Accuracy of residual urine measurement in post-operative gynecological patients by normal saline instillation versus Re-catheterization.

A total of 90 post-operative gynecological patients, who needed residual urine measurement were studied in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University between June 1, 1999 and April 30, 2000. Residual urine in each patient was measured by the normal saline instillation technique, followed by re-catheterization which is considered as the gold standard. The accuracy and agreement of the results of residual urine measurement by the two techniques were calculated. In comparison with re-catheterization, the accuracy of the normal saline instillation technique was 83.3%, sensitivity was 66.7%, specificity was 96.1%, positive predictive value was 92.8%, negative predictive value was 79%, false positive rate was 3.9%, and false negative rate was 33.3%. The Kappa coefficient was 0.65 (P < 0.001). No complications from either technique were found. Residual urine measurement in post-operative gynecologic patients by normal saline instillation yielded fair to good agreement with re-catheterization. Due to a high percentage of false negative rate, this new method may not be suitable for current clinical practice. Improvement in the technique and further studies are needed.

Ovarian tumors in children and adolescents: A 10-year review.

This retrospective study reports on 99 young patients (under 20 years) with ovarian tumors treated at Siriraj Hospital over a ten-year period from 1988-1997. The incidence was 5.9% of all ovarian tumors (1,665 cases). Ninety-five patients (96%) were nulliparity. The common presenting symptom was either abdominal mass (42.4%) or abdominal pain (33.3%). More than half of the patients (58.6%) had tumors between 6 and 15 cm in greatest diameter and the bilaterality rate was 12.1%. Fifteen patients (15.2%) had complication of the tumors, 14 of which were torsion. No statistic significant difference in presenting symptom, tumor size, laterality, and complication between benign and malignant tumors was found. Of the total, 77 (77.8%) patients were benign, 18 (18.2%) were malignant and four (4%) were borderline tumors. The frequency of ovarian malignancy correlated inversely with age of the patient (p=0.006). Germ cell, common epithelium, and stromal cell tumors were found in 60.6%, 37.4%, and 2% of patients, respectively. Surgical treatment was conservative in 90.9% and radical in 9.1% of the patients.

Primary ovarian tumors in postmenopausal women: A 10-year review.

This retrospective study reports on 403 postmenopausal women with ovarian tumors treated at Siriraj Hospital over a ten-year period from 1988-1997. Of the total, 206 (51.1%) were benign, and 197 (48.9%) were malignant. Common epithelium was the most common type (77.9%) and germ cell was the second most common tumor (13.9%), found in this age group. The risk of malignancy increased with age of the patient (p<0.001). More than half of the cases had advanced disease (stage III or IV). Nulliparity, absominal distension as the presenting symptom and bilaterality were more commonly found in patients with malignant disease than those with benign tumors. However, tumor size between the tow group was not significantly different.

Higher pregnancy rate with intrafallopian tubal gamete or zygote transfer (GIFT or ZIFT) than intrauterine embryo transfer (IVF-ET).

From November 1996 to September 1998, we had treated infertile couples who required assisted reproductive conception by allocating to either one of the three treatment methods: IVF-ET for those with bilateral tubal obstruction; ZIFT for those with at least one tubal patency but poor sperm ; and GIFT for those with at least one tubal patency and normal sperm (unexplained infertility). The ovarian stimulation protocol was all the same by using GnRH analogue (Suprefactฎ) for pituitary suppression and daily hMG (Metrodinฎ) injection for ovarian stimulation. The oocyte pick up was due when the leading follicle reach 18 mm. For IVF-ET and ZIFT, the fertilization was obtained by conventional in vitro fertilization or by ICSI depending on the sperm quality. Laparoscopic intrafallopian tubal gamete or zygote transfer was preformed on day 0 ( ovum pick up day) for the GIFT or on day 1 for the ZIFT group. Intrauterine embryo transfer was performed on day 2- 3 for the IVF-ET group. Every treatment cycle was conducted by the investigator group to minimize the variation of technical bias. Of all the 213 treatment cycles, 82 were IVF-ET, 92 were ZIFT, and 39 were GIFT. The average female patient age in each groups was not different. The pregnancy rate achieved in the GIFT and ZIFT groups were significantly higher than the IVF-ET group ( 46.2%, 40.2% and 23.2% respectively , p < 0.05). For the pregnancy outcome, the abortion rate seemed to be highest in the IVF-ET group ( 36.8%) whereas the multiple pregnancy rate seemed to be higher in the fallopian tubal transfer group ( 27% for ZIFT and 38.9% for GIFT), although there were no statistical significance. The benefit of the higher pregnancy rate for the intrafallopian tubal transfer treatment group could be due to the more suitable environment for the early stage embryo and the the more synchronize of the endometrial receptivity and the embryo arrival timing provided by the fallopian tube. In conclusion, until the optimal in vitro embryo culture system can be developed, gamete and zygote intrafallopian tubal transfer should yield higher pregnancy rate than intrauterine embryo transfer.

Tubal patency assessment: A comparison of hysterosalpingo contrast sonography (HyCoSy) and chromolaparoscopy.

Twenty nine fallopian tubes from 15 patients were examined for tubal patency using HyCoSy followed by chromolaparoscopy. The mean volume of contrast medium used was 14.3 ml and the duration of HyCoSy was 8.5 minutes. Concordance, sensitivity, specificity, positive predictive value and negative predictive value were 75.9, 44.4, 90.0, 66.7 and 78.3% respectively. The only adverse effect was mild pelvic pain and this was found in 60%. These results suggest that HyCoSy may become an established method for assessing fallopian tubal patency in the future.