Wu Shun Felix Wong

Current alternative and complementary therapies used in menopause

Objective. To determine the efficacy and safety of common complementary and alternative medicine (CAM) therapies used to relieve the menopausal symptoms. Design. Comprehensive literature search was conducted through the databases Medline, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Centre for Complementary and Alternative Medicine) to identify relevant monographs in English language. Results. Studies have shown that some therapies such as clonidine, selective serotonin receptor inhibitors (SSRIs) and gabapentin are effective in decreasing the degree and frequency of somatic symptoms in menopause, while phytooestrogens and black cohosh have shown mixed results. Use of Ginseng, evening primrose, Dong Quai or vitamin E appears not to be efficacious for the relieving hot flushes. Other effects of these therapies including possible improvements in mood are yet to be substantiated. Inclusion criteria. All available human complementary medicine studies on menopausal women with regard to the relief of menopausal symptoms. Exclusion criteria. Studies not meeting the inclusion criteria, published in languages other than English or animal studies. Conclusion. There is a general lacking of longer-term follow-up beyond the trial lengths of 6–12 weeks in the use of CAM, although women may be taking these medications for many years. Well-designed, randomised control trials are needed to elucidate the true effect of these therapies above the placebo effect.

Effect of acupuncture on induction of labor.

OBJECTIVE The objective of this study is to review the existing scientific evidence on the potential role of acupuncture on induction of labor during pregnancy. DESIGN The Medline, EMBASE, Cochrane Central Register of Controlled Trials, AMED (Allied and Complementary Medicine), and NCCAM (The National Center for Complementary and Alternative Medicine) databases were searched to identify relevant monographs from 1970 to 2008. INCLUSION CRITERIA These criteria included all available human acupuncture studies on pregnant women carrying a viable fetus due for third trimester induction of labor. EXCLUSION CRITERIA These criteria included studies not meeting the inclusion criteria, in languages other than English, or animal studies. RESULTS Ten (10) studies on labor induction were identified. The duration of labor as a result of acupuncture treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the studies demonstrated labor induction by acupuncture treatment. However, because two randomized controlled trials reported that there was no statistically significant effect of acupuncture, these results are more suggestive than definitive. Furthermore, although the relationship between cervical ripening and interleukin-8 (IL-8), prostaglandin F(2alpha) (PGF(2alpha)), and beta-endorphin is well documented in the literature, there is no evidence to suggest that acupuncture alters these mediators. Serum levels of IL8, beta-endorphin, and PGF(2alpha) were not found to be significantly influenced by acupuncture. CONCLUSIONS Although the definitive role of acupuncture in inducing labor is still yet to be established, the existing studies suggest that acupuncture may be beneficial in labor induction. Further randomized clinical trials are needed to investigate this further.

Hysteroscopic Appearance of Endometrial Cavity after Microwave Endometrial Ablation

STUDY OBJECTIVE To assess the appearance of the endometrial cavity after microwave endometrial ablation. DESIGN Prospective observational study. SETTING GuangDong Womens and Childrens Hospital, GuangDong, China. PATIENTS A total of 349 patients who underwent microwave endometrial ablation from January 2000 through August 2008 were followed up for 1 month to 8 years. At follow-up in 2007 and 2008, patients were advised of this clinical study and were randomly selected for participation if they agreed to undergo outpatient hysteroscopy to assess the uterine cavity during follow-up visits. Fifty three patients (median [range] age, 43.1 [33-53] years) were recruited into the study at the time of endometrial ablation. INTERVENTION Outpatient hysteroscopy. MAIN RESULTS Within the first 3 months after ablation, outpatient hysteroscopy revealed varying amounts of necrotic tissue from the endometrium and superficial myometrium of the uterus. Six months postablation, a granulomatous reaction and fibrosis were present. A fibrotic cavity was also evident, and menstrual flow was reduced or had ceased. One year after ablation, hysteroscopy demonstrated a fibrotic cavity with myofibrous scars. Most patients developed amenorrhea at this time. Two years or more postablation, a second hysteroscopy demonstrated various types of intrauterine adhesions in 28 of the 53 women (52.8%). A cervical adhesion was observed in 1 patient (1.9%), focal adhesions in the fundal area in 12 (22.6%), a narrowed and scarred uterine cavity with bilateral stenotic tubal ostia in 11 (20.7%), and complete obliteration of the cavity in 4 (7.5%). Of these 28 women, 22 had amenorrhea, 3 had vaginal spotting during menstruation, and 2 had hypomenorrhea. Of those without intrauterine adhesions, only 5 had amenorrhea, 10 had vaginal spotting, and 8 had hypomenorrhea. CONCLUSION The hysteroscopic appearance of the uterine cavity after microwave endometrial ablation varies considerably. In this study, the menstrual outcome was correlated with postablation uterine cavity appearance.

Polycystic ovarian syndrome in adolescence

Background. Polycystic ovarian syndrome (PCOS), which is a common endocrinopathy seen not only in adult women but also in female adolescents nowadays, is associated with reproductive, metabolic and cardiovascular problems. Objective. This article aims to review the current evidence on managing PCOS in adolescence. In addition, the pathophysiology, risk factors, clinical presentations and existing diagnostic criteria of PCOS will also be discussed. Discussion. Certain risk factors are available to assist the clinicians to identify adolescents at risk of PCOS as the signs can be masked by the normal physiological changes during puberty. It is important to screen and diagnose adolescent PCOS in order to prevent the development of future infertility, type II diabetes mellitus, cardiovascular disease, and even endometrial cancer. Lifestyle modification is of the greatest benefit for adolescents in terms of management, with the condition that full support is available from both the clinicians and their families. The psychological impact of PCOS also constitutes a major concern in adolescent PCOS.

Inguinal Endometriosis: An Uncommon Differential Diagnosis as an Inguinal Tumour

Inguinal endometriosis can present as a rare tumor when it occurs outside the abdomen and pelvis. We present a patient with a painful tumor in the right inguinal region, where its diagnosis was made before the operation. This enabled a conservative excisional surgery to be performed. The literature is reviewed and the diagnosis as well as management are discussed.

Regulatory Effect of Peptidoglycan on the Expression of Toll-Like Receptor 2 mRNA and Proteins in Trophoblast Cell Line TEV-1 Cells

Objective. To investigate the regulatory effect of peptidoglycan on the expression of human Toll-like receptors 2 (TLR2) mRNA and proteins in the human extravillous trophoblast cell line (TEV-1). Methods. TEV-1 cells were incubated with different doses of peptidoglycan. The expression of TLR2 mRNA and protein was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and immunocytochemistry SP staining. Results. TLR2 was expressed in TEV-1 cells and localized to both the cytoplasm and plasma membrane. Compared with the untreated control, TEV-1 cells incubated with 30 μg/ml peptidoglycan significantly upregulated the expression of TLR2 mRNA and protein after 12 hours of treatment (P < .01). However, the expression of TLR2 mRNA and protein was decreased but had no significant difference compared with the control (P > .05) after 24 hours of treatment. On the other hand, 10 μg/ml peptidoglycan did not seem to have regulatory effect on mRNA and protein expression of TLR2 (P > .05). Conclusion. Peptidoglycan has a role in regulating the expression of TLR2 mRNA and protein in TEV-1 cells. It suggests that the trophoblast cells may play important role in the immune response at the fetal-maternal interface and affect the result of pregnancy by expressing TLR2.

A retrospective study of laparoscopic-assisted vaginal hysterectomy (LAVH) in virgins and nulliparae

OBJECTIVE To study the feasibility and result of LAVH performed in virgins and nulliparae. STUDY DESIGN Retrospective review of 297 consecutive cases of LAVH using the Biswas Uterine Vaginal Elevator (BUVE) in a private hospital in Hong Kong for benign gynaecological conditions between July 2006 and February 2009. Variables analysed included patient demographics, operative times, uterine weight, hospital stay, intraoperative blood loss, and operative complications. Patients who were virgins and nulliparae were compared to each other and to a control group of patients receiving LAVH during the same period of time. RESULTS All 297 cases of LAVH were successfully performed without any conversion. Ninety-seven LAVHs were performed on 31 virgins and 66 nulliparae, while 200 LAVHs were performed on parous patients during the same study period. The uterine sizes in the virgin group were significantly larger than those in the other two groups. The operation times in the virgin and nullipara groups were significantly longer than those in the control group. The complication rates of LAVH in these three groups were 6.4%, 12.1% and 3% in the virgin, nulliparous and control groups respectively. The overall complication rate of this series was low at 5.3%. CONCLUSIONS LAVH is feasible with acceptable safety in virgins and nulliparae in spite of their narrow and tight vaginas.

A false positive fluorodeoxyglucose positron emission tomography/computed tomography diagnosis of pelvic lymph node recurrence following surgical treatment of Stage 1 endometrial cancer—a case report

A 47 year old patient with a G3, FIGO stage 1A endometrial cancer was treated by hysterectomy. Her two ovaries were conserved because of the pre-operative diagnosis of endocervical cancer. On follow up PET-CT follow up investigation, she had a benign ovarian corpus luteal cyst mistaken as a metastatic pelvic lymph node which was later removed and proven benign histologically. This paper is to raise the clinical awareness of possible false positive PET finding from a benign ovarian cyst, such that a misinterpretation of “recurrence” as in this case can be avoided.

Therapeutic Management of Vaginal Intraepithelial Neoplasia and Clinical Experience in South Western Sydney of Australia

Background : VAIN is consistently associated with prior or concurrent neoplasia elsewhere in the lower genital tract. Studies have shown 50-90% of patients with VAIN had or currently have either intraepithelial neoplasia or carcinoma of the cervix or vulva. VAIN represents 1% of all intraepithelial neoplasia and vaginal cancers account for 1-3% of all gynecological malignancies. Aim : This article is aimed to give an overview of the current therapeutic management options of VAIN. In addition, all available clinical cases of VAIN among South Western Sydney area’s hospitals were pooled to compare its treatment with the current therapeutic options as identified from the literature review. Method : A literature search was conducted using the Medline and Pubmed databases. All available clinical cases of VAIN among South Western Sydney area’s hospitals were pooled from the clinical databases within the network hospitals Results : Between July 1999 to February 2009, 61 patients aged 18 to 88 years (median = 42, average =44.3) were diagnosed with VAIN I to III at the Sydney South West Area Health Services (SSWAHS) in Sydney, Australia. Of these 10 patients, forty percent had a previous hysterectomy for cervical neoplasia. This is in keeping with the current literature regarding VAIN aetiology. Conclusion : Due to the rarity of this disease, many authors have identified the available literature on the natural history, aetiology and management of VAIN to be limited. Most of the studies on the management of VAIN were single-centre retrospective studies carried out on relatively small groups of patients. Further, the results of the success rates of the different management options vary greatly between each treatment centre. In order for our patients at SWSAHS may be managed optimally, higher levels of evidence are required in the future for standard recommendations on the management of VAIN.