiares de recepção de fala e índice de reconhecimento de fala evidenciados à audiometria tonal e vocal, quando comparadas com crianças normais.<br>PURPOSE: To investigate the existence of hearing impairments in infants with phenylketonuria with early diagnose and treatment, and to compare the audiological findings with those of their normal peers. METHODS: Vocal and pure-tone audiometry and acoustic immitance tests were conducted in 63 children, 30 from a control group, with mean age of 8.1 years, and 33 from a study group, with phenylketonuria and mean age of 7.7 years. The study group was subdivided according to diet control: 15 subjects had adequate (mean age of 8.1 years) and 18 had inadequate diet control (mean age 7.2 years). Statistical analysis used t-test or ANOVA. RESULTS: Audiometry showed that, in the control group, 83.3% of the subjects had normal hearing, and 16.7% had uni- or bilateral conductive hearing loss. In the study group, 66.7% of the subjects presented normal hearing, and 33.3% had conductive hearing loss. Immitance measures showed normal results in 91.7% of the children from the control group, and in 72.7% of the subjects with phenylketonuria. Differences were found between the groups regarding hearing thresholds, acoustic reflexes, speech reception thresholds, and speech recognition. No differences were observed between the results of phenylketonuria subjects with adequate and inadequate diets. CONCLUSION: Children with phenylketonuria early diagnosed and treated presented worse conductive hearing thresholds, speech reception threshold and speech recognition when compared to their normal peers, as evidenced in pure-tone and vocal audiometry