Erik Qvigstad

Treatment of endometrial polyps: a systematic review

Background. Transcervical resection of endometrial polyps is usually performed in order to exclude atypic and/or malignant endometrial changes, to relieve abnormal uterine bleeding or to improve infertility. Objective. To systematically explore the rationale of transcervical polyp resection. Search strategy. Electronic searches of MEDLINE, EMBASE and The Cochrane Library. Selection criteria. Studies reporting the prevalence of premalignant and/or malignant tissue changes within endometrial polyps, as well as outcomes of endometrial polyp removal in terms of symptom relief and improved fertility were included. Main results. 46 studies met the criteria for inclusion (malignancy: 20 studies including 9,266 women, symptom relief: 15 studies including 1,034 women, infertility: 11 studies including 935 women). Most studies were uncontrolled retrospective case series. Only two randomized controlled trials were identified. The prevalence of premalignant and malignant tissue changes within endometrial polyps varied in the included studies, 0.2–23.8% and 0–12.9%, respectively. Postmenopausal symptomatic women appeared to have the highest risk of premalignant and malignant tissue changes. The effect of polypectomy on periodic blood loss appeared to be questionable, but all studies measuring the effect of polypectomy by general terms such as improved/not improved reported a favorable outcome (75–100% success rate). Polypectomy appears to have a favorable outcome in infertile women. Conclusions. The evidence which substantiates the removal of endometrial polyps is limited, and future research evaluating the outcome of this common procedure is required. Based on the available evidence, however, we provide recommendations for treatment of women with endometrial polyps.

Prevalence, 1-Year Regression Rate, and Clinical Significance of Asymptomatic Endometrial Polyps: Cross-sectional Study

STUDY OBJECTIVE To estimate the prevalence, 1-year regression rate, and clinical significance of endometrial polyps in women aged 45 to 50 years. DESIGN Cross-sectional study (Canadian Task Force II-2). SETTING University teaching hospital. PATIENTS Two hundred fifty-seven of 1000 randomly selected women aged 45 to 50 years. INTERVENTIONS Transvaginal ultrasonography and saline infusion sonography were performed in all study participants and were repeated in women with endometrial polyps after 12 months. Polyps present at follow-up were removed by hysteroscopic polyp resection. MEASUREMENTS AND MAIN RESULTS Endometrial polyps were diagnosed in 31 women (12.1%). At 1 year, the polyp regression rate was 27%. Myomas occurred more often in women with endometrial polyps, and women with polyps experienced significantly heavier periodic bleeding compared with women without polyps. CONCLUSION Our study findings suggest that endometrial polyps are common in women aged 45 to 50 years and that women with such polyps experience heavier periodic bleeding. Although some polyps seem to regress spontaneously during 1-year follow-up, most seem to persist.

Long-term outcomes following laparoscopic supracervical hysterectomy.

Objective  Evaluation of long‐term outcomes following laparoscopic supracervical hysterectomy (LSH).

A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy.

INTRODUCTION: In this study, we investigated the dose requirements, pain relief, and side effects of oxycodone versus morphine after surgery with visceral pain. METHODS: Ninety-one women received IV oxycodone or morphine before the end of laparoscopic hysterectomy and then continued with patient-controlled analgesia for 24 h postoperatively. RESULTS: The accumulated oxycodone consumption was less (13.3 ± 10.4 mg vs 22.0 ± 13.1 mg, P = 0.001) than morphine. With oxycodone, the visual analog scale scores were significantly lower in the first hour postoperatively and sedation was less during the 24-h postoperative period, P = 0.006. CONCLUSIONS: Oxycodone was more potent than morphine for visceral pain relief but not for sedation.

Low molecular weight heparin (dalteparin) for the treatment of venous thromboembolism in pregnancy

Objective To evaluate the effect and dose of dalteparin given to pregnant women with acute venous thromboembolism.

Total Laparoscopic Hysterectomy with Single-Port Access without Vaginal Surgery

There has been increasing attention to decreasing incisional morbidity and improving cosmetic outcomes in laparoscopic surgery by using fewer and smaller ports. Hysterectomy through single-port access has been reported in which the cuff was closed transvaginally. We report total laparoscopic hysterectomy through a single-port without vaginal surgery. Using improved instruments and bidirectional self-retaining sutures, the laparoscopic technique is almost as easy to perform as with the traditional 4-port access. This case illustrates the advantages and limitations of single-access laparoscopy.

Laparoscopic occlusion compared with embolization of uterine vessels: a randomized controlled trial.

OBJECTIVE: To compare clinical outcome 6 months after treatment with bilateral laparoscopic occlusion of the uterine artery versus uterine leiomyoma embolization. METHODS: Sixty-six premenopausal women with symptomatic uterine leiomyomata were randomized to treatment with either laparoscopic occlusion of uterine arteries or uterine leiomyoma embolization. The primary outcome was reduction of blood loss from pretreatment to 6 months postoperatively, measured by a Pictorial Bleeding Assessment Chart. Secondary outcomes included patients’ own assessment of symptom reduction, postoperative pain assessed using visual analog scales, ketobemidone used postoperatively, complications, secondary interventions, and failures. RESULTS: Fifty-eight women were included; 6-month follow-up data were available for 28 participants in each group. The percentage reduction in Pictorial Bleeding Assessment Chart scores did not differ between the treatment groups (52% after uterine leiomyoma embolization and 53% after laparoscopy, P=.96). The study had 52% power to detect a 20% difference on the Pictorial Bleeding Assessment Chart. Fewer participants in the group treated with uterine leiomyoma embolization complained of heavy bleeding after 6 months (4% compared with 21%, P=.044). The postoperative use of ketobemidone was higher after uterine leiomyoma embolization (46 mg compared with 12 mg, P<.001). CONCLUSION: Both laparoscopic occlusion of uterine vessels and embolizaton of uterine leiomyoma improved clinical symptoms in the majority of patients. Participants with the laparoscopic procedure had less postoperative pain but heavier menstrual bleeding 6 months after treatment. A larger study and longer follow-up is necessary before a definite conclusion can be made regarding the most effective treatment. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT 00277680 LEVEL OF EVIDENCE: I

Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design

Objective  To compare the impact of 1000 micrograms of self‐administered vaginal misoprostol versus self‐administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women before operative hysteroscopy.

T-Cell clones with similar antigen specificity may be restricted by DR, MT (DC), or SB class II HLA molecules

In man, at least three different class II HLA molecules have been detected: DR, DC, and SB. While the DR molecules appear to be analogous to the murine I-E molecules (Shackelford et al. 1982, Trowsdale et al. 1983), the DC molecules are composed of e and/~ chains structurally different from those of DR (Corte et al. 1981, Shackelford et al. 1981) and bear structural similarities to the I-A molecules. It is not settled whether the DC molecules are responsible for the serologically defined MT determinants (Arnot et al. 1984), or whether the DC and MT determinants are controlled by nonallelic genes (Sorrentino et al. 1983). The MT3 specificity may also represent a cross-reactive determinant present on products of both the DR and the DC loci (Goyert and Silver 1983). The secondary B-cell (SB) molecules were identified a few years ago by primed lymphocyte typing (PLT; Mawas et al. 1978, Shaw et al. 1980, Termijtelen et al. 1980), and they are encoded for by a locus centromeric to DR (Kavathas et al. 1981, Shaw et al. 1981). The SB system seems homologous to the murine I-E molecules (Hurley et al. 1982). Human T helper/amplifier (T4) cells generally co-recognize antigenic epitopes together with restriction elements on class II HLA molecules in antigen-presenting cell (APC) membranes. We have previously reported that antigen-specific (i. e., specific for Chlamydia trachomatis) human T-lymphocyte clones (TLC) may be restricted by elements on DR or MT (DC) molecules (Qvigstad and Thorsby 1983). Quite recently, Eckels and co-workers (1983) reported that virus antigen-specific TLC may also use parts of the SB molecules as restriction elements. We describe here that TLC with specificity for antigens on C. trachomatis may also use parts of the SB molecules as restriction elements. Second, we demonstrate that TLC from a single donor, with similar antigen specificity, may be restricted by elements on DR, MT (DC) or SB HLA class II molecules.

Weight gain during the first year of life in relation to maternal smoking and breast feeding in Norway.

OBJECTIVE: To assess the weight gain during the first year of life in relation to maternal smoking during pregnancy and the duration of breastfeeding. DESIGN: This was a one year cohort study. SETTING: The city of Oslo, Norway. PARTICIPANTS: Altogether 3020 children born in Oslo in 1992-93. Children were divided into three groups as follows: 2208 born to non-smoking mothers, 451 to mothers who were light smokers (< 10 cigarettes per day), and 261 to mothers who were heavy smokers (> or = 10 cigarettes per day). MAIN RESULTS: The mean birth weights were 3616 g, 3526 g, and 3382 g and 1 year body weights were 10,056 g (gain 6440 g per year), 10,141 g (6615 g), and 10,158 g (6776 g) in children of non-smoking and light and heavy smoking mothers respectively. Cox regression analysis showed that children of heavy smokers were 2.0 (95% confidence interval, 1.7, 2.3) times and children of light smokers 1.3 (1.2, 1.5) times more likely to have stopped breast feeding during their first year of life compared with children whose mothers were non-smokers. Linear regression analysis, adjusting for confounders, showed that weight gain was slower in breast fed children than in those who were not breast fed (-38 g (-50, -27) per month of breast feeding). Compared with children of non-smokers, the adjusted weight gain was 147 g (40, 255) per year greater in children of light smokers and 184 g (44, 324) per year in children of heavy smokers. CONCLUSION: Children catch up any losses in birth weight due to maternal smoking, but some of the catch up effect is caused by a shorter duration of breast feeding in children of smoking mothers.