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PubMed1986

Surgical techniques of uterine evacuation in first- and second-trimester abortion.

Induced abortion is an ancient procedure. Vacuum curettage is a recent innovation and is demonstrably superior to other methods for first-trimester abortions. Patient selection, patient preparation and the necessary instruments are described. The only absolute contraindications for local anaesthesia, vacuum curettage abortions are pregnancies too far advanced and allergy to local anaesthestics. The only mandatory laboratory tests are Rh blood group and cervical culture for gonorrhoea. Rh-negative patients must receive anti-D (Rh0) immunoglobulin. Perioperative antibiotics are of proven benefit. The technique of first-trimester vacuum curettage is described in detail here. The technique for very early abortion with the Karman cannula is also described. Fresh examination of tissue is critical after any abortion in order to rule out incomplete or missed abortion and to detect ectopic or molar pregnancy. Management of suspected perforation, haemorrhage, post-abortal syndrome and failed abortion are described. Dilation and evacuation (D&E) is the safest technique for mid-trimester abortion, especially when performed at 13-16 weeks. Some mid-trimester techniques are reviewed and the technique we follow is described in detail. Laminaria tents are left in place overnight, and the procedure is performed under paracervical block with intravenous sedation using low doses of diazepam and fentanyl. Evacuation is by means of large-bore vacuum cannula system and large ovum forceps. General anaesthesia is avoided because it increases the risk of perforation and haemorrhage. Adjuncts to D&E are described: intraoperative real-time ultrasound, intracervical vasopressin, two days' treatment with laminaria tents, and Hern's technique combining laminaria with intra-amniotic infusion of urea prior to D & E.

Abortion, Induced↗

PubMed1986

Detection of antibodies to HTLV-III by ELISA in AIDS risk groups in Taiwan: a preliminary report.

A total of 2321 serum samples were collected from a variety of AIDS risk groups. The samples were tested for anti-HTLV-III using ELISA. Low prevalences of seropositivity were detected in the high-risk groups. Among 120 homosexuals/bisexuals, one seropositive suffering from full-blown AIDS was an American traveler. Another native homosexual who yielded a high ELISA reading was a "possible" AIDS. Three hemophiliacs with strongly positive reactions received injections of a U.S.-produced factor VIII; all are asymptomatic currently. A patient with hairy cell leukemia had a markedly elevated ELISA reading. Another patient with syphilis also had a markedly high reading, despite having no other known risk factor. Among the low-risk groups a patient who had suffered from oral candidiasis for eight years had no risk factor, yet he yielded repeatedly high ELISA readings. Another patient with a weak positive reaction was a symptomless blood donor. This preliminary study concludes that Taiwan is several years behind the U.S. and is at present not an endemic area for AIDS. To achieve successful AIDS control in the future, however, the homosexuals in Taiwan should change their sexual behavior now. Since many initially weakly-reactive samples became negative on repeated testing it appears that non-specific or false positive ELISA reactions occur frequently. Accordingly when ELISA is used for diagnostic purposes, additional confirming tests are mandatory.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Exercise and sudden death.

Sudden death during exercise is rare, but limited data suggest that vigorous physical activity is associated with an increased risk for this event, particularly in individuals with overt cardiac disease or a high coronary risk profile. The mechanism of exercise-associated sudden death is usually a lethal arrhythmia; however, this may vary depending on the underlying cardiovascular disease. In the great majority of cases, cardiovascular disease is present in persons who die during exercise. In young individuals (less than 35 years old) hypertrophic cardiomyopathy and congenital coronary anomalies are the most common conditions, whereas older victims usually have coronary artery disease. Cardiac disease is typically unrecognized prior to death in young persons; in the older population, most have overt coronary disease or recognizable coronary risk factors. Screening asymptomatic individuals to identify increased risk of a cardiac event during exercise presents major problems in terms of logistics, expense, and accuracy, but careful evaluation, including exercise testing, is mandatory before a program of increased activity in patients with overt cardiac disease. In other cases, the extent of any evaluation must be determined on an individual basis.

Adult↗

PubMed1986

Banning drugs in sports: a skeptical view.

Recent proposals to punish athletes for taking drugs or to impose mandatory drug testing cannot be defended in ethical terms. Nor is it possible to distinguish consistently between ethical and unethical uses of restorative drugs, additive drugs, painkillers, and recreational drugs. We oppose drugs in sports because they violate the majority notion of acceptable behavior. But such opposition has more to do with defending the ideals of the community than with creating policies that are ethically sound.

Anabolic Agents↗

PubMed1987

Vasectomy.

Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.

Ambulatory Surgical Procedures↗

PubMed1980

[Thyroid autonomous nodule. Surgical treatment and postoperative outcome, retrospective study of 102 cases (author's transl)].

Follow-up of 102 patients operated upon for autonomous thyroid nodules is reported. Retrospective study of operative findings and aftermath of surgery clearly demonstrates that the patho-physiological concept of autonomous nodule does not snugly fit practical problems experienced with the management of such patients. The autonomous nodule can be a malignancy. Ipsilateral thyroid lobectomy seems more suitable than nodulectomy. Gross appearance of the thyroid remnant makes sometimes post-operative hormonotherapy unexpectedly advisable. From a theoretical point of view, post-operative thyroid scan, TSH assay and TRH test are mandatory, to assess recovery.

Adolescent↗

PubMedDate not supplied

The tampon: investigated and challenged.

Tampons have been associated with toxic shock syndrome, a newly-recognized disease which attacks women of menstrual age and has caused at least 84 deaths so far. A study of the medical literature since 1933, when tampons were first put on the market, reveals warning of possible dangers as a foreign body, as an irritant, as a carrier of bacteria. Today more health professionals are aware of the dangers of tampon use, but they have not yet applied this knowledge to diseases other than TSS. We believe this should be done. Tampons, now considered a Class II Medical Device, should be re-classified into Class III, where pre-market testing is mandatory.

Deodorants↗

PubMed1983

Assessment of a geriatric exercise programme using ambulatory electrocardiography.

The purpose of this study was to assess the efficacy as well as the immediate possible cardiovascular risk of a geriatric exercise programme, administered without prior medical screening or evaluation of the exercise capacity of the participants, in improving cardiorespiratory fitness. Ambulatory electrocardiography performed during exercise on 6 randomly selected male participants in a physiotherapist-controlled geriatric exercise programme revealed heart rates of 72-97/min, values unlikely to produce significant improvements in cardiorespiratory fitness. This low-intensity exercise session did not induce any ischaemic ST-segment displacements, or arrhythmias displaying the generally accepted criteria for premonitory arrhythmias known to precede the development of ventricular fibrillation. However, subsequent stress testing, performed at the lower threshold intensity of exercise needed to elicit a significant physiological training effect, resulted in an adverse cardiac response in 3 subjects, of whom 2 were asymptomatic. We conclude that the geriatric exercise programme under investigation would be unlikely to result in improved cardiorespiratory fitness in the majority of participants, but if such a programme is to be implemented in a safe manner in a geriatric population, prior medical screening including exercise testing is mandatory.

Aged↗

PubMed1995