ABSTRACT
OBJECTIVE: Several randomised controlled trials have been published in the last few years which evaluated the efficacy of various analgesics in reducing visual analogue (VAS) pain scores during intrauterine device (IUD) placement. Their results seem to be conflicting and inconclusive. METHODS: We searched Medline (1966-2013), Scopus (2004-2013), Clinicaltrials.org (1997-2013), Popline (1973-2013), Cochrane CENTRAL (1999-2013) and Google Scholar (2004-2013) engines for published randomised controlled trials, as well as the reference lists from all electronically retrieved studies. RESULTS: Thirteen studies, involving 1353 women, were finally included in the present meta-analysis. Among the products used, and with respect to their mode of delivery, only paracervical lidocaine was effective in producing lower VAS pain scores related to tenaculum placement (mean difference [MD]: - 20.54; 95% confidence interval [CI]: - 39.92, - 1.15) and IUD insertion (MD: - 28.99; 95% CI: - 53.14, - 4.84). Misoprostol produced higher VAS pain scores for the immediate post-insertion period (MD: 2.83; 95% CI: - 0.79, 6.45) and it caused various side effects. CONCLUSION: Paracervical administration of lidocaine prior to IUD insertion reduces VAS pain scores. In view of the small number of studies assessing its efficacy further studies should confirm our findings.
Subject(s)
Analgesia/methods , Intrauterine Devices , Pain/prevention & control , Prosthesis Implantation/adverse effects , Anesthetics, Local/administration & dosage , Female , Humans , Lidocaine/administration & dosage , Misoprostol/administration & dosage , Oxytocics/administration & dosage , Pain/etiology , Pain Measurement , Prosthesis Implantation/methods , Randomized Controlled Trials as TopicABSTRACT
Dehydration during pregnancy may be harmful for the mother and fetus; thus our objective was to understand whether pregnant women balance water intake and loss. The Water Balance Questionnaire (WBQ) was modified to reflect pregnancy (WBQ-P). Validation was performed using 3-day diaries (n = 60) and hydration indices in urine (osmolality, specific gravity, pH and color, n = 40). The WBQ-P was found valid according to Kedhal τ-b coefficient agreement. The WBQ-P was administered to 95, 100 and 97 women per trimester, in Greece. Median (IQR) water balance, intake and loss were, respectively, 203 (-577, 971), 2917 (2187, 3544) and 2658 (2078, 3391) ml/day; these did not differ among the trimesters or between pregnant and non-pregnant women. However, more pregnant women were falling in the higher quartiles of water balance distribution. No differences in sources of water intake were identified except that women in the third trimester had lower water intake from beverages.
Subject(s)
Body Water/metabolism , Dehydration/metabolism , Drinking , Surveys and Questionnaires , Water-Electrolyte Balance , Adult , Beverages , Color , Female , Greece , Humans , Hydrogen-Ion Concentration , Osmolar Concentration , Pregnancy , Pregnancy Trimesters , Specific Gravity , UrinalysisABSTRACT
Mucocele of the vermiform appendix is a rare entity that may mimic a right-sided adnexal mass. We describe a case of appendiceal mucocele in a 78-year-old woman that was initially misdiagnosed as a potentially malignant right ovarian tumor and briefly review the literature on sonographic features of this entity. It is important to improve preoperative diagnosis so as to prevent rupture of mucocele at surgery, which may lead to pseudomyxoma peritonei, and also to seek intraoperatively for the presence of synchronous colorectal neoplasms.
Subject(s)
Appendiceal Neoplasms/diagnostic imaging , Appendix/diagnostic imaging , Diagnostic Errors , Mucocele/diagnostic imaging , Ovarian Neoplasms/diagnostic imaging , Ultrasonography, Doppler/methods , Adnexal Diseases/diagnostic imaging , Adnexal Diseases/pathology , Aged , Appendectomy/methods , Appendiceal Neoplasms/pathology , Appendix/pathology , Diagnosis, Differential , Female , Humans , Hysterectomy/methods , Laparotomy/methods , Magnetic Resonance Imaging/methods , Mucocele/pathology , Ovarian Neoplasms/pathology , Risk Assessment , Treatment Outcome , Uterine Prolapse/diagnostic imaging , Uterine Prolapse/surgery , VaginaABSTRACT
OBJECTIVE: To identify and compare risk factors among endometrial cancer patients ≤40 years of age, postmenopausal women with the same malignancy and women ≤40 years without malignancy. DESIGN: Retrospective case-control study. SETTING: Athens University, department of obstetrics and gynecology of a tertiary hospital serving a mainly urban population. POPULATION: Endometrial cancer patients ≤40 years (study group, n = 40), postmenopausal women with the same malignancy (positive controls, n = 40) and women ≤40 (negative controls, n = 40) without endometrial cancer. METHODS: Clinical history, treatment and follow-up of patients were evaluated. Factors studied included age, histology, stage, grade, lymphovascular space involvement, body mass index (BMI), cytology, lymph node status, parity, smoking, family history, hypertension recurrence and survival. MAIN OUTCOME MEASURES: Differences in risk factors and characteristics. RESULTS: Nulliparity, smoking and hypertension were significantly related with endometrial cancer in the study group compared to positive controls (p = 0.001, p < 0.01 and p < 0.001, respectively). BMI >30 significantly characterized patients in the study group compared to negative controls (p = 0.006). Finally, irregular menstruation and family history of cancer were observed more often in the study group compared to both control groups. Stage, grade, myometrial invasion, lymphovascular space involvement and lymph node status were comparable between the study and positive control groups. CONCLUSION: Nulliparity, obesity, unstable menstruation, smoking and cancer in the family are strongly correlated with endometrial cancer risk in women ≤40 years.