Audit of IV access sites in Medical Ward Patients

Abstract no. 24published_or_final_versio

An open and randomized study comparing the efficacy of standard danazol and modified triptorelin regimens for postoperative disease management of moderate to severe endometriosis

Objective To compare the efficacy of danazol and triptorelin (Decapeptyl CR, Ferring, Kiel, Germany) in the management of moderate and severe endometriosis in terms of symptom control and revised American Fertility Society (AFS) score reduction, and to evaluate the hormonal profile of patients treated with triptorelin every 6 weeks. Design Open and randomized trial. Setting Kwong Wah Hospital, a large public hospital in an urban location (Hong Kong). Patient(s) Forty patients after their first conservative operation for endometriosis, with surgical confirmation of revised AFS stage III or IV endometriosis. Intervention(s) Postoperative 6 months' therapy of danazol or triptorelin every 6 weeks, postmedical therapy second-look laparoscopy. Main outcome measure(s) Symptom control and patients' tolerance during medical therapy, posttherapy revised AFS score, hormonal profile during triptorelin therapy. Result(s) Pain control was similar between danazol and triptorelin therapy. There was less breakthrough bleeding with triptorelin. More patients failed to complete the whole course of danazol because of its side effects. The revised AFS score at second-look laparoscopy did not show a significant difference between the two medications. Adequate pituitary suppression was observed with injection of triptorelin every 6 weeks. Conclusion(s): Lengthening of triptorelin administration intervals from 4 weeks to 6 weeks is effective in maintaining a hypoestrogenic state. Patients were more compliant with triptorelin than danazol. Thus, triptorelin injection every 6 weeks is more cost-effective than conventional regimens. © 2004 by American Society for Reproductive Medicine.link_to_subscribed_fulltex

Stepwise pain score analysis of the effect of local lignocaine on outpatient hysteroscopy: A randomized, double-blind, placebo-controlled trial

Objective: To assess the efficacy of lignocaine gel in reducing the overall pain and pain of individual steps during outpatient hysteroscopy in comparison with placebo (no anesthesia). Design: A prospective, randomized, double-blind, placebo-controlled trial. Setting: Outpatient hysteroscopy clinic in a regional hospital in Hong Kong. Patient(s): A total of 500 Chinese patients undergoing outpatient hysteroscopy. Intervention(s): Application of lignocaine gel to the cervix during outpatient hysteroscopy. Main Outcome Measure(s): Mean pain score using present pain intensity, overall pain score measured by total area under the curve, and the pain score of individual steps in the procedure in patients receiving lignocaine gel were compared with those of patients having no anesthesia. The failure rate and poor-view rate in both groups were also compared. Result(s): There were no statistically significant differences in mean pain score, overall pain score, and pain score of individual steps between the lignocaine group and controls. The failure rate and poor-view rate also showed no statistically significant differences. Conclusion(s): Outpatient hysteroscopy without anesthesia is acceptable to most Chinese women, and the local application of lignocaine gel is not effective in reducing pain. (C) 2000 by American Society for Reproductive Medicine.link_to_subscribed_fulltex

Findings in women with postmenopausal bleeding investigated with hysteroscopy

Most reports on histopatological findings of postmenopausal bleeding were published before hysteroscopy was widely used. Recent studies have shown that hysteroscopic examination is better than dilatation and curettage alone in detecting intrauterine pathology. The aim of this study is to assess histopathological findings of patients presented with postmenopausal bleeding after incorporation of hysteroscopic examination. Between 1 January 1996 and 31 December 1996, a total of 199 consecutive patients presenting with postmenopausal bleeding to a regional hospital were reviewed. Patients were investigated with cervical biopsy, endometrial aspiration or hysteroscopy and curettage. Excluding patients who had hysterectomy and cervical cancer, 97% of the patients had hysteroscopic examination. The majority of patients with postmenopausal bleeding had atrophic vaginitis and/or atrophic endometrium (58.8%). Other common diagnoses were endometrial polyp (9.4%), endometrial carcinoma (9.4%) and carcinoma of the cervix (6%). Other diagnoses included submucous fibroid, endometrial hyperplasia, pyometra, ovarian cancer and urethral caruncle. Pathologies found were similar to early reports, except that incidences of submucous fibroids and endometrial polyps were higher (13.4%). We concluded that all patients with postmenopausal bleeding should be investigated thoroughly as 22% have significant pathology. Hysteroscopy is the preferred investigation because of high incidences of endometrial polyps and submucous fibroids.link_to_subscribed_fulltex

Second trimester pregnancy termination using gemeprost

A retrospective study of 72 second trimester pregnancy terminations using gemeprost vaginal pessary is reported. The success rate with this method of induced abortion was 93%. The mean induction to abortion interval was 12.6 hours. Minor side-effects such as fever, vomiting and diarrhoea occurred in 46%, 10%, and 18% of patients, respectively. Major complications were uncommon. One patient had blood loss of more than 500 ml and one patient had genital tract trauma. It is our experience that gemeprost is a safe and efficient method for effecting a second trimester termination.link_to_subscribed_fulltex

Season distribution of ectopic pregnancy

We analysed the records for 464 consecutive patients with histologically documented ectopic pregnancy during a 9-year period in Hong Kong and found a seasonal pattern. There was a statistically significant increase in the likelihood of conceptions during the summer months (June-September) resulting in ectopic pregnancies as compared with the winter months (October-February) (p ≤ 0.02). No such difference was observed when conception occurred in other seasons.link_to_subscribed_fulltex

Season distribution of ectopic pregnancy

We analysed the records for 464 consecutive patients with histologically documented ectopic pregnancy during a 9-year period in Hong Kong and found a seasonal pattern. There was a statistically significant increase in the likelihood of conceptions during the summer months (June-September) resulting in ectopic pregnancies as compared with the winter months (October-February) (p ≤ 0.02). No such difference was observed when conception occurred in other seasons.link_to_subscribed_fulltex

Levonorgestrel-releasing intrauterine system (Mirena®) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: A randomised controlled trial

Background: Progestogen therapy has been found to be useful in controlling endometriosis. For patients after conservative surgery, long-term medical maintenance therapy should be sought to prevent recurrence and control symptoms. Levonorgestrel-releasing intrauterine system (LNG-IUS) may be a useful form of prolonged progestogen therapy for endometriosis. Aims: To evaluate and compare the efficacy and safety of LNG-IUS to depot medroxyprogesterone acetate (MPA) for patients with moderate or severe endometriosis following conservative surgery, in terms of symptoms control, recurrence prevention and patients' acceptance. Methods: A total of 30 patients after conservative surgery for endometriosis underwent randomisation. Of these patients, 15 received LNG-IUS and 15 had three-monthly depot MPA for three years. Their symptom control, recurrence, compliance and change in bone mineral density (BMD) were compared. The data were analysed using student's t-test and chi-square test. Results: Symptoms and recurrence were controlled by both therapies. The compliance was better in LNG-IUS Group with 13 patients staying on their therapy versus seven patients in Depot MPA Group. LNG-IUS users had a significantly better change in BMD (+0.023, +0.071 g/cm2) than Depot MPA users (-0.030, -0.017 g/cm2) in both hip and lumbar regions. Conclusions: Levonorgestrel-releasing intrauterine system was effective in symptom control and prevention of recurrence. LNG-IUS users showed a better compliance. After three years, bone gain was noted with LNG-IUS, but bone loss with depot MPA. © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.link_to_subscribed_fulltex

Omental trophoblastic implantation following laparoscopic salpingostomy for tubal pregnancy

A case is presented in which laparoscopic salpingostomy was performed for unruptured tubal pregnancy. The patient remained well with falling hCG levels until 41 days later, when she developed acute abdominal pain. Laparotomy confirmed haemoperitoneum as a result of haemorrhage from implantation of trophoblastic tissue on the omentum. This case report highlights the potential risk of residual gestational products in sites other than the fallopian tube and the fact that hCG monitoring after the initial operation may not fully guarantee complete clearance.link_to_subscribed_fulltex

Use of fetal-pelvic index in the prediction of vaginal birth following previous cesarean section

Aim: To clarify the usefulness of the fetal-pelvic index as a predictor of vaginal birth after previous lower segment cesarean section. Methods: One hundred and seventy women with one lower segment cesarean section who attempted for trial of vaginal birth were enrolled. Pelvimetry was performed to measure maternal pelvic inlet and mid-cavity circumferences at 37 weeks gestation. Ultrasound was performed to measure fetal head and abdominal circumferences at 38-39 weeks. The fetal-pelvic index was derived. The predictability of fetal-pelvic index in the predicting the outcome of delivery was calculated. Results: Fifty-seven (33.5%) women required repeated cesarean section and 113 (66.5%) delivered vaginally. Twenty-two women with positive fetal-pelvic index had repeated cesarean section. The predictability of positive fetal-pelvic index was 48.9%. Ninety of the 125 patients with a negative fetal-pelvic index delivered vaginally. The predictability of negative fetal-pelvic index was 72.0%. Conclusions: Fetal-pelvic index derived in the antenatal period has low predictive value in predicting of successful vaginal birth after cesa-rean section. This index is not useful in clinical practice.link_to_subscribed_fulltex