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Biomedical subjects

A L Magos

Publications and source records attributed to A L Magos.

At least 55 records · Page 3Linked to original sources
PubMed1991

Experience with the first 250 endometrial resections for menorrhagia.

234 patients with menorrhagia were treated hysteroscopically by transcervical resection of the endometrium (TCRE) instead of hysterectomy. 250 procedures were performed under general anaesthesia (63%) or under sedation plus local anaesthesia (38%). The endometrium was excised either totally (91%) or partially (9%) in all but one case, and 56 (22%) of the patients underwent simultaneous resection of submucous fibroids. Surgical time (range 10-100 min) varied with the gynaecologist's experience. 479 ml was the average volume of uterine irrigant absorbed by the patient. Blood loss was usually slight. Operative complications were uncommon, but 4 (2%) women sustained a uterine perforation (without serious sequelae), 7 (3%) absorbed more than 2 litres of fluid, and 1 required tamponade to control postoperative bleeding. Hospital stay was short and full recovery usual by 1-2 weeks. Menstrual symptoms improved in over 90% of the patients throughout the follow-up of up to 2 1/2 years; 27-42% of the women became amenorrhoeic at some time after total TCRE. Results were best in women greater than 35 years of age, but was not influenced by the presence of fibroids or pretreatment dysmenorrhoea. 10 (4%) women later underwent hysterectomy. Hysteroscopy 3 and 12 months after surgery revealed a small, fibrotic uterine cavity in the majority.

Adolescent↗
PubMed1991

Prospective comparison of videopelviscopy with laparotomy for ectopic pregnancy.

OBJECTIVE: To compare operative laparoscopy with laparotomy for the management of ectopic pregnancy in haemodynamically stable women. DESIGN: Non-randomized prospective cohort study, treatment allocation depending on the surgical preference and experience of the on-call medical team. SETTING: Provincial undergraduate teaching hospital. SUBJECTS: 87 consecutive and unselected haemodynamically stable women treated for ectopic pregnancy between 1 March 1988 and 31 August 1989. INTERVENTIONS: Salpingotomy, salpingectomy, salpingo-oophorectomy or simple extraction of the ectopic pregnancy depending on its site, size and nature performed under laparoscopic control or laparotomy. MAIN OUTCOME MEASURES: Operative outcome, duration of surgery, intra- and post-operative complications, post-operative hospital stay, return to normal domestic activities, return to work, changes in plasma beta-hCG concentrations, health and social service costs. RESULTS: 60 women were treated by videopelviscopy on 65 occasions and the other 27 were treated by laparotomy. The two groups were similar for age, parity and gestation at presentation. Of the 65 operative laparoscopies 61 (94%) were successful and all 27 laparotomies were completed uneventfully. Whereas the operating time was similar in the two groups, 55.3 and 51.1 min for videopelviscopy and laparotomy respectively, operative laparoscopy was associated with significantly shorter post-operative hospital stay (1.7 vs 5.2 days), faster return to domestic activities (1.5 vs 3.3 weeks) and work (2.5 vs 5.7 weeks) (P less than 0.001 for all). In economic terms, successful videopelviscopy was associated with a reduction in hospital accommodation costs by 69% (248 pounds vs 808 pounds), drug costs by 52% (8.38 pounds vs 17.57 pounds) and statutory sickness payment by 51% (130.25 pounds vs 266.51 pounds), that is an overall saving to the health and social services of 701.47 pounds or 50% per ectopic pregnancy (P less than 0.001). CONCLUSIONS: Operative laparoscopy can be used to successfully treat most cases of extrauterine pregnancy with advantages over laparoscopy in terms of reduced hospitalization, faster recovery and lower health service costs.

Cost-Benefit Analysis↗
PubMed1989

Managing gynaecological emergencies with laparoscopy.

A consecutive series of 49 women (50 procedures), whose conditions were haemodynamically stable, presenting with acute lower abdominal pain, pelvic tenderness, and either a urine concentration of greater than 50 U/l beta human chorionic gonadotrophin or a pelvic mass shown by ultrasonography were treated with operative laparoscopy under video monitoring (videopelviscopy) as an alternative to laparotomy. Ectopic pregnancy, ovarian and non-ovarian cysts, pelvic adhesions, endometriosis, and fibroids were found, for which salpingotomy, salpingectomy and salpingo-oophorectomy, cystectomy, adhesiolysis, thermocoagulation, and myomectomy were carried out by laparoscopy. In one patient pelviscopy was repeated because of persistent tubal pregnancy after the fimbria was expressed. Laparotomies were carried out on three patients because treatment was not possible by laparoscopy and on a further patient two days after adhesiolysis had been attempted. These were the only serious complications. For the 46 cases (45 patients) in which operative laparoscopy was successful the mean stay in hospital was 1.9 days after operation, and this group of patients returned to normal activities and to work after an average of 2.3 and 2.6 weeks respectively. Most gynaecological emergencies that are managed by laparotomy can be treated by laparoscopy and benefit both patients and the health service.

Adult↗
PubMed1989

Transcervical resection of endometrium in women with menorrhagia.

As an alternative to hysterectomy 16 women with menorrhagia were treated with hysteroscopic transcervical resection of the endometrium with an unmodified urological resectoscope. Twelve patients requested total resection of the endometrial lining with the intention of producing amenorrhoea, and four chose partial resection and hypomenorrhoea. Surgery was completed successfully in 15; the remaining woman, who had an acutely retroflexed uterus, sustained a uterine perforation during insertion of the rigid hysteroscope. There were no important postoperative complications, and 13 patients were discharged from hospital the day after operation. Follow up for up to six months showed beneficial effects on the duration of menses and the subjective assessment of menstrual blood loss and pain in the treated women, six of them becoming amenorrhoeic after total resection. Hysteroscopy at three months in 13 patients showed fibrosis confined to the upper half of the uterine cavity. Endouterine biopsy specimens showed the presence of microscopic deposits of normal endometrium in 10 women. Although these results are preliminary, transcervical resection of the endometrium may have an important role in managing this common complaint.

Adult↗
PubMed1989

The development of laparoscopic surgery.

For centuries people have been trying to look inside the abdomen but it is only relatively recently that the technology has been available to make this a meaningful possibility. Major milestones have included safe peritoneal insufflation, cold-light illumination, laparoscopes with the rod lens system, instruments for the safe manipulation of pelvic organs, techniques to ensure haemostasis, laser, video monitoring and most recently double-optic laparoscopy. As a result, the indications for gynaecological laparoscopy have been greatly extended from its initial use as a diagnostic aid or a means of female sterilization, and procedures such as adhesiolysis, ovarian cystectomy, tubal surgery for infertility or ectopic pregnancy, excision of endometriosis and even myomectomy are now possible without open surgery. Well-defined safety guidelines must of course be adhered to and proper training is essential in the various techniques, but the medical, financial and social advantages are such that we owe it to our patients to exploit the full potential of this new mode of management.

Female↗
PubMed1989

Characterisation of cyclical symptoms.

The ovarian cycle has a fundamental effect on the lives of women, both in health and disease. Although the mechanism for this is presently unknown, the continuing study of the cycle will produce greater understanding.

Female↗
PubMed1988

A simple method for the diagnosis of premenstrual syndrome by use of a self-assessment disk.

A diagnostic disk based on the obstetric calculator was developed for the self-assessment of menstrual cycle symptoms. The instrument, called the PMT-Cator (Rocket of London, Watford, England) can be used to monitor five symptoms for up to 6 weeks. A set of simple calculations are described inside the disk to determine whether the symptom scores are suggestive of premenstrual syndrome. Results of the PMT-Cator correlate well with those of more complex analysis. The PMT-Cator may have other uses as well.

Female↗
PubMed1988

Effects and analysis of the menstrual cycle.

The menstrual cycle is much more than a cycle of periods. Menstruation is only one manifestation of the ovarian cycle which is itself associated with more than 200 physical, psychological and behavioural changes. Numerous medical disorders also appear to be modulated by cyclical ovarian activity. Objective assessment of these cyclical changes can be difficult. One approach is by trend analysis, which can be used to provide both qualitative and quantitative information concerning daily menstrual cycle data. The application of this technique to the assessment of menstrual cycle symptoms and the premenstrual syndrome are demonstrated.

Adult↗
PubMed1987

Effects of subcutaneous oestradiol implants on ovarian activity.

The effects of subcutaneous oestradiol implants on ovarian activity were investigated in 14 ovulating premenopausal women. Treatment with either 100 mg or 150 mg oestradiol was combined with cyclical oral norethisterone from days 20 to 26 of the cycle to ensure regular withdrawal periods and prevent endometrial hyperplasia. Ovarian function was monitored by regular pelvic ultrasonography and urinalysis over a period of nine cycles. During the first three cycles after hormone implantation, follicular development continued in almost half the study group, but only one of the women in each treatment group showed signs of follicular rupture and luteinization. By the sixth cycle, over half the women given the lower dose of oestradiol were developing follicles, including a large functional cyst in one, but none of them ovulated. A further implant given early in the seventh cycle was associated with ovarian suppression in all cases. Both doses of implant elevated the excretion of oestrone-3-glucuronide compared to pretreatment. The contraceptive and therapeutic implications of these results are discussed.

Adult↗
PubMed1987

Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement.

The thigh skin collagen content and the metacarpal index were measured in 69 untreated postmenopausal women and in 37 postmenopausal women who had been receiving oestradiol and testosterone implants for 2-10 years. There was a significant positive correlation between the skin collagen content and the metacarpal index in both groups of patients. In the untreated group, there was a statistically significant decrease both in the thigh skin collagen content and in the metacarpal index with the years since the menopause. This decrease was preventable in women who were on sex hormone replacement therapy.

Collagen↗
PubMed1987

Response of skin thickness and metacarpal index to estradiol therapy in postmenopausal women.

A radiologic method for measuring skin thickness and metacarpal index was used to investigate 41 postmenopausal women treated with estradiol (100-mg) subcutaneous implants (Organon, UK). All the women completed the first six months of the study, and 33 completed one year. Both skin thickness and metacarpal index increased to a statistically significant degree over the one-year period, with most of the increase occurring in the first six months of therapy. Skin thickness showed the largest increases, from a mean of 0.86 mm at the start of the study to 0.97 mm at six months and 1 mm at one year. The metacarpal index increased from a mean of 0.77 at the start of the study to a mean of 0.799 and 0.8 at six months and one year, respectively.

Estradiol↗