Surasak Taneepanichskul

Bone mineral density in long-term depot medroxyprogesterone acetate acceptors.

The study of bone density in long-term DMPA users is reported. The aims were to study and compare bone density in long-term DMPA users with intrauterine device (IUD) users. Fifty current users of DMPA with a minimum 36 months previous use were compared to 50 current IUD users as control. The bone mineral density was measured by dual energy x-ray absorptiometry (DEXA) at the non-dominant distal and ultradistal forearm. Serum estradiol was measured by microparticle enzyme immunoassay technique in both groups. Age, income, weight, height, BMI, and parity of both groups were matched. The mean bone mineral density of distal forearm in DMPA and IUD users was 0.48 +/- 0.05 g/cm2 in both groups. The mean bone mineral density of ultradistal forearm was 0.38 +/- 0.06 g/cm2 in DMPA users and 0.4 +/- 0.05 g/cm2 in IUD users. No differences in mean bone mineral density of distal and ultradistal forearm between DMPA and IUD users was demonstrated (95% CI -0.02, 0.02 and -0.04, 0.001, respectively). However, the serum estradiol levels were significantly different between DMPA and IUD users (95% CI -122, -68.1). From this study, it is suggested that long-term DMPA use should not have any adverse effect on bone density even if it reduces serum estradiol.

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.

Use of Norplant® implants in asymptomatic HIV-1 infected women

The study of Norplant implants use in HIV-1 infected women was conducted at the Family Planning Clinic, Department of Obstetrics and Gynaecology. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, from January 1993 to June 1996. The purpose of the study was to evaluate efficacy, clinical effects, side effects, and menstrual patterns of the Norplant system in HIV-1 infected acceptors. Forty one cases of asymptomatic HIV-1 positive women voluntarily participated in using Norplant implants after delivery or abortion. The mean age was 25.4 years. The most common menstrual pattern was irregular bleeding (63.4%). Mean blood pressure, body weight, and hemoglobin level were not different at insertion and at 12 months (p > 0.05). No pregnancy occurred during a 12-month period. It was concluded that the Norplant system was safe, efficacious, and well tolerated in HIV-1 positive women and is an appropriate contraception in these women.

Association of Contraceptives and HTV‐1 Infection in Thai Female Commercial Sex Workers

EDITORIAL COMMENT: We accepted this paper for publication because it shows that condom usage is significantly associated with a lower incidence of HIV‐1 infection in commercial sex workers. This important message can more readily be obtained from a community with a high prevalence of HTV‐1 infection. This paper also provides a sad glimpse into the lives of these sex workers whose condom usage is at best described as modest.

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.

Maternal and Umbilical Cord Serum Zidovudine Levels in Human Immunodeficiency Virus Infection

EDITORIAL COMMENT: Because of the low prevalence rate for HIV in Australian antenatal populations and lack of a national or state policy for offering routine HIV testing in pregnancy, we have relied on our colleagues from Thailand to provide readers with information concerning treatment of pregnant women known to be HIV positive. Readers are referred to the January 24, 1998 issue of the British Medical Journal which contains 7 papers concerning HIV infection in pregnancy and neonates. The editorial by Danielle Mercey ‘Antenatal HIV testing. Has been done badly in Britain and needs to improve’ (A) should interest readers since HIV testing has been sufficiently performed in the United Kingdom to provide the information that in 1996 only 15% of previously unrecognized HIV infections were diagnosed in pregnancy. The prevalence in tested women in London increased 6‐fold from 0.03% in 1988 to 0.191% in 1996; for the rest of the United Kingdom the comparable percentages in tested women were 0.005% and 0.016% (B). For comparison, as noted in this paper, the prevalence rate of HIV positive mothers in Thailand was 2% in 1993, or more than 10 times greater than in London in 1996 and 125 times greater than in the rest of the United Kingdom. Tourists with sex adventures in mind should be aware of these facts when planning their itinerary for overseas tours. Obstetricians in Australia should heed the statement that ‘The advantages of ascertaining a pregnant womans HIV positive status before delivery are clear’: transmission to the baby can be roughly halved by avoiding breastfeeding and reduced by a further two‐thirds by the administration of zidovudine (A).

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.

Effect of Zidovudine Treatment in Late Pregnancy on HIV‐1 In Utero Transmission

EDITORIAL COMMENT: This paper was accepted for publication to update readers on the effectiveness of treatment with zidovudine to prevent vertical transmission (mother to child by any route before or after delivery) of HIV infection antenatally. In the ACTG 076 trial referred to in this paper the treatment regimen was antepartum zidovudine (ZDV) (100 mg orally 5 times a day) initiated between 14 and 34 weeks gestation and continued throughout the remainder of pregnancy, followed by intrapartum intravenous ZDV (loading dose 2 mg/kg, starting in labour followed by continuous infusion 1 mg/kg/hour until delivery), followed by oral administration of ZDV (syrup 2 mg/kg every 6 hours for 6 weeks beginning 8 to 12 hours after birth) to the infant. HIV infection of the infant was defined by 1 positive viral culture obtained from peripheral blood specimens taken at birth, 12, 24 and 78 weeks postpartum. Preliminary results showed HIV infection (at least 1 positive culture) in 7.2% (13 of 180) in the treatment group and 21.7% (40 of 184) in the untreated control group. The present study suggests that a less complex ZDV regimen is effective against vertical transmission since no evidence of HIV infection was found in any of the 50 infants within 48 hours of birth. The authors properly comment that these infants require follow‐up to assess intrapartum and postpartum transmission of HIV, and long‐term side‐effects of the ZDV treatment.

Modified minilaparotomy technique of interval female sterilization

The study of a modified minilaparotomy technique of interval female sterilization is reported. The modified minilaparotomy technique of interval female sterilization is performed under local anesthesia using the Ramathibodi uterine manipulator, bivalve speculum, and a low midline incision. Sixty cases were treated with this technique. From the study, it was revealed that the mean age of patients +/- SD was 31.2 +/- 5.6 years, the mean body weight +/- SD was 43.3 +/- 5.1 kg, and the mean height +/- SD was 152.1 +/- 8.2 cm. The mean operating time was 24.3 +/- 5.5 min with a range from 15 to 35 min. All patients recovered and were allowed home within 2 h after operation. No immediate or late complications were observed. It was concluded that this technique is quick, safe, inexpensive, and easy to perform as an outpatient procedure.

Outpatient laparoscopic interval female sterilization

A 23-year retrospective review of laparoscopic sterilization in Ramathibodi Hospital, Bangkok, Thailand, is reported. A total of 9041 cases of outpatient laparoscopic interval female sterilizations were done from January 1973 to December 1995. Intraoperative complications occurred in 35 cases (0.39%) and hospital admissions totalled 65 cases (0.72%). Adnexal injuries were the most frequent complication. There was one case of death from anesthetic complication. Management and prevention of complications are discussed.