Ovarian endometriomas: Effect of laparoscopic cystectomy on ovarian response in IVF-ET cycles

OBJECTIVE: To investigate the follicular response to controlled ovarian hyperstimulation (COH) in IVF-ET cycles after laparoscopic ovarian cystectomy for large endometriomas. PATIENTS AND METHODS: In the set of a retrospective controlled study, the medical records of 113 infertile women who underwent IVF-ET cycles after laparoscopic surgery were reviewed. The study group (A) consisted of 63 patients with severe pelvic endometriosis and endometrioma excision. The control group (B) consisted of 50 infertile patients with mild or minimal endometriosis. Interventions were laparoscopic ovarian cystectomy in the study group, and COH in both groups. RESULTS: Groups A and B were not different in terms of epidemiologic data. The total numbers of recruited follicles (9.1+/-3.3 vs 10.6+/-4.2; P = 0.001), mature follicles (> or =16 mm) (4.2+/-1.7 vs 4.8+/-2.2; P = 0.04), mature oocytes retrieved (5.8+/-3.8 vs 7.4+/-4.6; P = 0.02), and fertilization rate (48.9+/-34.9 vs 61.8+/-32.1%; P = 0.02) observed in group A were lower than those observed in group B, respectively. While the mean number of rFSH ampoules (75 IU) was increased in group A (38.1+/-20.4) compared to group B (29.3+/-16.4; P = 0.004), cumulative pregnancy rates were similar in both groups (27.5+/-8.8% vs 37.2+/-10.6%; P = 0.37). DISCUSSION AND CONCLUSIONS: Ovarian response was reduced during IVF-ET cycles in patients with history of severe endometriosis and laparoscopic excision of endometriomas compared to women with mild or minimal endometriosis without ovarian surgery.     

Effectiveness of a multidisciplinary rehabilitation program in elderly patients with hip fractures.

BACKGROUND AND PURPOSE: Hip fracture is a significant health challenge to the elderly, with a high risk of complications, long hospital stay, and functional deterioration. The purpose of this study was to evaluate the effectiveness of a multidisciplinary rehabilitation program (MRP) in older patients with hip fractures. METHODS: A before-and-after quasi-experimental design was used. Data were collected at a large teaching hospital in Taipei. The first 105 consecutive patients admitted received conventional care (control group). The next 50 consecutive patients received physical therapy, nurse-supervised exercise, and discharge planning (intervention group). Subjects were assessed upon admission, on the fourth postoperative day, and on the discharge day. The 155 patients recruited met the following criteria: 60 years of age or older, and hospitalized to receive either closed reduction and internal fixation, or hip arthroplasty. RESULTS: Compared with the control group, the intervention group had a shorter average hospital stay (9.9 vs 11.6 days, p = 0.01), earlier ambulation (5.7 vs 6.5 days postoperatively), and a lower rate of bowel incontinence (4.0% vs 23.8%) and pressure sores (14.0% vs 24.8%) during hospitalization. The intervention group experienced less decline in mobility (relative to pre-fracture status) than the control group. No significant difference was found in other outcome variables between the control and intervention groups. CONCLUSIONS: The findings of this study indicate that an MRP involving physical therapy, nurse-supervised exercise, and discharge planning positively affects health outcomes in older patients with hip fractures.     

胰岛素抵抗与妊娠高血压综合征发病的关系

目的　探讨胰岛素抵抗与妊娠高血压综合征 (妊高征 )发病的关系。方法　选取 1998年在上海市第一人民医院进行产前妊娠期糖尿病筛选异常的 199例孕妇为研究对象 ,进行 75g葡萄糖耐量试验 ,同时进行胰岛素释放试验 ,计算胰岛素曲线下面积及胰岛素敏感性指数 ,并随访至妊娠晚期发生妊高征的情况 ,比较 199例孕妇中 ,发生妊高征者和血压正常者胰岛素敏感性的差异。结果　 (1)妊高征发病有 39例 ,空腹血糖为 (4 .2± 0 .7)mmol/L ,空腹胰岛素为 (10 7.8± 48.8)pmol/L ,胰岛素敏感性指数为 - 3.2 5± 0 .2 7。血压正常的孕妇 16 0例 ,空腹血糖为 (3.8± 0 .7)mmol/L ,空腹胰岛素为 (5 0 .4± 40 .5 )pmol/L ,胰岛素敏感性指数为 - 2 .5 8± 0 .6 6 (P <0 .0 5 )。 (2 )胰岛素曲线下面积 ,妊高征患者为 112 5 .6± 331.0 ,血压正常孕妇为 10 5 7.6± 44 2 .2 ,两者比较 ,差异无显著性 (P >0 .0 5 )。结论　孕中期胰岛素抵抗可能是妊高征发病的原因之一。妊娠中期存在胰岛素抵抗可以作为一项预测妊高征的指标     

Functional recovery after hip fracture: six months' follow-up of patients in a multidisciplinary rehabilitation program.

BACKGROUND AND PURPOSE: Hip fracture is a major source of disability among the elderly. The purpose of this study was to evaluate the effects of an in-hospital multidisciplinary rehabilitation program (MRP) on basic activities of daily living (BADL) and mobility 6 months after hospital discharge in patients with hip fractures. METHODS: A before and after quasi-experimental design was used. Subjects were recruited in a large teaching hospital in Taipei, Taiwan. The first 44 consecutive patients recruited received conventional care (control group). The next 50 consecutive patients received physical therapy, nursing-supervised practice of exercise, and discharge planning (intervention group). The 94 patients recruited were aged 60 years or older and were hospitalized to receive open reduction and internal fixation or arthroplasty. Subjects were assessed at admission, on the fourth operative day, on the day of discharge, and 6 months after discharge. RESULTS: On average, subjects did not regain their prefracture functional score for BADL and mobility 6 months after discharge. The intervention versus control group had a lower incidence of functional decline in BADL (16.0% vs. 34.1%; p = 0.01) and mobility (48.0% vs. 75.0%; p = 0.01) 6 months after discharge. Subjects who were independent before fracture (odds ratio [OR], 12.24), did not receive MRP intervention (OR, 4.63), or who were female (OR, 5.24), were more likely to have a decline in function 6 months after discharge. CONCLUSION: An MRP had a continuous positive effect on hip-fracture patients, thus facilitating improved recovery in BADL and mobility 6 months after discharge.     

Femoral head preservation in non-united femoral neck fracture and head osteonecrosis in Cushing's disease.

There have been few reports associating avascular necrosis of bone with Cushing's disease. Patients with Cushing's disease and avascular necrosis of the femoral head usually receive total hip arthroplasty. However, hip prosthetic replacement in younger patients has been criticized due to a high incidence of component loosening. We report a case of successful femoral head preservation in non-united femoral neck fracture and head osteonecrosis in a 14-year-old girl with Cushing's disease (adrenocorticotropic hormone-secreting pituitary adenoma) who developed avascular necrosis of the right femoral head and pathologic fracture of the right femoral neck 2 years after the onset of hypercortisolism. Subtrochanteric valgus osteotomy was performed to preserve the femoral head after successful transsphenoidal surgery to remove pituitary microadenoma. At follow-up 10 years after the osteotomy, the femoral head had revascularized and the femoral neck fracture were united with much improvement of hip function. Dual energy X-ray absorptiometry scan of the right hip showed +0.86 SD from the normal bone densitometry. Aggressive femoral head preservation may be an effective alternative to treat this rare situation in a teenager.     

A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy

STUDY OBJECTIVE: To compare the amount of pain during and after hysteroscopy using local intracervical and combined local and paracervical anesthesia. DESIGN: Prospective randomized trial (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: Eighty-four women who underwent outpatient hysteroscopy for evaluation of the uterine cavity at McGill University Health Center. INTERVENTIONS: Randomization to local intracervical or combined local and paracervical anesthesia. MEASUREMENTS AND MAIN RESULTS: Amount of pain experienced during the procedure and at 10, 30, and 60 minutes after the procedure was measured using a visual analog scale ranging from zero to 10 (zero = no pain; 10 = excruciating pain). The mean age of the patients in the local anesthesia group was 36.1 +/- 0.7 years and in the combined local and paracervical anesthesia group was 35.2 +/- 0.7 years. Patients experienced significantly more pain during than after the procedure. The mean pain scores in the local anesthesia group were significantly higher than in the combined anesthesia group during the procedure (3.2 +/- 0.3 vs 2.1 +/- 0.2; p <.01; 95% CI 0-2), 10 minutes after the procedure (1.9 +/- 0.2 vs 1.5 +/- 0.3; p = .03; 95% CI 0-1), and 30 minutes after the procedure (1.7 +/- 0.2 vs 1.0 +/- 0.2; p = .02; 95% CI 0-1). However, there was no significant difference in pain scores at 60 minutes after the procedure between the local anesthesia and combined anesthesia groups (0.9 +/- 0.2 and 0.7 +/- 0.1, respectively). CONCLUSIONS: Outpatient hysteroscopy with local or combined local and paracervical anesthesia was well tolerated by patients. However, combined anesthesia was associated with less pain during and at 10 and 30 minutes after the procedure. Most patients considered the pain as mild.     

Predictive value of total body bone mineral density for vertebral fractures in elderly women. Geriatric Study Group.

In a general population-based geriatric disease survey in Taipei City, the bone mineral density (BMD) of 58 women over 65 years of age was measured for the whole body, lumbar spine (L2-L4), and proximal femurs using a 153Gd based dual photon absorptiometer. These women were found to have at least one vertebral fracture. The results showed that the BMD readings of both the lumbar spine (L2-L4) (mean Z score +/- SEM = 0.05 +/- 0.12) and the femoral neck (mean Z score +/- SEM = -0.20 +/- 0.10) were not statistically different from those of age-matched controls. However, the total body BMD in these 58 patients was significantly lower than in the normal controls (mean Z score +/- SEM = -1.07 +/- 0.10, p < 0.0001). In the normal control group (N = 69, age 50-85), there was a significant linear correlation between the total body and lumbar BMD (r = 0.81, p < 0.0001). This correlation was not found in the 58 women with vertebral fractures (r = 0.14, NS). Our results suggest that geriatric women with vertebral fractures are more osteoporotic than normal aged women, even though they have a relatively mild degree of spinal osteoporosis. But, because of age-associated degenerative changes or other factors, conventional anteroposterior lumbar BMD measurements cannot detect the difference. The total body BMD readings, but not the lumbar or femoral neck BMD readings, seem to be less affected by these local changes and may provide a better discriminative or predictive value for vertebral fracture in this particular age group.     

Comparison of critical conservative treatment versus emergency operation in children with ruptured appendicitis with tumor formation.

BACKGROUND AND PURPOSE: Management of ruptured appendicitis with tumor formation in children includes emergency appendectomy or initial conservative treatment, the choice of which remains controversial. This study compared the clinical courses of children with ruptured appendicitis with tumor formation (RATF) who received emergency appendectomy or initial conservative management. METHODS: A retrospective study was conducted of 59 pediatric patients with RATF treated from January 1996 to September 2002. Twenty seven patients received emergency appendectomy and 32 patients received initial conservative treatment. Patients who received initial conservative treatment were further divided into those who recovered from the initial conservative treatment (n = 23) and those 9 patients who failed initial conservative treatment and received appendectomy at the same admission. Clinical factors including age, gender, body weight, duration of symptoms, duration of ileus after initial treatment, duration of fever and the usage of antibiotics, hospital stays, and major and minor complications were compared between groups. RESULTS: The emergency appendectomy group and initial conservative treatment group had similar distributions of age, gender, body weight, and duration of symptoms. Patients who received emergency appendectomy had a shorter duration of fever (2.7 +/- 1.9 vs 8.0 +/- 7.0 days; p = 0.003) but were fed later (4.4 +/- 3.9 vs 1.8 +/- 2.9 days; p = 0.005) compared with those who received conservative treatment initially. Patients who received emergency appendectomy also had a higher complication rate (33.3% vs 17.4%; p = 0.038). Patients who recovered from initial conservative treatment were fed earlier after operation (0.7 +/- 0.6 vs 4.2 +/- 4.1 days; p = 0.002), had a lower complication rate (33.3% vs 4.3%; p = 0.02) and a shorter hospital stay (16.6 +/- 10.9 vs 29.3 +/- 33.6 days; p = 0.03) than those who failed initial conservative treatment. Histopathological study of the appendix in the 17 patients who received interval appendectomy showed fecal materials (58.8%) and fecoliths (29.4%) in lumen, microscopically suppurative inflammation (31.3%), and focal mild inflammation (31.3%). CONCLUSIONS: In this study, conservative treatment of RATF in children was associated with a lower complication rate. Pathological analysis of the appendix suggests that interval appendectomy should be advocated in patients with successful initial conservative treatment.     

Kinematic navigation in total knee replacement--experience from the first 50 cases.

BACKGROUND/PURPOSE: Proper alignment of the prosthesis is critical in total knee replacement (TKR) to minimize long-term wear, risk of osteolysis, and loosening of the prosthesis. This study examined the accuracy of lower limb alignment obtained using a kinematic navigation system for TKR, and the extra time needed to adopt this system. METHODS: From August 2002 to April 2003, 71 patients with knee osteoarthritis underwent 79 primary TKR operations by the same surgical team. Fifty of these operations were performed with the aid of the CT-free kinematic navigation system, and the remaining 29 were performed with conventional manual methods. Results, including operation time, radiographic alignment of the prosthesis and complications, for the two groups were compared. RESULTS: Patients in the kinematic navigation group achieved better accuracy in the coronal plane than the conventional group in terms of postoperative mechanical axis (1.89 +/- 0.63 degrees vs. 3.38 +/- 1.07 degrees ). Less variation was noted in the navigation group (femur: SD 1.88 degrees vs. 7.12 degrees ; tibia: SD 1.54 degrees vs. 2.99 degrees ), although the difference in the mean values was not significant (p = 0.475 and 0.55, respectively). The operation time (from skin to skin) in the navigation group (100.6 +/- 4.3 minutes) was longer than that in the conventional group (92.7 +/- 5.1 minutes; p = 0.027). Two perioperative fractures occurred in the navigation group, both of which were attributed to patient factors as opposed to operation procedures. No major complications such as infection or pulmonary embolism occurred during this study. CONCLUSION: Use of a kinematic navigation system in TKR provides better accuracy than conventional manual methods. The technique is easy to use, has a short learning curve, and requires an additional operation time of less than 10 minutes. Precise alignment can be achieved with the aid of navigation in most cases.     

Retrograde intramedullary nailing for nonunions of supracondylar femur fracture of osteoporotic bones.

Nonunion of supracondylar femur fracture remains a challenging problem because of limited treatment options. The situation is more complex when it occurs in elderly patients with osteoporotic bones. We report the treatment of 3 elderly patients with supracondylar femur fracture nonunion after open reduction and internal fixation with various plate-screw internal fixation systems. Two of these patients had traumatic fractures and the third had a periprosthetic fracture after primary total knee arthroplasty (TKA). After revision surgeries using retrograde nailing techniques, all fractures united eventually. When combined with indirect reduction, these techniques provide superior biomechanical properties and reduce the need for soft tissue dissection.     

Effect of growth hormone therapy on adult height of children with turner syndrome

Background/Purpose: Short stature is a common manifestation of Turner syndrome. The purpose of this study was to evaluate the effect of growth hormone (GH) therapy alone on the adult height of children with Turner syndrome. Methods: From 1987 to 2006, 21 Turner syndrome patients who had been treated with GH for > 2 years and had reached adult height were enrolled in the study. The dosage of GH was 0.33 mg/kg/week. Estrogen replacement therapy was prescribed at the age of 15.6 +/- 0.9 years, if indicated. The patients had been followed-up until they reached their adult height. During the same period, 28 Turner syndrome patients who were not treated with growth-promoting agents were enrolled for comparison. Mann-Whitney U test and Wilcoxon signed rank test were used for comparison. Results: Twenty-one patients in the study group started GH therapy at the age of 11.5 +/- 1.8 years. The duration of GH therapy was 4.0 +/- 1.5 years. The growth rate before treatment was 3.8 +/- 0.7 cm/year, which increased to 7.1 +/- 1.4, 5.4 +/- 1.4 and 4.7 +/- 0.9 cm/year during the first 3 years of GH therapy, respectively. Patients who received GH reached an adult height of 150.0 +/- 5.1 cm, which was significantly higher than the 144.7 +/- 5.9 cm of the control group (p < 0.05). The adult height of the study group was 6.3 +/- 3.3 cm taller than their projected adult height upon enrolment. No major adverse events were detected during GH therapy. Conclusion: GH alone is safe and effective for the promotion of growth in children with Turner syndrome in Taiwan.     

Ovarian function after uterine artery embolization and hysterectomy

STUDY OBJECTIVE: To evaluate the effect of uterine artery embolization (UAE) and hysterectomy on ovarian function. DESIGN: Prospective case control study (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Eighty-four healthy premenopausal women with symptomatic uterine myoma(s) undergoing UAE or hysterectomy. INTERVENTION: Patients had blood drawn to measure follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels and underwent transvaginal ultrasound to measure volume of the myoma(s) and uterus on cycle day 3 before the procedures. These measurements were repeated 3 and 6 months after treatment. MEASUREMENTS AND MAIN RESULTS: The main outcome was the differences in serum FSH, LH, E2, and ultrasound findings before and after UAE or hysterectomy. Of the 68 patients who underwent UAE and 16 who underwent hysterectomy, 48 and 13 respectively, completed 6-month follow-up. The mean age of the patients in the UAE group was 44.9 +/- 3.8 years and 43.7 +/- 5.6 years in the hysterectomy group. There was no significant difference in serum FSH before (8.9 +/- 0.7 IU/L) and 6 months after UAE (9.9 +/- 1.0 lU/L), and between the baseline (10.4 +/- 1.8 lU/L) and 6 months posthysterectomy (7.8 +/- 1.8 lU/L). The uterine volume 6 months after UAE (361 +/- 50 mL) was significantly smaller than before UAE(538 +/- 38mL; p =.005, 95% CI 44-241). Compared with baseline (154 +/- 20 mL), the dominant myoma volume was smaller at 6 months after UAE (97 +/- 16 mL; p <.05, 95% CI 1.57-62). CONCLUSION: Uterine artery embolization is associated with a significant reduction in myoma and uterine volume. Ovarian function at 6 months, as indicated by day 3 FSH levels, is not affected by UAE or hysterectomy.     

GnRHa flare and IVF pregnancy rates.

OBJECTIVES: GnRH agonist administered early in the menstrual cycle (flare) causes an endogenous discharge of FSH and LH. Flare has been used in conjunction with gonadotropin ovarian stimulation for IVF 'poor responders'. There is an ongoing controversy regarding whether flare protocols improve pregnancy rates in 'poor responders'. The current study was designed to compare a GnRHa flare protocol with long suppression GnRHa IVF in 'poor responders'. METHODS: Seventy-three newly diagnosed poor responders who failed long GnRHa suppression IVF attempts were compared retrospectively with 128 age-matched IVF patients previously known poor ovarian responders treated with a long GnRHa suppression protocol. 'Poor responders' consisted of patients with peak E(2) less than 1000 pg/ml and/or less than five mature follicles with diameter >15 mm on the day of hCG administration. Student's t-test was used to analyze the data and the chi-squared test was used to compare fertilization and pregnancy rates. RESULTS: The flare protocol produced higher peak E(2) levels (1647+/-747 vs. 720+/-258 mIU/ml, P<0.05) and a larger number of mature follicles (5.8+/-2.2 vs. 4.0+/-1.0 P<0.05) in the study vs. the control group. A 30% pregnancy rate was achieved during this second IVF attempt using GnRHa flare protocol in the study group vs. 37 in the control group (P>0.05, NS). CONCLUSIONS: A comparison between the flare protocol group and the age-matched control group of poor ovarian responders subject to down regulation protocol, revealed higher peak E(2) levels and more mature follicles, respectively. However, both groups yielded comparable pregnancy rates. The use of high dose gonadotropin treatment in our study groups seems to be the only explanation for their subsequent successful outcome. We concluded that GnRH agonist flare protocol does not result in better IVF outcome compared with long GnRH agonist suppression protocol in IVF poor responders.     

Treatment of open femoral and tibial shaft fractures preliminary report on external fixation and secondary intramedullary nailing.

From January 1987 to May 1989, a total of 38 adult cases were treated with 15 femoral and 25 tibial shaft shifting procedures from external fixation to reamed intramedullary nailing and followed up for at least 1 year (average, 23 months) at the authors' institution. The indications for the shifting procedures included routine sequential femoral external fixation and failed tibial external fixation treatment such as loss of reduction, atrophic healing process and inability of patients to tolerate casting. The delay period for the shifting procedure was 5 days in the femur and 48 days in the tibia. The union rate for the femur was 93% (14/15), and the tibia, 96% (24/25). The union period after the shifting procedure was 4.8 +/- 1.7 months in the femur, and 5.2 +/- 1.8 months in the tibia. Range of motion of the knee and ankle were satisfactory. Deep infection was the most serious complication, and the tibia was involved more often than the femur (20% to 13%) (p greater than 0.05). The most favorable management of deep infection was local drainage till bony union. We conclude that a shifting operation can be considered as one of the alternative procedures for several femoral or tibial shaft open fractures after fixation with external fixation. Wound and pin tract care, a shorter period of external fixation, a longer delay period before nailing, and perioperative antibiotic use may significantly lessen the infection rate.     

Carotid pulsatility indices in surgical menopause

A large body of literature is available concerning association of hormone replacement therapy (HRT) and postmenopausal women; to our knowledge, only few publications in purely surgical menopausal women. The aim of this study was to evaluate pulsatility indices (PI) of internal carotid arteries in two groups of surgical menopausal women who underwent HRT vs who did not. Measurements of the PIs of internal carotid arteries in both Groups were performed with color Doppler ultrasound. Measurements of the untreated group (n = 38, mean age = 47.10 +/- 2.45, group 1) were compared to those of treated group (n = 42, mean age = 47.35 +/- 2.37, group 2). A statistically significant increase in PIs of the carotid arteries were observed in Group 1 as compared to Group 2 in post-operative follow-up (p < 0.001). Pre- and post-operative PIs in Group 1 measured at significantly different values pre- and post-operatively (right, 0.73 +/- 0.031 vs 0.80 +/- 0.049; left, 0.73 +/- 0.030 vs 0.80 +/- 0.052) (p < 0.001). No such pre- and post-operative difference in PIs were noted among patients in Group 2 (right, 0.74 +/- 0.046 vs 0.73 +/- 0.044, p = 0.200; left, 0.73 +/- 0.04 vs 0.73 +/- 0.04, p = 0.504). When comparing both groups, no statistical difference was noted pre-operatively (right, p = 0.501; left p = 0.625); however, postoperative PIs did reveal a statistically significant difference (p < 0.05). Pre- and post-operative side-to-side differences in the PIs of internal carotid arteries were not statistically significant (group 1, 0.158 vs 0.211; group 2, 0.152 vs 0.356). In surgical menopausal women, the beneficial effects of HRT are in concordance with previous studies in terms of PI, which were performed with natural menopausal women.     

Transmission of human immunodeficiency virus through bone transplantation: a case report.

Human immunodeficiency virus (HIV) can be transmitted through tissue or organ transplantation. Since 1988, eight cases of bone transplantation-associated HIV infection have been reported. We describe a 34-year-old woman with osteoarthritis, who was hospitalized in 1996 because of painful locomotion and deformity in the right knee. An old fracture of the femur and genu varum in the right knee was repaired by open reduction and internal fixation, with allogeneic bone transplantation for defect reconstruction. Five months later, she presented at another hospital with pain and swelling of the right thigh, where screening for HIV was positive. The transmission was tracked to a 50-year-old man with no history of HIV screening, from whom the femoral head was procured when he underwent a hip replacement for left femoral neck fracture. This is the first reported case of HIV infection through bone transplantation in Taiwan, and the preventable nature of this transmission should be underscored.     

Effect of long-term alcohol ingestion on the femoral head of rabbit.

Twenty New Zealand rabbits were chosen for this study (5 for controls and 15 for the alcohol group). In the alcohol group, each rabbit was fed with rice wine (2 g/kg/day alcohol) for 1 year. Bone marrow pressure of the femoral basal neck, erythrocyte sedimentation rate (ESR), liver functions, uric acid, triglyceride, cholesterol, amylase, and blood alcohol level were measured at 0 day, 6 months and 1 year. Finally, the rabbits were sacrificed at the end of the study. The livers and femoral heads were examined for pathology. The bone volume and fat cell size of the femoral head were measured with a computerized "Bone Scanner". The results (1 year comparison) were a significantly higher level of cholesterol in the alcohol group (72 +/- 40 mg% vs 26 +/- 8 mg%, p less than 0.05) and greater bone marrow pressure (27.71 +/- 8.97 mmHg vs 18.20 +/- 4.09 mmHg, p less than 0.05), and no significant difference in triglyceride, uric acid and liver function, ESR, etc., when using Student's 2-tailed t-test. Liver changes (fatty liver) occurred in 3 animals in the alcohol group. The effect of alcohol on the trabecular bone volume was not significant (51.5 +/- 4.6 vol.% vs 50.0 +/- 5.2 vol.%), but the average fat cell size of the femoral head was significantly larger than that for normal controls (2,745 +/- 605 mu2 vs 2,185 +/- 458 mu2, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Vasopressin as an etiologic factor for infection in gynecologic surgery: A randomized double-blind placebo-controlled trial

OBJECTIVE: The purpose of this study was to evaluate the risk of pelvic infection with the use of vasopressin at time of vaginal hysterectomy with a randomized controlled trial. STUDY DESIGN: Women who underwent vaginal hysterectomy and agreed to participate were randomly assigned to pericervical injections of vasopressin or normal saline solution. Surgeons and patients were blinded to the injected substance. Power analysis revealed that a sample size of 116 patients would be sufficient to detect a 4-fold difference in pelvic infection rates between the 2 groups, with 90% power and a probability value of.05. RESULTS: Analysis with 117 patients found no difference in infection rate between the normal saline solution group and the vasopressin groups (7.3% vs 1.6%; P =.19). Estimated blood loss (312 +/- 222 mL vs 446 +/- 296 mL; P =.006) and change in hemoglobin and hematocrit levels (2.1 +/- 1.4 gm vs 2.9 +/- 1.4 gm; P: =.02; and 6.7% +/- 3.4% vs 8.5% +/- 3.8%; P =.01; vasopressin versus normal saline solution, respectively) were significantly less in the vasopressin group. There were no significant differences in interval blood pressure measurements after vasopressin administration between the 2 groups. CONCLUSION: The use of vasopressin during vaginal hysterectomy does not increase the risk of pelvic infection, does decrease operative blood loss, and does not significantly affect blood pressure.     

Favorable outcome following emergency second trimester cerclage.

BACKGROUND: To evaluate the outcome of midtrimester emergency cerclage with or without bulging of membranes. METHODS: A retrospective cohort study of 99 women who underwent emergency second trimester cerclage (16-27 gestational weeks). In 75 women the cervix was dilated and effaced but without bulging of membranes (group 1), and in 24 women the dilation and effacement of the cervix were accompanied by bulging of membranes into the vagina in an hourglass formation (group 2). McDonald technique was applied in all patients. RESULTS: Prolongation of pregnancy was significantly longer in group 1 compared to group 2 (14.3+/-6.5 vs 9.3+/-4.8 weeks, p=0.007). The mean gestational age at delivery was significantly higher in group 1 compared to group 2 (34.6+/-4.6 vs 29.5+/-3.2 weeks, p=0.001). The incidence of chorioamnionitis was higher in group 2 compared to group 1 but statistically insignificant (25% vs 15%, p=0.2). The overall neonatal survival was 83% (82 out of 99 neonates), without statistical difference between the two groups (86% in group 1 and 71% in group 2, p=0.2). CONCLUSIONS: Favorable neonatal outcome may be accomplished in patients with cervical incompetence in the second trimester of pregnancy following cervical emergency suturing even performed when the membranes are bulging through the cervix into the vagina.     

Intramyometrial injection of vasopressin in laparoscopic supracervical hysterectomy

STUDY OBJECTIVE: To investigate the effectiveness of vasopressin in reducing blood loss in laparoscopic supracervical hysterectomy (LSH). DESIGN: Retrospective chart analysis (Canadian Task Force classification II-2). SETTING: University-affiliated teaching hospital. PATIENTS: In all, 143 women who had LSH for benign gynecologic disease. INTERVENTIONS: Laparoscopic supracervical hysterectomy. MEASUREMENTS AND MAIN RESULTS: From January 2001 through December 2006, 143 patients were identified who had consecutive, successful LSH performed by different gynecologic laparoscopists. There were no exclusion criteria. The patients were divided into 2 groups based on whether intramyometrial vasopressin injection was used intraoperatively to reduce blood loss; 77 (54%) patients received intramyometrial vasopressin injection and 66 (46%) did not. The 2 groups were compared with regard to blood loss, operating time, uterine weight, hospital stay, concomitant salpingo-oophorectomy, perioperative complications, and patient characteristics including age, gravity, parity, body mass index, surgical history, and number of cesarean deliveries. No difference existed in the first postoperative day decrease in hemoglobin between the vasopressin and control group (2.3 +/- 0.9 vs 2.1 +/- 1.2 g/dL, respectively, p = .56). No significant difference existed between the groups with respect to operating time (146.9 +/- 52.6 vs 131.9 +/- 42.8 min, p = .07) or uterine weight (145.4 +/- 121.8 vs 119.5 +/- 66.9 g, p = .14). All other parameters and patient characteristics were similar between the 2 groups except for the duration of hospital stay. Patients who received intramyometrial vasopressin injection experienced a slightly longer duration of hospital stay (1.4 +/- 0.7 vs 1.1 +/- 0.4 days, p = .02). CONCLUSION: Our study does not support the routine use of intramyometrial vasopressin injection during LSH to reduce blood loss.