Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis.

OBJECTIVE: To compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis. METHODS: A retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes-including operative time, blood loss, length of hospital stay, and need for blood transfusion-were analyzed and compared between the 2 treatment groups. RESULTS: Operative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P<0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [P<0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [P<0.001]; and 18.3% versus 49.0% [P<0.001], respectively). CONCLUSION: Compared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.

Unexpected ovarian malignancy after conservative laparoscopic surgery: five case series in a half decade of experience.

AIMS: To analyse and describe cases of unexpected ovarian malignancy after conservative laparoscopic surgery for an apparent benign ovarian mass at our centre. METHODS: This retrospective study was performed by collecting data from records of premenopausal women who underwent conservative laparoscopic surgery for benign ovarian mass at Siriraj Hospital over a 5 year period from 2006 to 2010. The rate of unexpected malignancy, histopathological type of the ovarian neoplasm and follow-up after surgery were reviewed. RESULTS: During the study period, 1,161 patients underwent conservative laparoscopic surgery. Of these, five (0.43%) had ovarian malignancy which were diagnosed after reviewing histopathological report postoperatively. The histopathological diagnosis was borderline tumour in two patients, clear cell carcinoma, granulosa cell tumour and mucinous cell adenocarcinoma in the other three patients. All patients are alive after a mean follow-up of 9-60 months with two patients developed recurrence. CONCLUSION: The main concern for laparoscopic management of ovarian masses is unexpected malignancy. However, with careful patient selection, proper technique and an experienced operator, laparoscopic treatment of ovarian masses is the best approach and should be implemented, with low risk of unexpected malignancy and recurrence.

Association between HSV-2 and HIV-1 viral load in semen, cervico-vaginal secretions and genital ulcers of Thai men and women.

We studied the association between herpes simplex virus type-2 (HSV-2) and HIV-1 viralload in plasma, semen, cervico-vaginal secretions and genital ulcers. Forty-seven (68%) men and 57 (80%) women were HSV-2 antibody positive, of whom 12 (26%, 95% confidence interval [CI] 20, 32) and five (8%, 95% CI 4, 12), respectively, had HSV-2 genital shedding detected by polymerase chain reaction. The mean HIV-1 seminal and cervico-vaginal viral loads did not differ significantly according to the presence of HSV-2 shedding. Eleven men and 15 women presented with genital ulcers; all ulcers were due to HSV-2. Ten men and nine women were followed up over six days: the mean (95% CI) HIV-1 log viral load copies/mL in the genital ulcers at baseline and final visits were 2.5 (2.3, 2.7) and 3.1 (2.0, 4.2) for men and 3.0 (2.6, 3.4) and 2.7 (2.3, 3.1) for women. These findings do not support the hypothesis that HSV-2 increases the HIV-1 viral load in genital secretions.

High prevalence of cervical squamous cell abnormalities among HIV-infected women with immunological AIDS-defining illnesses.

AIM: To assess the results of Pap smear at postpartum scheduled visit, especially the prevalence of squamous cell abnormalities including association with CD4(+) T-lymphocyte count (CD4(+) count) levels at delivery among HIV-infected women between the years 1996 and 2004. METHODS: As part of the research and implementation programs of short course antiretroviral regimens for the prevention of mother to child perinatal HIV transmission in HIV-infected pregnant women delivered at Siriraj hospital, CD4(+) count at delivery and Pap smear at postpartum were evaluated. RESULTS: Among 636 women, 13.3% had squamous cell abnormalities. Seventy-seven cases (90.6%) of squamous cell abnormalities were low grade squamous intraepithelial lesions. The prevalence of squamous epithelial cell abnormalities detected by Pap smear, was higher in women whose CD4(+) count at delivery was < 200 cells/microL than in women whose CD4(+) count at delivery was > or = 200 cells/microL, with a significant difference (21.2%vs 12.2%). CONCLUSIONS: All HIV-infected pregnant women should be evaluated for clinical and immunological status during the antepartum period. Pelvic examination and Pap smear should be considered as a part of this evaluation. They should receive comprehensive health-care services that continue after pregnancy, including postpartum gynecologic examination and Pap smear. Women with normal cervical cytological findings but low CD4(+) count should be offered an antenatal Pap smear and long-term follow-up including a 6-monthly Pap smear.

Lack of resistant mutation development after receiving short-course zidovudine plus lamivudine to prevent mother-to-child transmission.

A short-course regimen of zidovudine plus lamivudine starting from 34 weeks' gestation in pregnant women to prevent mother-to-child HIV infection, and discontinued after delivery, was evaluated for the development of resistance at 6 weeks postpartum. No resistant mutation was found in 32 women. One of the three infected infants carried the M184V and K219Q mutations.

Laparoscopic cystectomy of an ovarian mucinous cystadenoma in a 12-year-old girl: a possible role of operative laparoscopy for a huge benign adnexal mass.

The case of an obese 12-year-old girl with a huge and mobile pelvic cystic mass is presented. After ultrasonography and determination of tumor markers, a right huge benign adnexal mass was suspected. In order to avoid exploratory laparotomy because severe pain and a large operative scar were expected, an operative laparoscopy was performed. No intra-operative and post-operative complications were observed. With the uneventful recovery, only a one-day hospital stay was needed. Neither residual nor recurrent evidence was suspected after 2-, 6-, 12-, 18- and 24-months follow-up. With proper case selection, good pre-operative counseling and the operation performed under familiarity and good training in laparoscopy, laparoscopic management of a huge suspected benign adnexal mass is technically feasible. The benefits are reducing hospital stay, lowering morbidity, especially less pain and cosmetic acceptance of the operative scar.

Relationship between human papilloma virus infection and abnormal Pap smear in HIV-seropositive women at Siriraj Hospital.

The purpose of this prospective study was to determine the prevalence of human papillomavirus and abnormal Pap smear in HIV-seropositive women, particularly in HIV-seropositive women who undertook antiretroviral drug. The consecutive series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics and Gynecology, Siriraj Hospital. All general information and laboratory results of the patients were recorded. Pap smears are obtained from the endocervix, cervical transformation zone and vagina by using a cotton tip stick and Ayre spatula, as described in the VCE technique. The patients were assigned into two groups, the AZT and non-AZT group. The comparison between the groups was calculated statistically. It was found that 88 of 178 HIV-seropositive women (49.4%) undertook Zidovudine. The prevalence of abnormal Pap smear in HIV-seropositive women, who had an abnormal Pap smear, was 59.6 per cent. However, the prevalence of human papillomavirus infection detected by Pap smear was reported in 17 patients (9.6%). There was no difference between the AZT and non-AZT group statistically. There was a significantly higher probability of finding an abnormal Pap smear for cervical dysplasia in HIV-seropositive women who were infected with human papillomavirus compared to. It is concluded that there is a higher risk of developing cervical dysplasia in HIV-seropositive women who carry the human papillomavirus.

A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok.

OBJECTIVES: To examine the impact of high-dose multiple micronutrient supplementation on survival and disease progression among HIV-infected individuals in Thailand. DESIGN: Randomized placebo-controlled trial. METHODS: Four-hundred and eighty-one HIV-infected men and women living in and around Bangkok with CD4 cell counts in the range 50 x 10(6)- 550 x 10(6)/l were randomized to receive micronutrients or placebo for a period of 48 weeks. Trial participants were examined clinically 12-weekly and tested for CD4 cell count 24-weekly. A subset were tested for HIV plasma viral load at 48 weeks. RESULTS: Seventy-nine (16%) trial participants were lost to follow-up and 23 (5%) died. The death rate was lower in the micronutrients arm with the mortality hazard ratios [95% confidence interval (CI)] of 0.53 (0.22-1.25; P = 0.1) overall and 0.37 (0.13-1.06; P = 0.052) and 0.26 (0.07-0.97; P = 0.03) among those with CD4 cell counts < 200 x 10(6)/l and < 100 x 10(6)/l respectively. There was no impact on CD4 cell count or plasma viral load. CONCLUSIONS: Multiple micronutrient supplementation may enhance the survival of HIV-infected individuals with CD4 cell counts < 200 x 10(6)/l. This could have important public health implications in the developing world where access to antiretrovirals remains poor. The clinical findings need to be reproduced in other settings and the mechanism, which appears to be independent of change in CD4 cell count, merits further investigation.

Short-course therapy with zidovudine plus lamivudine for prevention of mother-to-child transmission of human immunodeficiency virus type 1 in Thailand.

To evaluate the efficacy and safety of short-course therapy with zidovudine plus lamivudine for reduction of perinatal transmission of human immunodeficiency virus type 1 (HIV-1), a single-arm, open-label, prospective, nonrandomized study was conducted. One hundred six treatment-naive pregnant women received zidovudine (300 mg) plus lamivudine (150 mg) twice daily from week 34 of gestation until the onset of labor. During labor, zidovudine and lamivudine were given every 3 h. Neonates received zidovudine syrup for 4 weeks and were bottle fed. The median maternal virus load and CD4+ cell count at weeks 32-34 of gestation were 4.33 log10 copies/mL and 274 cells/mm3, respectively. At delivery, the mothers' mean decrease in virus load was 1.55 log10 copies/mL and the mean increase in CD4+ cell count was 93 cells/mm3, compared with enrollment levels. Three neonates were HIV-1 infected, for a transmission rate of 2.83% (95% confidence interval, 1%-8%). There were no serious adverse events in the mothers. Adverse events noted in neonates were anemia (in 6 neonates), elevated transaminase levels (in 1), and thrombocytopenia (in 3). Short-course therapy with zidovudine plus lamivudine appeared to be safe and effective for prevention of perinatal transmission of HIV-1.