Pregnancy: Bereavement, grieving and psychological morbidity after first trimester spontaneous abortion: comparing expectant management with surgical evacuation

Early pregnancy loss is a profound adverse life event for manywomen, and increased psychiatric morbidity has been shown tooccur after spontaneous abortion. Dilatation and curettage (D&C)has been the cornerstone in the treatment of first trimesterspontaneous abortion over the last few decades. During recentyears the possibility of conservative management has, however,been increasingly discussed. In a prospective randomized trial,we compared psychological reactions and morbidity, after eitherexpect ant management or D&C, for miscarriages of <13weeks gestation In which a transvaginal ultrasound examinationshowed Intrauterine tissue and/or blood clots with an antero-posteriordiameter of between 15 and 50 mm. Of the 86 patients included,58 were randomized to expectant management and 28 to primaryD&C. In patients randomized to expectant management, pregnancyproducts shown by transvaginal ultrasound disappeared within3 days in 43 cases (74%), whereas 15 patients (26%) underwentD&C owing to retained products of conception after 3 days.At 2 weeks after indusion, all patients answered self-administeredquestionnaires, induding visual analogue scales, concerningtheir experience of the pregnancy loss, the present situationand concerns about the future. A brief anxiety status inventorywas included. This study showed no increase in anxiety or depressivereactions 2 weeks after a first trimester spontaneous abortionwhen these patients were compared with non-pregnant healthyworking females 19–39 years of age. Moreover, there wereno significant differences in psychological reactions betweenpatients managed either expectantly or by D&C.     

子宫内膜增生性病变新分类法的临床应用探讨

为探讨国际妇科病理协会１９８７年制订的子宫内膜增生性病变新分类法的临床应用价值，对１９８９年９月～１９９５年２月我院收治的子宫内膜增生性病变４２４例中的复合性增生２８例和非典型增生５７例进行了分析。结果：５７例非典型增生病变中，轻度１７例、中度１８例、重度２２例。总刮宫率为６３．５％（５４／８５）。≤４０岁组中子宫内膜非典型增生１８例，子宫切除１５例；复合性增生８例，子宫切除３例；＞４０岁组中子宫内膜非典型增生３９例，子宫切除３０例；复合性增生２０例，子宫切除１２例。由此表明子宫内膜增生新分类法可避免子宫内膜增生性病变患者病理上的过分诊断及临床上的过分治疗；术前诊断性刮宫仍是诊断宫内膜病变的主要手段。     

颌骨中心性动静脉畸形的栓塞与手术治疗(附1例报告)

目的探讨颌骨中心性动静脉畸形进行栓塞与手术治疗的效果。方法对1例颌骨中心性动静脉畸形行栓塞结合刮治手术患者,随访30个月,观察其治疗效果。结果栓塞后术中出血量明显减少,单纯刮治维持了原有的面容,随访30个月无复发。结论栓塞加刮治为颌骨中心性动静脉畸形的首选治疗方法。     

保守治疗颌骨大型牙源性囊性病变的临床应用

目的：探讨保守治疗法对颌骨大型牙源性囊性病变的颌面美容效果的影响及其临床应用价值。方法：回顾2001年4月～2006年9月的28例用囊壁部分或彻底刮除术,对可疑角化囊肿和造釉细胞瘤刮除术后再用石炭酸烧灼骨腔创面,囊腔碘仿纱条填塞,术后每日按压原骨质膨隆区,定期更换碘仿纱条和X线检查,随访0.5～3.5年。结果：术后3月面部膨隆畸形消退,经随访X线检查,26例患者囊腔都有不同程度缩小,术后2年,有22例囊腔完全消失,其余4例,骨腔体积仅剩原体积的20%～30%,新骨与正常骨结构一致。结论：保守治疗颌骨大型牙源性囊性病变,手术方法简单,既可以修复面部的膨隆畸形,又可以最大限度地保存颌骨的连续性,防止手术继发畸形,改善咬合关系,是一种有效可行的治疗方法。     

Psychological aspects of vabra curettage in menopause clinics

A study has examined the psychological reactions towards undergoing Vabra curettage in a menopause clinic. An unselected sample of women (n = 30) were assessed pre and post the procedure on a number of pain, stress and attitudinal measures. The results document the pain experienced with this procedure. A range of anxiety levels was evident, with in some cases pronounced anxiety identified. In spite of these negative experiences, attitudes were generally positive towards subsequent curettage and the majority of women were aware of the objectives of this procedure. The results suggest the possibility of attempting to reduce discomfort and anxiety levels. This could be accomplished by psychologically or pharmacologically preparing the patient. The present study offers a model whereby such interventions could be evaluated.     

Effects of subgingival chlorhexidine irrigation on periodontal inflammation

Abstract The purposes of this study were to investigate the effect of direct application of chlorhexidine to periodontal pockets and the practicability of patient self-therapy using a technique of subgingival irrigation. Patients received no other oral hygiene instruction. After initial assessment of parameters, patients were given scaling and polishing and then instruction in the irrigation of designated pockets with chlorhexidine or a placebo using a disposable syringe and blunt needle. During the 28-day irrigation period with chlorhexidine there was a highly significant reduction in periodontal inflammation which was maintained at levels significantly below the baseline values for a further 28-day period without irrigation. There was a deterioration in the periodontal state of those patients who had used the placebo. The irrigation technique itself caused no discernible injury in this group of routine periodontal patients. Also, staining in the chlorhexidine group was minimal. It is concluded that subgingival irrigation with chlorhexidine is effective in reducing periodontal inflammation and in controlling subgingival plaque. Intermittent treatment of this kind by the patient at home might reduce to more manageable levels the frequency of hygiene visits and the need for rigorous interdental oral hygiene.     

Experimental use of a slow release device employing chlorhexidine gluconate in areas of acute periodontal inflammation

Abstract Eleven patients suffering acute exacerbations of chronic periodontitis were treated by the insertion into affected periodontal pockets of dialysis tubing containing 20% chlorhexidine gluconate. After 7 days, 9 of the 11 patients exhibited greatly reduced crevicular fluid flow, relief of discomfort and the cessation of bleeding on probing.     

A comparative clinical study of three periodontal surgical techniques

Abstract A comparative 4-month trial was performed after initial preparation. The procedures used were curettage, replaced flap and apically repositioned flap procedures with osseous recontouring respectively in a split-mouth technique in 17 male and 23 female patients, 22 to 65 years old. Changes were assessed with plaque and gingival indices, and measurements of pocket depths, attachment levels and tissue contours. All procedures reduced pocket depths. Apically repositioned flaps were the most successful, reducing overall mean pockets from 3.5 to 1.9 mm. Changes in attachment levels post-operatively showed only a small degree of variation among the three surgical procedures, and would not affect the choice of the apically repositioned flap as the most effective method for pocket reduction. A marked improvement in tissue contour was obtained in those areas treated by apically repositioned flap procedures and osseous recontouring. Despite failure to improve tissue contour, replaced flap procedures showed an equal degree of success in maintaining plaque control when compared to apically repositioned flaps, as evidenced by static plaque indices. Replaced flap procedures were also the only group to show improved gingival health over the 4-month post-operative period with lower gingival indexes. It would seem that good healing, followed by a high standard of oral hygiene, may overcome the presence of gingival and marginal osseous deformities.     

A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage

BACKGROUND: Medical management and expectant care have been considered possible alternatives to surgical evacuation of the uterus for first trimester spontaneous miscarriage in recent years. AIM: To compare the effectiveness and safety of medical and expectant management with surgical management for first trimester incomplete or inevitable miscarriage. METHODS: Forty women were recruited following diagnosis of incomplete or inevitable miscarriage, and randomised to surgical, medical or expectant care via an off-site, computerised enrollment system. The primary outcome was the effectiveness of medical (vaginal misoprostol) and expectant management relative to surgical evacuation, assessed at 10-14 days and 8 weeks post-recruitment. Infection, pain, bleeding, anxiety, depression, physical and emotional recovery were assessed also. Analysis was by intention-to-treat. RESULTS: Effectiveness at 8 weeks was lower for medical (80.0%) and expectant (78.6%) than for surgical management (100.0%). Two women in the medical group had confirmed infections. Bleeding lasted longer in the expectant group than in the surgical group. There were no significant differences in pain, physical recovery, anxiety or depression between the groups. 54.6%, 42.9% and 57.1% of the surgical, medical and expectant groups respectively would opt for the same treatment again. CONCLUSION: Expectant care appears to be sufficiently safe and effective to be offered as an option for women. Medical management might carry a higher risk of infection than surgical or expectant care.     

Endometrial cancer: can nodal status be predicted with curettage?

OBJECTIVE: To determine whether histologic or molecular markers assessed in pretreatment curettage specimens predict nodal metastasis in endometrial cancer. METHODS: Phenotypic and molecular variables (ploidy, proliferating cell nuclear antigen, MIB-1, p53, HER-2/neu, and bcl-2) were analyzed in preoperative specimens from 82 patients with endometrial cancer who had lymph nodes dissected. These 82 patients had been selected from a total population of 283 patients with endometrial cancer, using a case-cohort design. Weighted logistic regressions were then used to determine significant predictors of positive lymph nodes, and results were estimated for the total population of 283 patients. RESULTS: Of the overall population, 12% of patients were estimated to have positive lymph nodes. Histologic subtype, p53, and bcl-2 each were significantly correlated (P <0.05) with lymph node status. With application of stepwise logistic regression, p53 was the only independent predictor of lymph node status. In addition, a statistical model predictive of positive lymph nodes was generated which incorporated the risk factors p53, bcl-2, and histologic subtype. CONCLUSION: In pretreatment curettage specimens, the presence of unfavorable levels of p53 or bcl-2 or of nonendometrioid histologic features, or combinations of those, significantly predicted lymph node status, thus facilitating the preoperative identification of patients at risk of lymph node metastases.