Interruption of early pregnancy with mifepristone in combination with gemeprost.

BACKGROUND: Mifepristone in combination with prostaglandin has been used since 1988 for induction of early abortion. The aim of the present investigation was to assess the tolerance and efficacy of 600 mg. mifepristone orally followed by gemeprost 1 mg. vaginally either 24 hours (group one) or 48 hours (group two) later. METHODS: Sixty-four healthy women applying for abortion within the first 8 weeks of pregnancy were randomly allocated to one of the two treatment groups. Intrauterine pregnancy and gestational age were verified by ultrasonography. Symptoms after administration of mifepristone and gemeprost were recorded, and the patients observed at the hospital for at least three hours after prostaglandin-insertion. Blood samples for blood group, hemoglobin, beta-chorion-gonadotrophin, aspartate-aminotransferase and creatinine were drawn. RESULTS: Outcome was established by gynecological examination, the level of beta-hCG and ultrasonography, at visits one, two and if necessary three to four weeks later. Surgical curettage was performed in case of incomplete abortion, of which there were four in the 24-hour interval group and five in the 48-hour interval group with a success rate (complete abortion) of 55 out of 64 patients (86%). CONCLUSIONS: There was no difference in efficacy or side effects whether the prostaglandin was administered 24 or 48 hours after mifepristone intake, which suggests that the treatment period can be reduced from the conventional 48 hours.

Risk of haemorrhage from transurethral prostatectomy in acetylsalicylic acid and NSAID-treated patients.

Postoperative bleeding in patients who regularly ingest acetylsalicylic acid (ASA) has been reported after several types of surgery. However, data on the influence of ASA on the risk of haemorrhage from transurethral prostatectomy (TUR-P) have been conflicting. We have studied retrospectively the unselected clinical records of all patients undergoing TUR-P in the Department of Urology at Hvidovre Hospital (during 1992-1994) with special focus on the use of ASA and non-steroidal anti-inflammatory drugs (NSAIDs). In total, 457 records were examined: 99 patients on ASA/NSAID received 42 units of blood, while 358 patients free from such medication received 68 units of blood, a significantly smaller amount (p = 0.0390). We conclude that ASA and NSAIDs increase the risk of bleeding during and after TUR-P, and we recommend the withdrawal of these drugs for one week before TUR-P.

Extracorporeal shock wave lithotripsy as first line monotherapy of solitary calyceal calculi.

Eighty-four patients with solitary calyceal stones were treated with Extracorporeal Shock Wave Lithotripsy (ESWL) as first line monotherapy. The indications for treatment were pain in 51 patients (61%), infection in 11 patients (13%), pain and infection in 18 patients (21%) and others in 4 patients (5%). Stone size (largest diameter) was median 9 mm (range 2-25 mm). Follow-up consisted of clinical control, isotope renography and a plain film after 1 month; hereafter plain films after 3 and 6 months. Auxiliary procedures due to steinstrasse were performed in 3 out of 4 patients (1 nephrostomy, 1 nephrostomy + ESWL of ureteral fragments, and 1 ureteroscopic manipulation). Retreatment of the calyceal stone was performed in 3 patients within 6 months (2 re-ESWL, 1 lower pole resection). Stone-free (without retreatment or auxiliary procedures) were 26/84 (31%) after 1 month, 34/84 (40%) after 3 months and 38/84 (45%) after 6 months. Free of pain were 43/69 (62%) after 1 month, 50/69 (72%) after 3 months and 59/69 (86%) after 6 months. Free of infection were 18/29 (62%) after 1 month, 19/29 (66%) after 3 months and 21/29 (72%) after 6 months. Complications included steinstrasse in 4 patients, sepsis in 3 patients, displacement of JJ-stent in 2 patients and atrio-ventricular dissociation in 1 patient. To conclude: ESWL as first line therapy for solitary calyceal calculi offers good results with regard to pain and clearance of infection, but leaves 55% with residual stone material.

Stripping of the distal ureter in association with nephroureterectomy. Evaluation of the method.

Nephroureterectomy is the standard treatment for transitional cell tumours of the renal pelvis. A single-incision surgical technique with use of a vein stripper to remove the distal ureter is evaluated. The method proved to be safe. There was no evidence of increased immediate or long-term risks, including extravesical recurrence of tumour. The method can be recommended for patients with renal pelvic papilloma and probably also for tumours in the upper part of the ureter, but should not be used when there is tumour in the distal ureter.

Prostatic abscess. A review of literature and a presentation of 5 cases.

Abscess of the prostate has become increasingly rare due to modern antibiotics and a decreasing incidence of gonococcal infections. It is still difficult to diagnose the disorder on clinical grounds. Ultrasound examination is recommended. The preferred treatment is nowadays transurethral prostatic resection. We report 5 cases from a urologic department, during a period of 12 years.

[Stab wounds and lacerations among operating room personnel]. / Stik- og snitlaesioner hos operationspersonale.

In order to illustrate frequency of peroperative accidental needle-stick injuries and lacerations among operation theatre staff, the theatre staffs in the Central Hospital in Hillerød (CH), the County Hospital in Roskilde (ASR) and the St. Elisabeth Municipal Hospital in Copenhagen (SE) were requested to complete a questionnaire after every operation in which they had participated. This investigation took place during a period of three months in CH and two months in ASR and SE. A total of 861 questionnaires were completed with a percentage of replies of 54.4. Of these, 355 (41%) were gynaecological/obstetric interventions, 297 (35%) orthopaedic surgical interventions and 188 (22%) general surgical while 21 (2%) were unspecified. A total 187 (21.7%) cases of holes in the gloves, 47 (5.5%) accidental needlesticks and two (0.23%) accidental lacerations. The frequency of needlestick injuries was greater during gynaecological operations than with the orthopedic surgical and general surgical operations. No differences were observed in the average durations of operation in cases of lesion or total number of lesions. Among the operations, 657 (76.3%) were elective operations, 168 (19.5%) were emergencies and 36 (4.2%) were unspecified. Thirty (4.6%) of the needlestick injuries occurred during the elective interventions and 14 (8.3%) during the emergency operations. As a rule, it was the operating surgeon who injured himself with a needle and the commonest site of the lesion was the pulp of the left index finger. Only one of these lesions had been notified as an occupational injury.

Prediction of ovulation.

The purpose of this investigation was to evaluate all available ovulatory diagnostics with respect to sensitivity, specificity, diagnostic specificity (predictive value of a positive test, PVP) and diagnostic sensitivity (predictive value of a negative test, PVN). Twenty-one ovulatory women with more than 3 years of infertility problems were included in the study. PVP and PVN were highest for detection of urinary luteinizing hormone (LH) peak at ovulation (PVP = 90%, PVN = 95%) and for serum-estradiol peak 1 day before ovulation (PVP = 83%, PVN = 97%). The predictive values were lower for all other tests. The PVP (54%) and PVN (90%) were rather low for detection of ovulation with vaginal electric impedance. However, all ovulations were predicted when urinary LH peak and vaginal impedance were combined. Two women were stimulated with human chorionic gonadotropin to investigate a possible connection between the LH peak and the preovulatory vaginal electric impedance. No close connection between them could be demonstrated. Basal body temperature should not be used for the prediction of ovulation (PVP = 25%). We suggest that ovulation should primarily be predicted from the identification of the urinary LH peak and that other methods be supplementary.

Ultracentrifuge schlieren photographs: automatic analysis.

Schlieren photographs can be digitized and stored in a computer's memory. A computer program then interprets and measures the Schlieren curve and calculates molecular properties.