A comparison study between oral morphine syrup and morphine intramuscular injection in premedication.

A randomized single blind clinical trial was carried out in order to compare the effectiveness of oral morphine syrup and injected morphine in premedication of postpartum tubal sterilization by local anaesthesia. A total of 200 postpartum patients were divided into two groups by systemic random sampling. The first group of 100 patients was premedicated with 30 mgs of syrup morphine orally 90 minutes before operation, and the second group of 100 patients was premedicated with 10 mgs of morphine hydrochloride via the intramuscular route 15 minutes before operation. All patients were given tubal sterilization by first- and second- year residents, using the modified Pomeroy technique. The pain experienced by each patient during the operation was evaluated by verbal and numerical rating scales. The pain scores and the operating time of both groups were analysed by the Mann Whitney U test and pair t test, respectively. The pain scores of the first and second group were 3.644 + 1.802 and 3.570 + 1.470, respectively, with no significant difference. The operating time was 10.300 + 1.904 and 11.200+ 2.543 minutes in the first and second group, respectively. The effectiveness of oral morphine syrup and intramuscular morphine in premedication for postpartum tubal sterilization was found to give the same results. The cost-effectiveness of oral morphine syrup is greater and it can therefore replace intramuscular morphine in premedication for postpartum tubal sterilization.

Detection and typing of human papilloma virus DNAs in normal cervix, intraepithelial neoplasia and cervical cancer in Bangkok.

We detected and typed HPV-DNA by polymerase chain reaction (PCR) in cervico-vaginal lavages of 102 women with normal cervical cytology, 57 patients with cervical intraepithelial neoplasia (CIN), and 23 cervical cancer patients. HPV-DNA detection and typing by in situ hybridization were also performed in cervical biopsies from CIN lesions and cancers. Five percent of women with normal cervical cytology, 46% of CIN, and 61% of cervical cancer were positive for HPV-DNA. Of CIN cases with positive HPV-DNA, 69, 15, 8, 4 and 4% were HPV-16, -33, -18, -11 and -16/33 respectively. Of cervical cancer cases with positive HPV-DNA, 86% were HPV-16, 7% were HPV-16/33, 7% were HPV-18/31. HPV typing was performed in biopsies from 37 CIN and 18 cervical cancers by in situ hybridization. By this method, 38% of CIN were HPV-DNA positive, of which 71% were HPV-16 and 7% were each of HPV-11, -18, -31 and -33. Thirty-nine percent of cervical cancers were positive, of which 71% and 29% were HPV-16 and HPV-16/18 respectively.

Accuracy of speculoscopy in detection of cervical neoplasia.

From May 1995 to June 1996, a total of 256 patients with associated gynecologic conditions requiring further cervical biopsy, cervical conization or total abdominal hysterectomy at Siriraj Hospital underwent examination for cervical neoplasia by speculoscopy without prior knowledge of the results of previous Pap smears. Compared with the histological results for the cervix, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and false negative rate of speculoscopy in the detection of cerical neoplasia were 82.0, 84.6, 79.2, 82.1, 81.9, 20.8 and 15.4 per cent respectively. When speculoscopy and Pap smear were combinded, sensitivity increased and the false negative rate decreased. In places where cervical cancer screening by Pap smear are not well established, speculoscopy could be an alternative method offering fair to good results compared with Pap smear.

Diagnostic dilatation and curettage at Siriraj Hospital.

Dilatation and curettage (D & C) was carried out in 914 patients, with abnormal uterine bleeding, who visited GYN-section, Siriraj Hospital between April 1985 and March 1986. The histological results showed that proliferative endometrium was most common (47.5 percent). Endometrial hyperplasia (16.1 percent), secretory endometrium (13.1 percent), atrophic endometrium (9.8 percent) were next in order. Endometrial carcinoma was found in 22 cases (2.4 percent), with 0.39 percent of the women younger than 40 years of age, and 4.94 percent of the women 40 years of age or order. There were 154 patients with previous history of oral or injectable contraceptive use, proliferative endometrium was found in 88 cases (57.1 percent) and no malignancy was found. This study showed that the common cause of abnormal uterine bleeding was anovulatory bleeding. Women who are younger than 40 years of age without risk factors of endometrial cancer, would have an alternative treatment of ateriod hormone, followed by D & C when he uterine bleeding could not be controlled. All woman with previous history contraceptive pills use or DMPA who show no abnormalities finding on pelvic examination.