Kamheang Chaturachinda

Bone mineral density during long-term treatment with norplant® implants and depot medroxyprogesterone acetate : A cross-sectional study of thai women

This cross-sectional study compares bone mineral density (BMD) in long-term Norplant implants and depot medroxyprogesterone acetate (DMPA) users. The objectives of this study were to evaluate and compare the bone mineral density between women using these contraceptives. Forty-one current users of Norplant implants and 50 DMPA users participated in the study. The BMD was measured by dual energy x-ray absorptiometry in the nondominant distal and ultradistal forearm. Serum estradiol was measured by microparticle enzyme immunoassay technique. The demographic characteristics were similar in both groups. The mean durations +/- SD of DMPA and Norplant implants were 59.14 +/- 30.73 and 31.1 +/- 11.2 months, respectively. The BMD of long-term Norplant implant and DMPA users was similar. The serum estradiol in the Norplant implant group was significantly higher than in DMPA users. However, the serum estradiol level in DMPA users ranged into normal for the follicular phase, which is higher than for postmenopausal women. This study suggests that two long-acting progestogen contraceptives do not differ with respect to their impact on BMD in long-term users.

Cesarean and postpartum hysterectomy

Objective: To review the cases of cesarean and postpartum hysterectomy. Method: A retrospective study of all cases of cesarean and postpartum hysterectomy during 1985–1994. Maternal characteristics, method of delivery, indications for hysterectomy and complications were reviewed. Results: The rate of cesarean and postpartum hysterectomy was 1:1667 deliveries. Half of these cases were delivered by cesarean section. The main indications for hysterectomy were massive bleeding due to uterine atony, abnormal placental adhesions or uterine rupture. Maternal morbidity was high and there was one maternal death. Conclusion: Cesarean and postpartum hysterectomy is a necessary life‐saving operation. Although maternal mortality is rare, morbidity remains high. Prevention of complications that give rise to hysterectomy and optimally timed surgery should decrease maternal morbidity and mortality.

Laparoscopic sterilization: an outpatient procedure.

Abstract Laparoscopic tubal sterilization with fulguration and resection under local anesthesia in combination with neuroleptanalgesic agents was carried out in 210 patients as an outpatient procedure. The period under study was 16 months. The majority were done on considered request. Average age of the patients was 30.6 years; average parity, 3.8. The operative time averaged 15.5 minutes. There were 2 major complications from hemorrhage requiring laparotomy and 4 minor complications were recorded. The cost per patient of this procedure averaged fifteen dollars. No failure has been recorded within 15 months of follow-up. It is concluded that this procedure can be as simple as vasectomy.

Serum lipids and lipoproteins in women with polycystic ovarian disease with different body mass index

A study to determine serum lipids and lipoproteins in 54 women with polycystic ovarian disease (PCOD) who had varying body mass index (BMI) compared to the normal regular menstruating women was carried out. All patients had similar hormonal profiles of PCOD and differed from the control group. The significant observations were high level of triglyceride and low percentage of alpha lipoprotein in obese PCOD. The BMI was positively correlated with serum triglyceride level, beta and prebeta lipoproteins but inversely correlated with high density lipoprotein (HDL) cholesterol, the low density lipoprotein (LDL) cholesterol/HDL cholesterol ratio and alpha lipoprotein. No significant correlation between lipids, lipoproteins and testosterone levels was observed. It appeared that the alteration of serum lipids and lipoproteins in PCOD is due to the effect of obesity.

Obstetric hysterectomy: Ramathibodi's experience 1969–1987

Obstetric hysterectomy was performed on 121 women at Ramathibodi Hospital, Bangkok, between 1969 and 1987, an incidence of 1:875 deliveries. Of 88 women whose records were available, 91% had emergency hysterectomy, with uterine atony as the most common indication (32.5%), followed by placenta accreta (26.2%), uterine rupture (10.0%), extension of cervical tear to the lower uterine segment (8.7%), broad ligament hematoma (6.2%) and placenta previa (5.0%). The intraoperative and postoperative problems included febrile morbidity (52%), intraoperative hypotension (41%), and disseminated intravascular coagulation (5.7%). Late complications included Sheehans syndrome (3.4%), post‐transfusion hepatitis (2.3%), hematoma (2.3%) and wound infection (2.3%).

Laparoscopy: A technique for a tropical setting

Abstract The technique of laparoscopy with the use of local anesthesia is described. The procedure has been found to be safe, simple, and effective in diagnostic gynecology in the tropics in over 250 cases. It is suggested that modification of this method may be utilized in other areas of the world.

Effects of combined desogestrel-ethinylestradiol treatment on lipid profiles in women with polycystic ovarian disease *

A longitudinal study was conducted to determine the effect of combined desogestrel-ethinylestradiol treatment on lipid profiles in 28 women with polycystic ovarian disease. Mean patient age was 26.3 years (range, 16 to 36 years). Mean patient weight and height were 59.2 kg and 153.8 cm, respectively. After initial assessment, all patients were treated with a cyclical pill containing 150 micrograms desogestrel and 30 micrograms ethinylestradiol. Clinical, hormonal, and lipid determinations were evaluated after 3 and 6 cycles of treatment. The results revealed that, during the treatment course, serum luteinizing hormone, testosterone (T), free testosterone, and dehydroepiandrosterone sulfate decreased significantly, while serum follicle-stimulating hormone and prolactin levels did not change. Increased levels of total triglyceride, alpha, and prebeta lipoproteins, and decreased levels of beta lipoproteins, were observed. The ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol, although showing no significant change, had a tendency to decrease. This lipoprotein change seems to have a favorable rather than an adverse effect on the patients.

Laparoscopic sterilization in HIV-1-positive women

Laparoscopic sterilizations in HIV-1-positive women were performed. Patients, who were HIV-1-positive, underwent voluntary laparoscopic sterilization. The mean age of patients was 27.5 +/- 3.8 years. Most were of low socioeconomic status. The mean duration of the operation was 14.4 +/- 5.4 min. No accidental injury to the surgical team was recorded, and no complications occurred among the patients. It was concluded that laparoscopic sterilization in HIV-positive patients was safe with low risk of HIV transmission to the surgical team.

Failed instrumental delivery: Ramathibodi hospital, 1980–1988

All cases (70) of failed instrumental deliveries which occurred between 1980 and 1988 at Ramathibodi Hospital, Bangkok, Thailand were critically reviewed. The incidence of failure was 0.5%, and failure occurred more often in primigravidae. Failure to appreciate the true level of the fetal head and too early intervention accounted for failure in 50% of the cases. Failed instrumental delivery can be minimized if the prerequisites for the procedure are strictly adhered to.

Modified needle elevation technique for misplaced Norplant® implants removal

This study reports on a simple, feasible and easily learned technique for Norplant implants removal. This technique is modified from the needle elevation technique. The objective of this study was to introduce an alternative Norplant implants removal technique, especially for misplaced capsules. Fifteen Norplant implants clients whose capsules were difficult to palpate had removal by this technique. The mean duration of Norplant implants use was 18.4 +/- 12.5 months. The mean length of removal time was 10.4 +/- 4.5 minutes. None of the capsules was damaged during the removal. No immediate or late complications were observed. The conclusion is that the modified needle elevation technique is a simple and easy method of removing misplaced Norplant capsules with less complications.