A prospective randomized control trial was designed to assess the effectiveness of single dose, 800 microg misoprostol administered p.v. compared with surgical evacuation for the treatment of early pregnancy failure. A total of 80 women with a diagnosis of early pregnancy failure were randomized to study (vaginal misoprostol) and control (surgical curettage) groups. Success of treatment, side-effects as assessed during, immediately after and 10 days after treatment, and patient satisfaction were compared. Intravaginal misoprostol was successful in 82.5% (33 out of 40) of the patients. None of the control group patients required a repeat evacuation. The number of patients who experienced significant abdominal pain following treatment did not differ between the groups. The duration of pain was shorter in the control group; however, they required more analgesics during this short period. The number of patients with significant vaginal bleeding, the duration or severity of bleeding did not show any significant difference between the groups. All 33 patients in the study group who had successful treatment expressed satisfaction, whereas only 58% of the control group did so. In conclusion this randomized control study demonstrated the efficacy and safety of the administration of 800 microg of misoprostol p.v. for the management of early pregnancy failure.
The Ultracision harmonic scalpel and laparosonic coagulating shears use high-frequency ultrasound energy and can be used as a substitute for electrosurgery, lasers and steel scalpels in both laparoscopic and conventional gynaecological surgery. Its unique mechanism of action allows cutting and coagulation without causing a significant rise in temperature at the tissue level. Its safety has been tested extensively in animal experiments and there is now ample evidence to suggest that it produces less thermal damage in vitro compared to electrosurgery and lasers. Although these results have been extrapolated to human beings, there are no in vivo studies in humans to corroborate the above observations. This review highlights the mechanism of action, tissue effects, safety aspects, applications, versatility and limitations of this novel technique. The many advantages demonstrated by this instrument over other energy sources used in laparoscopic surgery should make it more popular in forthcoming years.
This study assesses the feasibility of performing the tension-free vaginal tape (TVT) operation under general anaesthesia (GA). Fifty patients underwent TVT operation under GA. The mean age was 51.3 years (range 32-80). The mean operating time was 21 minutes (range 15-24). Forty (80%) were primary and 10 (20%) were secondary procedures. Postoperatively 22 (44%) patients passed urine within 24 hours and an indwelling catheter was used in 28 (56%) patients. The mean stay was 40 hours (8 hours-5 days). Postoperative evaluation was performed at 2, 6 and 11 months (median follow up 6 months). One patient had an infected retropubic haematoma, necessitating removal of the sling. Of the 49 patients analysed, 72% were completely cured and another 20% were significantly improved. Our findings show that TVT operation can be performed under GA without intra-operative continence demonstration. The success rate of the operation is comparable with the published results.
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