Limpaphayom K

Dengue Hemorrhagic Fever during Pregnancy : Antepartum, Intrapartum and Postpartum Management

Dengue hemorrhagic fever is a common tropical disease in Thailand that nowadays has an increasing incidence during adulthood.

A randomized trial of oral contraceptive and hormone replacement therapy on bone mineral density and coronary heart disease risk factors in postmenopausal women

Objective To identify the effects of oral contraceptive (OC) and hormone replacement therapy (HRT) on bone mineral density and coronary heart disease risk factors in postmenopausal women. Methods Eighty healthy postmenopausal women were randomly assigned to a cyclic regimen of OC containing 30 μg of ethinyl estradiol and 150 μg of desogestrel or HRT containing 0.625 mg of conjugated equine estrogens 21 days per cycle and 5 mg of medrogestone 10 days per cycle for 12 months. Bone mineral density of lumbar spine and hip, biochemical markers of bone turnover, lipid-lipoprotein profiles, coagulation profiles, fasting plasma glucose, and blood pressure were evaluated. Results Both regimens caused significant increase in bone mineral density of lumbar spine, trochanter, intertrochanteric region, total hip, and Ward triangle. Only OC therapy was associated with a significant increase in femoral neck bone mineral density (mean score ± standard error 2.5% ± 0.7%, P < .01). Biochemical markers of bone turnover, total cholesterol, and low-density lipoprotein cholesterol decreased significantly in both groups. Posttreatment levels of those bone markers and lipid-lipoprotein were significantly lower after OC therapy than HRT. Fasting plasma glucose and systolic blood pressure decreased significantly in both groups; however, only the OC group showed a significant decrease in diastolic blood pressure. Conclusion Both OC and HRT increased bone mineral density of lumbar spine and hip, but OC suppressed bone turnover more than HRT. Both methods favorably affected lipid-lipoprotein metabolism, fasting plasma glucose, and blood pressure during the 12 months of treatment.

Assessment of Tubal Patency by Transvaginal Sonographic Hydrotubation with Color Doppler Flow

Objective: To assess the value of transvaginal sonographic hydrotubation with color Doppler flow (TSH) as a test of tubal patency.

Laparoscopic Tubal Electrocoagulation for Sterilization: 5000 Cases

Five thousand cases of laparoscopic tubal electrocoagulation were performed for voluntary interval sterilization in outpatient Thai women from January 1974 through June 1978. Immediate complications occurring during surgery resulted from mesosalpingeal hemorrhage, which was successfully managed by omental packing with or without repeated electrocoagulation. The overall failure rate was 0.40%. The authors find this method of tubal electrocoagulation for fertility management to be reliable and safe as an outpatient procedure and to provide rapid convalescence.

P3.13.21 Skin thickness in different menopausal status

Objective: The incidence of coronary artery disease (CAD) increases during climacteric period. The aim of the study was to investigate the preval ence of the classic risk factors. Study Methods: Sixty-five patients (pts) were included for a period of fifteen months (98110 to ZOOO/Ol), aged 37-64 years (mean = 51,69 + 7,13 years). They were divided into three age groups: Group I (GI) 2 35 2 45 years; GII 2 45 2 55 and GIII 2 55 2 65. All of them have confirmed CAD by angiography. Results: The prevalence of the risk factors in the different groups are: GI (n = 13 pts): Familiar Antecedents = 61,5%, Hypertension = 92,3%, Hyperlipidemia = 69,2%, Tabagism = 84,6% and Diabetes = 38,5%; GII (n = 31 pts) Familiar Antecedents = 64,5%, Hypertension = 80,6%, Hyperlipidemia =74,1%,Tabagism=67,7% and Diabetes = 35,4%; GIII (n = 21 pts) Familiar Antecedents = 66,6%, Hypertension = 85,7%, Hyperlipidemia = 76,2%, Tabagism = 47,6% and Diabetes = 19%. Conclusions: The prevalence of familiar antecedents from CAD and hyperlipidemia was the same in the three age groups. The hypertension was the most prevalent in all groups, followed by tabagism and diabetes. There was a significant statistical difference in the prevalence of tabagism: in the group I.

P3.13.28 Treatment of dry eyes in postmenopausal women with hormone replacement therapy

Objective: The aim of the study was to investigate the effects of hormone replacement therapy on dry eyes in postmenopausal women. Study Methods: A prospective, randomized, placebo-controlled trial was conducted in King Chulalongkorn Memorial Hospital to investigate the efficacy of conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 2.5 mg daily on tear volume in postmenopausal women. A total of 27 postmenopausal women were randomly assigned to receive the treatment, 13 cases with conjugated equine estrogen plus medroxyprogesterone acetate, 14 cases with placebo for 12 weeks. The tear volume was measured by Zone-Quick@ test before and after the treatment. The symptoms of dry eyes were recorded in visual analogue scale. The statistical analysis was unpaired ttest. Results: The two groups were not different in age, year since menopause, body mass index (BMI) or initial tear volume. The tear volume was significantly increased in the hormonal group after 12 weeks of treatment (P<O.O5), but the placebo group was not. There was no significant difference between groups in the tear volume after the treatment. The eye symptoms were not significantly changed in both groups. Conclusions: The treatment of dry eyes in postmenopausal women with conjugated equine estrogen plus medroxyprogesterone acetate neither increased the tear volume nor improved eye symptoms within three months.

P3.13.01 A two-year prospective randomized trial of oral contraceptive and hormone replacement therapy on bone density, lipid-lipoprotein and coagulation profiles in postmenopausal women

Diabetes Mellitus and arterial hypertension are associated with oxidative stress, but the temporal association between lipoperoxidation markers and plasma’ s antioxidant activity and the clinical development of gestational diabetes (GD) and pregnancy-induced hypertension (IH) is still not known. Objective: to determine the circulating levels of TBARS and vitamin E in healthy primigravidas at the moment of the first consult. Material and methods: 91 (healthy at the moment of incorporation) primigravidas (age 17 to 32 years) were incorporated between the gth and 12’h week of pregnancy. Blood was extracted at gth to 12’h, 22”d and 32”d week of pregnancy, respectively. The patients were controlled clinically on a weekly intervalsm until delivery. TBARS levels were determined (intraassay variation 4.7% and interassay 6.9%) (in pmolsil) as well as vitamin E (intraassay var. 4% and interassay 6.1%) (in pmolsil). Results: 85 patients had a normal gestation, whilst 6 of them developed IH between the 27’h and 32”d week, 2 of them, besides, developed gestational diabetes. TBARS levels in normal primigravidas were (mean f SD) 2.00 f 0.22, 2.11 f 0.53 and 1.92 f 0.39 respectively for the three trimesters; the maximun and minimun figures being 1.4 and 2.87. The values for vitamin E were 29.0 f 5.8, 27.1 f 4.9 and 29.3 f 6.4 for the three trimesters (absolute minimun of 21.0 and absolute maximum 48.1). Four out of the six patients who had IH (two of them with GD) presented TBARS levels clearly high (between 3.3 and 5.66 pmolsil) already in the first trimester and all of them presented high levels at the 22”d week, maintaining this until the 32”d week. Vitamin E scores were low (less than 12.0) in all the patients with IH except one. Conclusions: a) the values of TBARS and Vit. E in the three trimesters were similar to the ones found in a healthy population of eumenorrhoeic women; b) The gestants who finally had IH ( 2 of them with associated DM) presented high levels of TBARS and, in most of them, low levels of vitamin E preceding by several months the manifestation of the clinic signs; c) The determination of TBARS and, eventually, vitamin E, could be useful for a preclinical prediction of a late development of induced hypertension and gestational diabetes.