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Biomedical subjects

Adam Magos

Publications and source records attributed to Adam Magos.

At least 19 recordsLinked to original sources
PubMed2005

Digital recording of surgical procedures using a personal computer.

OBJECTIVE: To develop a system for recording surgical procedure digitally using a personal computer with real-time compression of the video signal. STUDY DESIGN: We built the system around a modern personal computer with a large hard disk to allow recording of over 250 h of continuous surgery. Digital capture from the camera was achieved using a standard external analogue-digital converter linked to the computer via a firewire cable. The software for capturing, compressing and editing movie files were obtained free of charge from the internet. The optimal settings for the software was determined. RESULTS: We have successfully used this system to record over 100 major and minor hysteroscopic, laparoscopic, vaginal and open gynaecological. Despite compression, the quality of the movies was judged to be very good and still images excellent. The recordings could be integrated in to standard presentation. Still pictures could be printed to provide hard copies for patients and medical notes, and movies burnt on to CDs or DVDs. CONCLUSIONS: A digital recording system built around a standard personal computer is relatively cheap, versatile and has a huge capacity to record surgical procedures.

Female↗
PubMed2005

Color Doppler evaluation of changes in uterine perfusion induced by the use of an absorbable cervical tourniquet during open myomectomy.

PURPOSE: To evaluate the hemodynamic changes in uterine perfusion following the vascular occlusion of the uterine arteries with an absorbable cervical tourniquet applied during open myomectomy. METHODS: Twenty-eight patients with symptomatic fibroids and a clinical uterine size equivalent to 14 or more weeks' gestation underwent open myomectomy. Patients were randomized to either the tourniquet or the control group. In the tourniquet group, a number 1 polyglactin suture was tied around the cervix to occlude the uterine arteries and left in situ. Doppler flow measurements were obtained at 5 days, 6 weeks, 3 months, and 6 months postoperatively and compared with preoperative values. RESULTS: Fourteen women were randomized to each group. Data were obtained from 12 patients in the tourniquet group and 11 in the control group. There were no statistically significant differences between the two groups for uterine artery at 5 days, 6 weeks, 3 months, or 6 months postoperatively. However, the peak systolic velocity was significantly reduced in the tourniquet group compared with the control group at 5 days (p < 0.05); thereafter, there were no significant differences between the two groups. CONCLUSIONS: A polyglactin cervical tourniquet causes only a temporary effect on uterine perfusion, which is consistent with its absorption profile.

Adult↗
PubMed2005

The cost of out-patient culdoscopy compared to in-patient laparoscopy in women with infertility.

Diagnostic laparoscopy is a common procedure performed in many hospitals worldwide to investigate infertile women. However, morbidity and cost prevent it being considered a first-line diagnostic tool. If out-patient culdoscopy could replace in-patient laparoscopy then a major component of the cost of investigations could be avoided. We studied ten consecutive infertile patients who had laparoscopy under general anaesthesia and another ten patients who had culdoscopy under local anaesthesia in The One Stop Fertility Clinic (OSFC) in The Royal Free Hospital in London. The costs for each patient from both groups was calculated and compared. We found that out-patient investigation in an OSFC produced a saving of over 350 pounds sterling per case or 28% to the hospital compared with in-patient investigation. Although there were other factors which may influence the costs of out-patient culdoscopy, it did provide noticeable savings to the healthcare system.

Adult↗
PubMed2005

Surgical and radiological management of uterine fibroids--a UK survey of current consultant practice.

BACKGROUND: The aim of this study was to determine the current surgical and radiological management of uterine fibroids by consultants working in the UK. METHODS: A structured questionnaire was posted to all 1439 UK consultants. Non-responders were sent one reminder. The main outcome measures were surgical route and technique used for myomectomy, and the use and availability of uterine artery embolization (UAE). RESULTS: Eight hundred fifty-two (59%) consultants replied. Seven hundred thirty-five (86%) admitted to regular sessions of gynecologic surgery, and 75% of this group performed open myomectomy, 16% laparoscopic myomectomy, and 66% hysteroscopic myomectomy. Open myomectomy: Forty-one percent of consultants performed open surgery on uteri equivalent to 12-week gestational age or less, 87% prescribed preoperative gonadotrophin-releasing hormone agonists (GnRHa) in order to reduce surgical bleeding, with 35% using myomectomy clamps, 23% tourniquets, and 19% vasoconstrictors. Laparoscopic myomectomy: The largest uterine size the majority would attempt was equivalent to a 12-week gestation, 58.6% used preoperative GnRHa, 21% used intraoperative vasoconstrictors, and 1.4% tourniquets in order to minimize bleeding. Hysteroscopic myomectomy: As with laparoscopic myomectomy, the largest uterine size the majority would attempt was equivalent to a 12-week pregnancy. Blood transfusion: Twenty per cent, 10%, and 7% reported the need for blood transfusion in up to 10% of patients undergoing open, laparoscopic, or hysteroscopic myomectomy, respectively. UAE: Fifty-one percent have access to UAE and 40% have referred at least one patient in 2001. CONCLUSIONS: Open and hysteroscopic myomectomy are frequently utilized in contrast to laparoscopic myomectomy. The reported rate of blood transfusion appears low. Although UAE is widely available, the majority of patients are still managed surgically.

Female↗
PubMed2005

Currently available devices for female sterilization.

Sterilization is now the method of family planning most commonly used in the world. Over the last 150 years, research has evolved in the search for the ideal method of female sterilization. The procedure should ideally have high efficacy, be readily accessible and be personally and culturally acceptable. The method should be simple, quick, easily learned and be able to be performed in an outpatient setting without general anesthesia. The most common and effective method for sterilization has, thus far, been via the laparoscopic route. Hysteroscopic sterilization, however, potentially fulfills many of these ideal criteria, but until recently has remained more of a concept than a reality.

Cautery↗
PubMed2004

Hysteroscopic tubal sterilization.

This article provides an overview of the history of hysteroscopic sterilization including the current state of the art and future ideals. Unlike laparoscopic techniques, sterilization by hysteroscopy can be performed in an outpatient setting without general anesthesia. Many attempts have been made to develop a safe and effective method, but until recently, without success. The Essure system is the first one that seems to be a realistic alternative to laparoscopic sterilization, but is irreversible. The search is still on for the optimum method of hysteroscopic sterilization.

Female↗
PubMed2004

A national survey of senior trainees surgical experience in hysterectomy and attitudes to the place of vaginal hysterectomy.

We set out to determine the current status of training in vaginal hysterectomy in the UK. In total, 255 year 4 or 5 'Calman' trainees were identified and sent an anonymous questionnaire assessing surgical experience, quality of training and attitudes towards vaginal hysterectomy. Our results demonstrate that senior trainees' experience in vaginal as opposed to abdominal hysterectomy is relatively poor. Despite this, trainees believed that the majority of hysterectomies should be done vaginally, and only a minority, laparoscopically.

Attitude of Health Personnel↗
PubMed2004

Chronic ectopic pregnancy diagnosed incidentally in an infertile woman: a case report.

BACKGROUND: Chronic ectopic pregnancy is an enigma. The clinical presentation can be mild, with absent or subtle symptoms. The high incidence of negative pregnancy tests and the poor specificity of sonographic patterns can be misleading, and the correct diagnosis is sometimes established only at surgery or even histopathologically after the operation. We report the first case of a woman who was accidentally diagnosed with chronic ectopic pregnancy during diagnostic laparoscopy performed as part of a routine investigation for primary infertility. CASE: A 28-year-old woman underwent laparoscopyfor infertility. She had a regular menstrual cycle and was asymptomatic. She gave a history of a possible but unconfirmed miscarriage earlier. Her hormone profile was normal apart from a slightly raised prolactin level. An earlier ultrasound showed a polycystic appearance of the ovaries. Laparoscopy was done on the 25th day of the menstrual cycle, and beta-human chorionic gonadotropin was negative. At laparoscopy, a 2-cm mass wasfound in the right fallopian tube. There was no free blood in the pelvis, and no adhesions. Both tubes were patent at hydrotubation. The mass was excised laparoscopically, and histology confirmed a diagnosis of chronic ectopic pregnancy. CONCLUSION: A review of articles on chronic ectopic pregnancy confirmed the difficulty in diagnosing this condition preoperatively.

Adult↗
PubMed2003

Endometriosis arising during estrogen and testosterone treatment 17 years after abdominal hysterectomy: a case report.

OBJECTIVE: To report the possible association between the use of oestrogen replacement therapy and endometriosis in a postmenopausal woman. METHODS: We present a case of a postmenopausal, previously hysterectomised, woman who received hormonal replacement therapy and developed a large broad ligament cyst. Two years prior to her presentation she had been complaining of pelvic pain and deep dyspareunia. RESULTS: Pelvic ultrasound showed an adnexal cyst that was increasing in size. CA-125 was normal. Laparoscopy revealed multiple endometriotic deposits and a broad ligament cyst. Cystectomy and oophorectomy were done. Histology confirmed a diagnosis of endometriosis including the broad ligament cyst. CONCLUSIONS: Hormonal replacement therapy can be associated with de novo endometriosis including at sites, which are unusual.

Aged↗
PubMed2003

Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse.

BACKGROUND: To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse. METHOD: In a two-center prospective, double-blind randomized trial, 36 women with dysfunctional uterine bleeding, uterine fibroids or pelvic pain scheduled for hysterectomy were randomized to abdominal or vaginal hysterectomy. The primary outcome measure was the duration of hospital stay. Secondary outcome measures included analgesic requirements and return to normal health and function. RESULTS: There were no significant differences in peri-operative patient or surgical characteristics. Vaginal hysterectomy was associated with a reduction in hospital stay compared to abdominal hysterectomy (median stay 3 days vs. 5 days, p = 0.01). In addition, patients undergoing vaginal hysterectomy had reduced analgesic requirements (mean 75.4 mg vs. 131.4 mg morphine equivalent, p = 0.002), shorter need for intravenous hydration (mean 25.3 h vs. 32.7 h, p = 0.05), and faster return of bowel action (median 3 days vs. 4 days, p = 0.002). They also returned to normal domestic activities (mean 4.6 weeks vs. 8.5 weeks, p = 0.01) and work (mean 7.0 weeks vs. 13.9 weeks, p = 0.005), and completed their recovery (mean 7.9 weeks vs. 16.9 weeks, p = 0.008) more quickly. CONCLUSIONS: Vaginal hysterectomy was associated with significant benefits in terms of reduced hospital stay and improved patient recovery. Vaginal hysterectomy should be the route of choice not only for women with genital tract prolapse but also those without.

Adult↗
PubMed2002

Hysterectomy: surgical route and complications.

OBJECTIVES: To compare the morbidity associated with abdominal, vaginal and laparoscopic hysterectomies in a group of patients suitable for anyone of these surgical routes. STUDY DESIGN: Retrospective analysis of 1000 consecutive hysterectomies. RESULTS: The 513 patients were deemed to be suitable for hysterectomy by anyone of the three surgical routes. The overall complication rates were 34, 24 and 21% for abdominal, vaginal and laparoscopic hysterectomy, respectively. Multiple regression analysis showed that the morbidity was similar when confounding factors were allowed for, in particular the use of peri-operative antibiotics. CONCLUSIONS: The route of hysterectomy is not a major determining factor of peri-operative complications when other confounding variables are taken into account.

Anti-Bacterial Agents↗
PubMed2002

Culdoscopy using an optical cannula.

OBJECTIVE: To describe a technique for inserting an endoscope through the posterior vaginal fornix under direct vision using an optical cannula. DESIGN: Prospective case study. SETTING: University Department of Obstetrics & Gynecology. PATIENT(S): Patients with infertility referred for investigation in secondary care. INTERVENTION(S): Insertion of culdoscope using an optical cannula. MAIN OUTCOME MEASURE(S): Successful introduction of the culdoscope. RESULT(S): Sixteen of 20 patients had successful introduction of the optical cannula. There were no reported complications. CONCLUSION(S): Insertion of a culdoscope into the cul-de-sac can be done under visual control and this may reduce the risks of complications associated with blind insertion using a modified Veress needle.

Adult↗
PubMed2002

Hysteroscopic treatment of Asherman's syndrome.

Although Asherman's syndrome (the presence of adhesions inside the cervical canal or uterine cavity) is relatively uncommon in the general population, it can be the cause of menstrual irregularity and subfertility in high risk women. The diagnosis is usually confirmed by hysterosalpinography, and more recently by hysteroscopy. Hysteroscopy has also become accepted as the optimum route of surgery, the aims being to restore the size and shape of the uterine cavity, normal endometrial function and fertility. Treatment can range from simple cervical dilatation in the case of cervical stenosis but an intact uterine cavity, to extensive adhesiolysis of dense intrauterine adhesions using scissors or electro- or laser energy. Patients in whom the uterine fundus is completely obscured, and those with a greatly narrowed, fibrotic cavity present the greatest therapeutic challenge. Several techniques have described for these difficult cases, but outcome is far worse than in patients with mild, endometrial-type adhesions. Non-hysteroscopic techniques area also beginning to be developed, but whether they will replace the current 'gold' standard of hysteroscopy remains to be seen.

Endometrium↗