Christine Felding

Influence of alcohol intake on postoperative morbidityafter hysterectomy

Summary Postoperative morbidity after hysterectomy was prospectively studied in 229 consecutive patients in ourdepartments. The incidence of alcohol abuse (>60 gm of alcohol daily) and social drinking (between 25 and 60 gm of alcohol daily) was 6.5% for each. When compared with the social drinkers and the control group, the alcohol abuse group had significantly more complications (80% vs 27% and 80% vs 13%, respectively)

Preoperative treatment with oestradiol in women scheduled for vaginal operation for genital prolapse. A randomised, double-blind trial

OBJECTIVE To disclose a clinical and histopathological effect of local low-dose oestradiol treatment on the vagina. DESIGN A randomised, double-blind trial. SETTING Two gynaecological departments at University Hospitals. SUBJECTS Forty-eight postmenopausal women scheduled for surgery because of genital prolapse. INTERVENTION 25 micrograms oestradiol or placebo, administered as vaginal pessaries daily, 3 weeks prior to surgery. MAIN OUTCOME MEASURES Cytological, histological and clinical changes of the vaginal mucosa. RESULTS The thickness of the vaginal wall increased as did the oestrogenic index. No clinical effect was seen apart from decreased incidence of recurrent cystitis postoperatively. CONCLUSIONS Preoperative oestrogen treatment has been shown to reduce the incidence of recurrent cystitis and may be needed for stimulation of vaginal mucosa; the short-term clinical effect is not convincing, however.

Pruritic urticarial papules and plaques of pregnancy

The charts of 437 patients with newly diagnosed invasive cervical cancer seen in British Columbia during 1985-1988 were reviewed to determine the age at diagnosis, stage of disease, and histology of the lesions. The patients immigration status and country of birth were also examined. Two hundred forty-two patients (55%) were age 50 or over and 149 (34%) had preclinical stage IB disease. One hundred seventy of these patients (39%) had never had a cytologic examination before presenting with clinical symptoms, and 45 additional patients had not had cytology for 5 or more years before presenting with invasive disease; thus, a total of 215 cases (49%) fell into the category of “no cytology or cytology longer than 5 years ago.” All negative smears were reviewed and in 39 patients (15%) having previous cytology, abnormal cells had been missed or undercalled. Native Indian women made up 10% of the cases of invasive carcinoma, a disproportionately large number as they represent only 2% of the British Columbian population. Of the 27 Native Indian patients in this series, 16 (59%) had never had a cytologic examination. Eighty-five (30%) of 276 women born in Canada had never had a cytologic examination, compared with 34 (71%) of 48 immigrants resident in the country for fewer than 10 years. Twenty-four patients were over the age of 60 with a history of negative Pananicolaon smears. We conclude that, if further gains are to be made in the reduction of death rates from invasive cervical carcinoma, new means must be found to encourage women to participate in Pananicolaon smear screening programs. In particular, special efforts must be made to attract specific groups, such as the Native Indian population and older recent immigrants.

Laparoscopy and ultrasound examination in women with acute pelvic pain

The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women had ultrasound examination performed. This investigation showed to be helpfull especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic pain, but it cannot replace laparoscopy.

Mast cells in the placenta. Is there a relation to the development of atopic disease in infants before 18 months of age

OBJECTIVE To disclose a relation between the amount of mast cells in placenta and the development of atopic disease in children before 18 months of age. DESIGN A prospective, descriptive study. SETTING Two obstetric departments at university hospitals. SUBJECTS 67 pairs of mothers and their newborn infants. MAIN OUTCOME MEASURES Family history of atopic disease was taken. The amount of mast cells in placenta was counted. Follow-up questionnaires of the children were evaluated after 18 months. RESULTS The follow-up rate was 84%. The number of mast cells in placenta did not differ between atopic and non-atopic children. CONCLUSION A new predictor, the amount of mast cells in placenta was evaluated. In this study the amount of mast cells, in placenta was not predictive of the development of atopic disease before 18 months of age.

Urinary Free Cortisol During Pregnancy

Abstract. Adrenocortical function was measured during early and late normal pregnancies by determining urinary free cortisol on three consecutive days. A marked intra‐indi‐vidual variation in urinary free cortisol excretion was found. This pattern did not differ in early and late pregnancy. No correlation was demonstrated between the excretion of free cortisol, estrogen levels and creatinine clearances.

Laparoscopy and Ultrasound Examination in Women with Acute Pelvic Pain

The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic pain, but it cannot replace laparoscopy.

Laparoscopy and ultrasound in patients with chronic pelvic pain

SummaryLaparoscopy was performed in 188 women with chronic pelvic pain. In 51 per cent of the patients the findings were normal.All the patients had had a pelvic examination; the predictive value of an abnormal pelvic examination was 70 per cent. Thirty-six per cent of the patients had had an ultrasound scan; the predictive value of an abnormal scan was 86 per cent.A major cause of discrepancy was the presence of pelvic adhesions, though it is doubtful if these alone cause pain. Both pelvic examination and ultrasound were inadequate to diagnose pelvic adhesions or endometriosis.Laparoscopy is recommended in differentiating between gynaecological disorders and psychogenic musculo-skeletal pain.