Sonographic findings of uterus and ovaries in normal pre- and post-menopausal women.

To investigate the significant findings of ultrasonography before hormonal replacement therapy (HRT) was given in normal pre- and post-menopausal women. Sixty eight Thai pre- and post-menopausal women with no previous HRT were recruited into the study, They were divided into 22 pre-menopausal women (group I), 28 post-menopausal women of < or = 5 years (group II) and 18 post-menopausal women of > 5 years (group III). Their mean age was 48.2, 50.2 and 57.3 years, respectively. Myoma uteri was found in 10 (45.5%), 2 (7.1%) and 1 (5.6%) in group I, II and III. There were 2 (9.1%), 3 (10.7%), 3 (16.7%) cases of ovarian tumor in these three groups respectively. The detection rate of ovaries from ultrasound was 90.7 per cent in group I, 89.1 per cent in group II and III. The corpus to cervix ratio in the three groups was 2.3, 2.4 and 2.3, respectively. Uterine volume in nulliparous and multiparous pre-menopausal women was 56.6 ml and 74.2 ml, but in group II and III were 60.1 ml and 37.1 ml respectively. Endometrial thickness was significantly different in group I, II and III (7.2, 4 and 2.9 mm.) Left and right ovarian volume of group I was significantly larger than that of group II and group III. In conclusion, the ultrasonography is highly recommended to detect uterine and ovarian abnormalities before HRT is given in pre- and post-menopausal women.

Prophylactic oophorectomy of benign uterine disease in premenopausal women: 11 years review.

Between 1982 and 1992, 695 consecutive abdominal hysterectomies and prophylactic oophorectomies in premenopausal women for benign uterine diseases were performed in our department. The trend of prophylactic oophorectomy has declined since 1988 to a minimum in 1990. 60 per cent were 41-45 years of age, 28 per cent were more than 46 years, 12 per cent were 36-40 years. Uterine fibroid was the most frequent indication (77.7%), followed by adenomyosis (21.0%). Ovarian histologies revealed abnormalities only in 1.3 per cent of the removed ovaries, the remainder appeared to be normal.

An evaluation of glycosylated hemoglobin measurement by a colorimetric method as a screening test for gestational diabetes mellitus.

To assess the potential value of glycosylated hemoglobin measurement (HbA1) in screening for gestational diabetes mellitus (GDM), HbA1 by a colorimetric method, plasma glucose level 1 hr after 50 g oral glucose loading, and 3-hr 100 g oral glucose tolerance test (3-hr OGTT) were performed in 334 pregnant women at Ramathibodi Hospital. These subjects carried high risk factors of GDM. Gestational ages varied from 24 to 38 wks. Twenty-four cases were diabetic (7.2%) by O'Sullivan and Mahan's criteria (1964). As a screening test to select subjects for 3-hr OGTT, plasma glucose level 1 hr after 50 g oral glucose load (plasma glucose level 7.8 mmol/L and above) has sensitivity: 87.50 per cent, specificity: 64.19 per cent. HbA1 level of 5.60 per cent (upper 95% confidence limit of the mean) and above yield sensitivity: 66.67 per cent, specificity: 61.29 per cent. Thus, glycosylated hemoglobin measurement as a screening test for GDM is not as effective as the conventional 50 g oral glucose loading test.

Detection of human immunodeficiency virus type 1 (HIV-1) proviral DNA in breast milk and colostrum of seropositive mothers.

There is increasing evidence of vertical transmission of HIV-1 to infants through breast feeding of milk from HIV-1 infected mothers. It has been postulated that transmission occurs mainly via ingestion of infected cells in breast milk and colostrum. In this study, detection of HIV-1 proviral DNA was used to prove that cells from colostrum and milk do contain HIV. DNA were extracted from these cells of colostrum and milk of 18 seropositive mothers and amplified by nested PCR for HIV-1 gag and pol and 44 per cent were positive mostly by two primers. All ten negative control samples from seronegative mothers were negative. This study demonstrated the infectivity of breast milk and colostrum. Nevertheless, recommendation against breast-feeding should be weighed against poor alternatives in low socioeconomic families.

Prevalence of positive anti-HIV in pregnant women at Ramathibodi Hospital.

Anti-HIV screening has routinely been done at the antenatal clinic in Ramathibodi Hospital since January 1990. The prevalence of positive anti-HIV during the first and second half of 1990, and the first half of 1991 are 0.056, 0.2, 0.24 per cent respectively. Twenty positive cases are now under counselling. Age range is between 18-35 years. Seventeen cases are from rural areas. Twelve of seventeen cases were from the north-eastern part of Thailand. Fifteen cases (71.4%) had their pregnancies terminated. This study shows that the prevalence of positive anti-HIV is increasing. Vertical transmission has already been known to be one of the most important and serious transmissions to newborns and infants. The data indicated that screening test for anti-HIV in pregnant women, previously regarded as a low risk group, should be reviewed and routinely done.

Diagnosis of placenta previa by ultrasonography: a review at Ramathibodi Hospital.

From 1,000 ultrasonographic examinations reviewed there were 80 (8%) done for the exclusion of placenta previa. Only 83.6 per cent of these had complete medical records and were the subjects of this study. The most common reason for requesting ultrasonography was antepartum hemorrhage (79.1%). False-positive and false-negative of the report were 16.7 per cent and at least 4.2 per cent respectively. Based on the theory of placental migration it can be recommended that a minor degree of placenta previa diagnosed in the early stage of pregnancy does not need follow-up scanning while the diagnosis of placenta previa totalis follow-up scanning is imperative. A judicious decision in the combined usage of ultrasonography and double-set-up technique can reduce the risk of brisk bleeding and unnecessary cesarean section.

Efficiency of modified medium for direct chromosome preparation of the chorionic villi.

The direct chromosome preparation from the CV is a reliable method for diagnosis of the gross chromosomal anomalies and could be completed in the shortest possible time. However, direct villi preparation does not always provide sufficient or good quality metaphases. The culture medium plays an important role in achieving a good success rate. We report the efficacy of our modified medium and compared it with Chang's. The modified medium showed slightly higher successful karyotyping (68.4%) than the Chang medium (65.4%). This success rate showed no statistically significant difference. The success rate enhanced up to 92.3 per cent using our modified medium when the CV was of good quality. The higher amount of CV did not lead to a higher success rate. Any amount more than 5 mg of the CV was sufficient for direct chromosome preparation.