ABSTRACT
Abnormal uterine bleeding poses a real challenge for the gynecologists Dilatation and curettage has been the gold standard for differentiating benign from malignant endometrium. Hysteroscopy and laparoscopy are the recent addition to the armamentarium of investigations for abnormal uterine bleeding. This study was done to evaluate the role of hysteroscopy and laparoscopy in 75 women with abnormal uterine bleeding. Hysteroscopy findings were compared with histopathology in the diagnosis and etiology of abnormal uterine bleeding. Majority of the patients presented with menorrhagia (40%) and metrorrhagia (20%). Hysteroscopy showed abnormality detection rate of 66% as compared to 26.6% with traditional curettage. Diagnostic accuracy of hysteroscopy was higher in patients with polyps and myoma. Hysteroscopy allows the exclusion of intra uterine pathology with greater precision. Hysteroscopy is superior to curettage, though not a substitute for tissue diagnosis. Laparoscopy was performed in 50 cases including 16 of coexistent infertility, 25 cases with normal hysteroscopy findings and in 9 patients symptoms and signs indicative of pelvic inflammatory diseases were present. An abnormaliity was detected in 40% of these cases in the form of adhesions, leiomyomas, ovarian cysts, misplaced IUCDs and endometriosis. Thus laparoscopy can be complimentary to hysteroscopy in evaluation and management of patients with abnormal uterine bleeding.
ABSTRACT
It has been estimated that one third of postmenopausal women in the U.S. use Hormone Replacement Therapy (HRT) to treat symptoms of menopause and prevent chronic conditions. In developing countries HRT use is not so common but there is an increasing trend in its use. It has been seen that women with better socio-economic status, higher education and urban population use HRT. It is important that benefits and harms of HRT based on scientific evidence should be considered when prescribing HRT. The health care workers should prepare themselves for a better dialogue with women including information about alternative treatment. OBJECTIVE: To review the available evidence on benefits and harms of HRT. METHODOLOGY: A Medline search was done for papers published in English language between 1990 to 2003, with abstracts available. The limitations set were original articles and reviews. The key words used were Menopause, Hormone Replacement, HRT, and ERT. The local libraries were searched and email requests were sent for full text articles. 10 full text articles were available, mostly review and large studies, which were studied in more detail. Some textbooks and reference books for gynaecology were also reviewed. RESULTS: Beneficial effects of HRT on vasomotor symptoms have been supported by various studies, but HRT to treat negative mood is not recommended. A systematic review of Cochran database showed little evidence regarding the effect of hormone replacement therapy or oestrogen replacement therapy on overall cognitive function in healthy postmenopausal women. Oestrogens and androgens have significant beneficial effects on skin collagen, but do not prevent the effect of aging on elastic tissue and have limited use in the prevention and treatment of skin changes of menopause. Short-term benefits have been shown for urogenital atrophy. Recent evidences suggest that benefits of HRT include prevention of osteoporotic fractures, and colorectal cancer while prevention of dementia is uncertain. Harms include Coronary Heart Disease (CHD), stroke, thromboembolic events, breast cancer, with 5 or more years of use, and cholecystitis. It is recommended that the regimen should not be initiated or continued for primary prevention of coronary heart disease. In women with CHD, it should not be used for secondary prevention of CHD events. Active living, alternative therapies and consumption of food rich in phyto-oestrogens are some areas, which need to be explored in more detail. CONCLUSION: Patient preferences as well as evidence are important to initiate and/or continue HRT. Benefits and harms need to be re-addressed periodically to apply newly published evidence and to reassess emerging risk, co-morbidities and need of individuals.
Subject(s)
Aged , Estrogen Replacement Therapy , Female , Humans , Middle Aged , Risk Assessment/methodsSubject(s)
Hepatitis C/transmission , Humans , Needlestick Injuries , Nepal , Periodicals as Topic , Quality ControlABSTRACT
Incidence of immune hydrops fetalis is decreasing with the liberal use of anti-D immunoglobulin, but this condition has not been eradicated. We report here a case of immune hydrops fetalis with meningocele detected on ultrasonography.
ABSTRACT
A rare case of ectopia cordis with unusual associated anomalies detected during antenatal ultrasonographic examination is presented.
ABSTRACT
Present study was conducted on 40 patients to assess the role of Foley`s catheter in improving crvical score prior to induction of labour. Patients consisting of primigravidae and multiparae, rquiring induction of labour for various conditions-postmaturity, pre-eclampatic toxaemia, intrauterine growth retardation, pregnancy with bad obstetrical history were included in the study. Eoley`s patient was subjected to cervical scoring by Bishop`s score prior to and afrer the procedure. Foley`s self retaining catherer No. 20 was inserted extramniotically upto the level of internal os and was rmoved after 24 hours. Ir was found that Foley`s catherer improved the cervical score to 10.50 ± 2.17 with mean induction –delivery interval of 9.72 hours.