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Biomedical subjects

L Mascarenhas

Publications and source records attributed to L Mascarenhas.

At least 37 records · Page 2Linked to original sources
PubMed1996

Persistent ectopic pregnancy following conservative surgery for tubal pregnancy.

OBJECTIVE: To audit the incidence and management of persistent ectopic pregnancy following conservative tubal surgery performed at laparotomy and via the laparoscope. DESIGN: A retrospective analysis of the case records. SETTING: The Birmingham and Midland Hospital for Women. PARTICIPANTS: Two hundred and fourteen women who received surgical treatment for ectopic pregnancy between October 1991 and December 1994. RESULTS: Of the 85 women who underwent conservative tubal surgery, nine were diagnosed as having persistent ectopic pregnancy on the basis of hCG values. The incidence after laparoscopy was no higher than after laparotomy. A second surgical procedure was indicated in only four cases. CONCLUSIONS: Post-operative surveillance of serum hCG remains mandatory. Patients who remain symptom free may be managed conservatively The threshold for a second-look laparoscopy should be relatively high and be based on the presence of symptoms rather than changes in hCG values.

Chorionic Gonadotropin↗
PubMed1994

Controlled ovarian hyperstimulation: an adjunct to assisted reproductive technology.

Controlled ovarian hyperstimulation was given to a study group consisting of male factor, endometriosis, and unexplained infertility. The aim of the study was to determine whether COH might be of value for such couples in a setting lacking ART facilities. When compared with their own spontaneous cycles or with a control group (untreated but scanned), COH proved significantly better for unexplained infertility. However, COH was not significantly effective for male factor infertility. This study shows that COH should be offered routinely in general hospitals to couples on long-term waiting lists for ART (especially those facing enforced expectant management).

Adult↗
PubMed1994

Superovulation and timed intercourse: can it provide a reasonable alternative for those unable to afford assisted conception?

Superovulation was performed prospectively with pure follicle stimulating hormone (FSH) to a group of 224 infertile patients with ovulatory factor (51), male factor (60), mild/moderate endometriosis (24) and unexplained infertility (72). The aim was to produce three or four leading follicles in order to compensate for a 'deficient' factor. Ovulation was induced with human chorionic gonadotrophin (HCG) and monitoring was performed entirely by serial transvaginal ultrasound on alternate cycles up to a maximum of six cycles (1120 treatment cycles) with intervening cycles being used as self-controls (932 rest cycles). A further control group of 56 patients was matched for age, category and duration of infertility and was only scanned serially (336 control cycles). Seventy-four pregnancies were achieved and 54 delivered, giving a cumulative pregnancy rate per couple of 33% and a cumulative take home baby rate of 24% per couple after a maximum of six cycles of treatment. When compared with the rest or control cycles, treatment was significantly effective for ovulatory (P < 0.001), mild/moderate endometriosis (P < 0.01) and unexplained infertility (P < 0.01) but not for male infertility. Furthermore, pregnancy was five times more likely during the first four treatment cycles (P = 0.00006, odds ratio = 5) at the expense of a significant multiple pregnancy rate (18.9%) and mild/moderate ovarian hyperstimulation rate (12%). We conclude that four cycles of superovulation should be routinely offered to couples on waiting lists for assisted conception or to those unable to afford it, in anovulatory, mild/moderate endometriosis and unexplained infertility. These results need confirmation by a prospective multi-centre randomized study.

Adult↗
PubMed1994

A comparative review of gynecological day case surgery between England and Wales, France, and Germany.

A comparison was made of gynecological day case surgery between England and Wales, France, and Germany. Hospital In-Patient Enquiry statistics (1979-1985) as well as Department of Health statistics (after 1985) and the Audit Commission Reports (1990-1992) were used for England and Wales; the Baudelocque Hospital Audit (Paris) between 1985 and 1990 was used for France; the Niedersachsen Regional Audit between 1989 and 1990 was used for Germany. These are the only available statistics for all three countries. A retrospective analysis of these statistics of gynecological day case surgery produced estimates of its rate for common gynecological operations in the three countries. It showed that England and Wales performed significantly more (18 per cent) gynecological procedures as day cases than either France (less than 5 per cent) or Germany (11 per cent). Additional specific comparisons were made for certain procedures between England and Wales and France (TOP) and between England and Wales and Germany (D&C, laparoscopy, TOP, ERPC, and cone biopsy). day case surgery was performed in hospitals in England and Wales and in France whereas it was performed in freestanding units in specialists surgeries in Germany. Furthermore, there seemed to be a wide regional variation in the rate in England and Wales and in Germany. Waiting lists were significant in England and Wales and nonexistent in France and in Germany. However, medical unemployment was almost nonexistent in England and Wales whereas it was alarming in France and in Germany. The methods of financing of the health care systems appear to explain the intercountry variation.

Ambulatory Surgical Procedures↗
PubMed1993

Lethal multiple pterygium syndrome. The importance of fetal posture in mid-trimester diagnosis by ultrasound: discussion and case report.

Lethal multiple pterygium syndrome and its variants provide an opportunity for prenatal diagnosis using mid-trimester ultrasound examination. The case presented here highlights the importance of postural deformity in reaching a diagnosis and illustrates the importance of full ultrasound examination of the fetus even when the well-documented common features of a condition are absent.

Journal Article↗
PubMed1993

Aggressive angiomyxoma of the female pelvis and perineum: case report and literature review.

A rare neoplasm was described in young white women in 1983. Its gelatinous appearance, histologic characteristics, locally infiltrative nature, and local recurrence are discussed. Twenty-five cases have been previously reported, our case being the first one in the United Kingdom. The value of a preoperative computed tomographic scan and a systematic anatomic, microscopic, and pathologic identification of all perineal tumors are described.

Adult↗
PubMed1993

Severe ovarian hyperstimulation syndrome, selective embryo reduction and heterotopic pregnancy.

Ovarian hyperstimulation syndrome is common (21.4%) in patients with polycystic ovarian disease, treated by gonadotrophins. It is much frequent (50%) in conceptual cycles. We report a case associated with a quadruplet pregnancy that underwent selective embryo reduction at 8 weeks' gestation to a twin pregnancy and was subsequently found to have an unruptured ectopic pregnancy at 11 weeks' gestation. After laparotomy and partial salpingectomy a successful twin pregnancy ensued.

Abortion, Therapeutic↗