Thinning the endometrium prior to ablation: is it worthwhile?
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Adult↗
Biomedical subjects
C J Sutton
Publications and source records attributed to C J Sutton.
Patients with chronic pelvic pain and/or infertility: psychological differences pre- and post-treatment.
This study investigated the psychological differences between gynecological clinic attenders with either pelvic pain or infertility, or with both pelvic pain and infertility both before and after laparoscopic investigation with concurrent treatment. Given the differing meaning attached to the procedure by these groups, it was hypothesized that infertility patients would be more anxious but with less evidence of psychopathology in comparison with the pain group prior to laparoscopic surgery. Postsurgery and in the short term, pain reduction was expected to be associated with decreased pathology for the pain group. Contrary to the hypotheses, pain patients obtained higher anxiety scores in comparison with the infertility group both pretreatment as well as post-treatment. The latter group's scores were comparable to normative data. Other results were generally in line with the hypotheses, pain reduction for both pain groups being associated with a reduction in psychopathology. Patients with pain plus infertility resembled pain patients at pretreatment, while at post-treatment, they bore a closer resemblance to infertility patients in their psychological profile. This was despite the fact that for both pain groups, pain relief was similar. This reinforces the notion that in the patient groups studied anxiety is associated with pain rather than with infertility.
Adaptation, Psychological↗
Persistent menorrhagia despite total absence of endometrium.
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Adult↗
Ruptured ectopic pregnancy in an amenorrhoeic women after transcervical resection of the endometrium.
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Endometrium↗
Death after marital bereavement--is the risk increased?
Previous studies on the effect of marital bereavement on mortality have suggested various time periods during which the risk of mortality is increased. As many of the studies compared the widowed group with national mortality statistics for the married, there has been no opportunity to adjust for confounders which might themselves be responsible for this increased risk after bereavement. In this paper the various hypotheses proposed are reviewed and then modelled on a dataset of 344 elderly persons who were living with a spouse and who were part of a survey of a population of people aged 75 years and over. The 344 index-cases and their spouses were followed up for seven years and the times of death (for those who died) of the index-case and spouse were noted. The data were analysed by fitting a proportional hazards model to the subject's survival time after adjustment for other factors such as mental and physical health which had already been shown to be associated with mortality. The bereavement effects were fitted as time-dependent covariates. The best fitting model for females and males indicated an increased relative risk of mortality which lasted for approximately six months after bereavement. In the case of widows this relative risk was significantly increased, being 3.8 with 95 per cent confidence interval (1.4, 10.3) while for widowers the risk was 0.03 with 95 per cent confidence interval (0.00, 37.3).
Aged↗
What can we expect from the surgical management of endometriosis?
In endometriosis, radical surgery to remove both ovaries appears to be the only truly lasting cure. However, to retain or improve fertility potential, conservative surgery to remove all visible endometriotic deposits is often employed. Traditional conservative surgery using laparotomy is time-consuming and involves large, painful, slow-healing incisions, but, it is argued, modern developments in minimally invasive endoscopic surgery using advanced laparoscopy with lasers offer significantly reduced operation time, discomfort and convalescence. These surgical advances are reviewed. Although their effectiveness remains to be confirmed in controlled clinical trials, they appear to produce good results and are safe in experienced hands.
Denervation↗
Diagnostic significance of octadeca-9,11-dienoic acid in cervical neoplasia.
The percentage molar ratio (%MR) of the 9,11 and 9,12 isomers of octadecadienoic acid was determined in cervical exfoliated cells from 148 subjects, of whom 27 had cytologically proven intraepithelial neoplasia and in cervical biopsy specimens from 43 subjects, of whom 24 had histologically diagnosed cervical intraepithelial neoplasia. The %MR in both cervical biopsy specimens and exfoliated cells did not significantly differ in subjects with or without cervical intraepithelial neoplasia. The measurement of the %MR of 9,11:9,12 octadecadienoic acid has no role in the detection of cervical intraepithelial neoplasia.
Female↗
Production of interferons during experimental African trypanosomiasis.
African trypanosomiasis is associated with profound changes in the function of the immune system. In this study we find that alpha/beta and gamma interferon (IFN) are released into the serum of mice infected with Trypanosoma brucei. The parasite-induced rise in serum IFNs is associated with a detectable parasitaemia, but the serum IFN peak precedes the peak parasitaemia in some cases. Unlike other protozoan interferon inducers, no parasite-dependent IFN production was observed in the pre-patent period of infection; while the most virulent clone induced very high IFN levels, no clear difference in stimulation was noted in the first waves of semi-acute and chronic T. brucei clones. However, subsequent IFN augmentation more closely reflected the host parasite load and virulence of infection. The nature of the stimulatory parasite component is as yet unknown, and the parasite surface glycoprotein had no effect on serum IFN. Injection of large quantities of lethally irradiated, but intact organisms did not stimulate IFN production; however this treatment significantly impaired antibody responses to the heterologous antigen SRBC. This suggests that the more severe effects of an actual trypanosome infection are required for induction of IFN synthesis, and that the presence of measurable serum IFN is not a prerequisite for parasite-induced suppression of host antibody responses.
Animals↗
Long-term follow-up of a controlled trial of laser laparoscopy for pelvic pain.
BACKGROUND AND OBJECTIVES: The purpose of this study was to assess the long-term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis. METHODS: We conducted a long-term follow-up of 56 patients who had participated in a randomized, double-blind controlled study at a tertiary referral center for the laparoscopic treatment of endometriosis. The patients had pelvic pain, minimal-to-moderate endometriosis, and underwent laser laparoscopy. We asked patients whether they had now achieved satisfactory symptom relief or whether they had received any further medical intervention for their endometriosis. The main outcome measure was continued symptom relief after treatment and subsequent medical history. RESULTS: Of the original 56 patients, we were able to contact 38 (67.9%). The mean (range) time since operation was 73 months. Painful symptoms had recurred in 28/38 (73.7%) patients at some point since their operation. The median (range) time for recurrence was 19.7 (5-60) months. At the time of follow-up, satisfactory symptom relief was reported in 21/38 (55.3%) patients. The remaining 17/38 (44.7%) patients continued to experience painful symptoms, and eight eventually had a hysterectomy. CONCLUSIONS: This study suggests that operative laparoscopy can have long-term benefits for the majority of women with pelvic pain due to endometriosis, but because of the small numbers, this study lacks the power to demonstrate this conclusively.
Adolescent↗
Thermoregulated radiofrequency endometrial ablation.
OBJECTIVE: To test the hypothesis that treating dysfunctional uterine bleeding by automated application of electrothermal energy to the uterine cavity, with precise regional control, might yield results equivalent to those reported for hysteroscopically directed laser and electrosurgical endometrial ablations. MATERIALS AND METHODS: Patients with life style compromising menorrhagia, referred to six gynecologic surgical centers for hysterectomy or endometrial ablation, were admitted to the study if they had normal cervical cytology, a benign endometrial biopsy, no defined cause for their bleeding, and consented to participate in the evaluation of a newly developed Vesta DUB Treatment System. The device consists of a silicone-inflatable electrode carrier to be inserted into the uterine cavity and a controller to monitor and distribute current from a matched electrosurgical generator. Treatment involved a 3-minute or shorter warm-up period and a 4-minute treatment phase. RESULTS: Three- to 24-month follow-up data were available for 187 patients, with a mean follow-up of 14.8 months. The amenorrhea rate was 38%. Bleeding was reduced in 95% of patients. Actuarially, 88 +/- 3% of patients should expect to be free of menorrhagia, dissatisfaction, or need for a second procedure out to 24 months. CONCLUSIONS: The unique regional feed-back control offered by this system causes thorough, evenly distributed, thermal destruction 4-5 mm into the myometrium that reduces bleeding with durability equivalent to published reports of hysteroscopic endometrial ablation.
Adult↗