ABSTRACT
To determine the role of estrogen replacement therapy [ERT] in the alleviation of climacteric symptoms in surgical menopause. Quasi experimental study. Two years study was conducted from March 2000 to September 2003, from out patient department, of [Menopausal Clinic] at Jinnah Postgraduate Medical Centre, Karachi. Hundred surgical menopausal women were selected who presented with severe climacteric symptoms. After detail history and examination, all patients were investigated to exclude the risk before institution of ERT. Intervention of ERT produced marked improvement in most common symptoms i.e. hot flushes and sweating in 92.9% [C.I. 78-98.9 - p value 0.001] and depression in 81% improved [C.I 56.5 - 95.2 - p value 0.001]. Vaginal dryness improved in 88% [C.I. 64.9 - 98.6]. Insomnia improved 53.3% [C.I. 54.4 - 97.4]. Less common symptoms like dysuria also showed marked improvement after oral estrogen replacement therapy, minimum after 6 months till 2 years of therapy. Short term [<5 years] ERT might be considered for relatively small group of women who experience severe disruptive vasomotor symptoms or severe atrophic vaginitis. But more similar large studies need to be performed for more generalized therapeutic recommendation of ERT
ABSTRACT
To determine the effect of maternal anemia on placental ratio. Cohort study. Unit-1, Department of Gynaecology and Obstetrics 1, Sir Ganga Ram Hospital, Lahore from August 2002 to August 2003. One hundred pregnant women, 50 anemic and 50 having normal range of Hb were included in the study. After delivery, weight of the new born and weight of placenta was recorded. The fetoplacental ratio was calculated for both groups and compared. The mean weight of the newborn [+/-SD] in anemic group was 3.12 +/- 0.45 kg and 3.18 +/- 0.35 Kg in control group. The difference was statistically non-significant [P=0.445]. The mean placental weight of anemic groups was 0.58 /- 0.13 Kg and that of control group was 0.52 +/- 0.088 Kg showing a significant increase [P<0.009]. Feto-placental ratio was 0.193 +/- 0.035 [Mean +/- SD] in anemic patients and 0.166 +/- 0.024 in control group. FP ratio of anemic patients was significantly higher than control group [P<0.001]. This study confirms that anemia during pregnancy is associated with significantly large placental weight and a high fetoplacental ratio
ABSTRACT
Vesicovaginal fistula is a fairly common occurrence in our country because of poor availability of obstetric care. The purpose of this study is to review our results in the surgical management of VVF.Design: Prospective study. Place and duration of the study: The study was conducted in the department of urology, Federal Government Services Hospital [F.G.S.H.]; Islamabad, from February 2002 to January 2004. Patients and Eleven patients were operated for vesicovaginal fistulae. Transvaginal repair was done in 8 [72.7%] patients while transabdominal repair was adopted in 3 [27.3%] patients only. Inclusion criteria: All patients presented with vesicovaginal fistulae only. Exclusion criteria: All patients presented with genitourinary fistulae other than VVFs. The majority of fistulae [10 [90.9%]] were caused by ischaemic necrosis of bladder and vaginal walls resulting from obstructed labour. One [9.1x] patient developed VVF after hysterectomy due to some gynaecological problem. Surgical repair proved to be successful through transabdominal route in all 3 [100%] cases of VVFs while in 6 [75x] of 8 [100%] cases through transvaginal route. To describe an overall result, 9 [81.8%] vesicovaginal fistulae were successfully repaired at first attempt. Vesicovaginal fistulae can be best managed following basic surgical principles like adequate exposure, identification of structures, wide mobilization, tension free closure, good haemostasis and uninterrupted bladder drainage