No abstract

No abstract

) has published the results of a first interim analysis (Choo 1994). Although a peer-reviewed publication is pending, these preliminary results suggest that the risk of vertical transmission can be reduced. Women enrolled in the trial were given AZT or a placebo orally during pregnancy, with an infusion during labour and delivery, and their infants were given the same AZT or placebo orally for six weeks after birth. In the placebo arm, 255% (SE 3.60) of infants were infected and in the AZT arm 8.3 % (SE 2-25). The estimated absolute difference between the two treatment groups was 17.2% (95% confidence interval 8.9-253 %; P = 0.000056). Based on these findings, the investigators have discontinued enrollment to the trial and offered AZT to all women and infants already enrolled. However, no general guidelines for clinical practice have been issued.These results are promising, but elucidate neither when transmission from mother-to-child occurs, nor the optimum method or timing for intervention. Research is required to evaluate alternative approaches, including obstetrical interventions, such as mode of delivery and cleansing of the birth canal (Newell & Peckham, 1994). Marie-Louise Newell Length of stay after vaginal hysterectomySir, We read with interest the paper by James Clinch (March 101. 1994) in which he describes a reduction in post-operative stay following vaginal hysterectomy over recent years. Although any financial savings which do not compromise patients' welfare are to be welcomed, we urge caution in adopting a policy of early discharge after hysterectomy. This study does not fully explore the long term physical and psychological impact of early discharge. Many women may be tempted to return to normal physical activity too soon, especially if there are domestic pressures to do so; this may compromise long term operative success and have long term implications for the utilisation of health resources, including primary health care, which do not appear to have been properly addressed. We feel that before any conclusions can be drawn recommending early discharge, prospective studies are required to assess the long and short term impact of early discharge on both the patient well-being and financial cost following hysterectomy.

No abstract