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Biomedical subjects

A Magos

Publications and source records attributed to A Magos.

At least 55 records · Page 3Linked to original sources
PubMed1996

Comparison of carbon dioxide and normal saline for uterine distension in outpatient hysteroscopy.

OBJECTIVE: To evaluate patient acceptance and the clinical feasibility of carbon dioxide compared with normal saline for uterine distension in outpatient hysteroscopy. DESIGN: Prospective, randomized clinical trial. SETTING: Outpatient hysteroscopy clinic in a university hospital. PATIENTS: One hundred fifty-seven patients undergoing outpatient hysteroscopy. INTERVENTIONS: Outpatient hysteroscopy was performed with carbon dioxide or normal saline with endometrial biopsy when indicated. MAIN OUTCOME MEASURES: Need for local anesthesia, cervical dilatation, view of uterine cavity, need to change from carbon dioxide to normal saline distension, procedure time, patient discomfort (lower abdominal pain, shoulder tip pain, nausea) and complications. RESULTS: Carbon dioxide was used for uterine distension in 79 women and normal saline was used in 78. Cervical dilatation was required more often with carbon dioxide hysteroscopy, although there was no increased requirement for local anesthesia. Hysteroscopic vision was similar between the two media, but eight carbon dioxide cases had to be converted to liquid distension. Procedure times were significantly longer for carbon dioxide hysteroscopy as was the occurrence of bubbles during the procedure. Lower abdominal pain and shoulder tip pain were significantly worse with carbon dioxide distension. Although the incidence of nausea and vomiting was higher with the use of carbon dioxide, the differences did not achieve statistical significance. CONCLUSION: The use of normal saline for uterine distension had no adverse affects on the hysteroscopic view. It provided a shorter operating time and was well accepted by patients. Because of its easy availability and low cost, normal saline is an excellent alternative to carbon dioxide in women undergoing outpatient hysteroscopy.

Adult↗
PubMed1996

Long-Term Results of Endometrial Resection

To evaluate the safety and effectiveness of initial and repeat transcervical resection of the endometrium (TCRE ) in the treatment of menorrhagia, and to estimate the likelihood of treatment failure, we reviewed 525 women treated over 5 years and analyzed our results by life table analysis. Total TCRE was completed in 95.3% of patients, and 112 patients had simultaneous hysteroscopic myomectomy. In 167 women TCRE was performed under local anesthesia. The complication rate was 7.2%. The satisfaction rate varied from 80% to 89.5% over the 5 years. Forty percent of women were amenorrheic at 1 year. Increasing uterine size, young age, fibroids, and lack of endometrial preparation were factors associated with negative outcome. Eighty-six women required further surgery after the initial TCRE, pelvic pain menorrhagia being the most common indications. Eighty percent of patients avoided further surgery and 90% avoided hysterectomy. The failures plateau after 4 years, and even if some women require further gynecologic surgery after this time, it is unlikely that this will have significant impact on the overall results.

Journal Article↗
PubMed1996

Vaginal hysterectomy for the large uterus.

OBJECTIVE: To assess the feasibility and safety of performing vaginal hysterectomy on enlarged uteri the equivalent of 14 to 20 weeks of gestation in size. DESIGN: A prospective observational study. SETTING: The Royal Free Hospital, London. PARTICIPANTS: Fourteen consecutive women undergoing vaginal hysterectomy for uterine fibroids up to 20 weeks in size. INTERVENTIONS: Vaginal hysterectomy with or without bilateral salpingo-oophorectomy or oophorectomy. MAIN OUTCOME MEASURES: Uterine size and weight, techniques used to reduce uterine size, surgical outcome, operative time, estimated operative blood loss, intra- and post-operative complications, duration of hospitalisation. RESULTS: The mean uterine size was 16.3 weeks (range 14 to 20 weeks). All hysterectomies were completed successfully by the vaginal route. The uteri weighed 380 to 1100 g, with a mean of 638.7 g. Bisection combined with myomectomy and morcellation were used in most cases to obtain reduction in uterine size, whereas coring was only utilised in two cases. The mean operating time was 84.3 min with a range of 30 to 150 min. The only complications were transient haematuria (n = 6) and superficial vaginal grazes (n = 5). One of the women required a blood transfusion. The mean post-operative hospital stay was 3.7 days (range 2 to 9 days). CONCLUSION: Enlargement of the uterus to a size equivalent to 20 weeks of gestation should no longer be considered a contraindication to vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic surgery.

Adult↗
PubMed1993

Endometriosis: radical surgery.

Radical ablative surgery for endometriosis is indicated chiefly for symptoms of pain that fail to respond to conservative treatment. The sites of involvement must be carefully assessed and surgery planned taking account of the wishes of the patient concerning her fertility. Procedures include oophorectomy, salpingo-oophorectomy, hysterectomy, appendicectomy, and the excision of deeply infiltrating endometriosis possibly involving bowel resection. The most important arbiter of therapeutic success is the removal of the ovaries, hysterectomy and bilateral salpingo-oophorectomy offering the ultimate cure for this chronic condition. Whereas laparotomy has been the traditional approach for most of these procedures, vaginal and laparoscopic surgery are modern alternatives for many of these cases offering important advantages in terms of reduced postoperative discomfort, shorter hospitalization, faster recovery and a superior cosmetic result. Preoperative and postoperative medical therapy has a limited role in surgery, whereas postoperative hormone replacement therapy after bilateral oophorectomy is generally recommended.

Appendectomy↗
PubMed1992

Psychological and physiological changes in severe premenstrual syndrome.

This study investigated differences in nervous system activity and in psychological and behavioural variables between the "baseline" follicular and the premenstrual phases. Twenty women with severe premenstrual syndrome were compared with 20 non-sufferers (10 from each group in each cycle phase). The Patient groups had higher autonomic activity than controls in both phases. In the follicular phase, patients did not differ on other important variables, though most measures were somewhat higher. Premenstrually, patients were higher on several negative moods and lower on cortical arousal. The patients' premenstrual distress appears to arise mainly from chronically high autonomic activity and a decline in cortical arousal, presumably interacting with other neurophysiological fluctuations of the cycle, rather than from any psychological characteristics. The direction of any causal relationship between autonomic and central activity and premenstrual symptoms is unknown.

Adult↗
PubMed1987

Skin collagen changes in post-menopausal women receiving oestradiol gel.

Sixteen post-menopausal women who had never previously received any hormonal treatment applied Oestrogel cream 1.5 mg/day percutaneously for 1 yr. Skin biopsies were taken from the abdomen and from the lateral aspect of the thigh at 0, 3, 6 and 12 mth, and the changes in skin collagen content were noted. The abdominal skin collagen content increased significantly (P less than 0.001) over the 1-yr treatment period. The thigh skin collagen content also increased, but did not reach significant levels. There was a strong correlation between the change in skin collagen content (in both the abdomen and the thigh) and the original skin collagen content, indicating that the change in collagen content in response to oestrogen therapy is dependent on the original level. There is no further increase once an 'optimum' skin collagen level has been reached.

Administration, Topical↗
PubMed1987

Hormone pellet implantation for the menopause and premenstrual syndrome.

Sex hormone implants have been available for almost 50 years, but only a few clinicians administer them regularly. Implants represent a physiologic mode of therapy with many metabolic advantages over other routes. Surprisingly, they are relatively ignored by physicians. This may well reflect their surgical nature, although the technique of hormone implantation is simple and fast and obviates daily oral medication. As the list of indications for hormone pellets grows, more patients will take advantage of the benefits they offer.

Climacteric↗
PubMed1987

Skin collagen changes in postmenopausal women receiving different regimens of estrogen therapy.

Collagen is a widespread body constituent that is affected by estrogen status in women. Its decrease after menopause can be prevented and/or restored by estrogen treatment. We explored the effect of four different hormonal replacement regimens on total skin collagen content by measuring hydroxyproline in skin biopsy specimens taken from postmenopausal women. All regimens showed increases in skin collagen levels proportionate to the levels at the start of the treatment. Estrogen replacement therapy is shown to be prophylactic in women who have higher skin collagen levels and both prophylactic and therapeutic in women with lower skin collagen levels.

Administration, Cutaneous↗