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Biomedical subjects

C J Haines

Publications and source records attributed to C J Haines.

At least 55 records · Page 3Linked to original sources
PubMed1996

An examination of the effect of combined cyclical hormone replacement therapy on lipoprotein(a) and other lipoproteins.

Lipoprotein(a) (Lp(a)) is an independent marker of cardiovascular disease which is relatively unresponsive to treatment with most of the commonly prescribed lipid lowering drugs. Concentrations of Lp(a) increase after the menopause, and the primary aim of this study was to determine whether combined hormone replacement therapy was effective in lowering levels of Lp(a) in postmenopausal women. An open longitudinal study was conducted among 42 women who had undergone a spontaneous menopause and were attending the outpatient clinic of the Prince of Wales Hospital, Hong Kong. All subjects were treated with 2 mg oral estradiol daily and 5 mg medroxyprogesterone acetate for 12 days each calendar month. Fasting blood samples for lipoprotein measurement were taken before the commencement of treatment and at 6 and 12 months. Lp(a) levels showed a skewed distribution with a median value before treatment of 9.45 mg/dl (range 1.47-95.62 mg/dl). After 6 months, there was a reduction to 7.70 mg/dl (1.12-72.59 mg/dl) (P < 0.01), and after 12 months the median concentration was 7.14 mg/dl (0.63-69.23 mg/dl) (P < 0.001 0-12 months). There were also significant reductions in the concentrations of apo B from 116.13 to 111.62 mg/dl and LDL-C from 3.02 to 2.74 mmol/l (P < 0.05), plus a lowering of TC of borderline significance. Apo A-I increased from 162.56 to 173.35 mg/dl (P < 0.01), but there were no significant changes in HDL-C or the HDL-C subfractions. TC, LDL-C, apo B and TG concentrations were higher and HDL-C and HDL2-C concentrations were lower when blood was sampled during combined treatment with estrogen and progesterone than when estrogen was being taken alone. Levels of Lp(a) were also lower during the estrogen only phase of treatment, but none of these differences were statistically significant. This study demonstrates that combined cyclical hormone replacement therapy is effective in reducing concentrations of Lp(a). The trend towards a more atherogenic lipid profile during the combined phase of treatment suggests that attention should be given to the timing of blood sampling in future studies of this nature.

Adult↗
PubMed1996

Sexual behavior in pregnancy among Hong Kong Chinese women.

Sexual behavior during pregnancy was examined in a retrospective study of 150 Hong Kong Chinese women interviewed in the immediate postpartum period. Sexual activity was found to decline abruptly during the first trimester of pregnancy, and continued to decrease in frequency as the pregnancy advanced. The frequency of intercourse was lower both before and during pregnancy than has been reported in similar studies among Western populations. There was no consistent relationship between age, parity, level of education, or employment status and sexual behavior either before or during pregnancy. These results suggest that a relatively conservative attitude toward sexual activity persists within this population.

Adolescent↗
PubMed1996

A randomized, double-blind, placebo-controlled, crossover study on the effect of oral oestradiol on acute menopausal symptoms.

Acute menopausal symptoms occur less frequently in Asian than in Caucasian women. Oestrogen replacement therapy has been shown to be effective in controlling acute symptoms in Caucasians, but the effect of oestrogens is not well documented in Asian women. A randomized, double-blind, placebo-controlled, crossover study of the effect of oral oestradiol on the incidence of acute menopausal symptoms was conducted in 83 Hong Kong Chinese women who had experienced a surgical menopause. Although there was a significant increase in the oestradiol concentration with treatment compared with placebo (P < 0.001), there were no significant differences in the reporting of symptoms between the treatment and placebo groups. There is no obvious explanation for this apparent lack of effect of oestrogen on acute menopausal symptoms in Chinese women. Whilst it may be related to the generally low incidence of symptoms or to a higher dietary intake of phytoestrogens in Chinese women, further studies are necessary to explain these findings.

Administration, Oral↗
PubMed1996

Fetal sex as a risk factor for fetal distress leading to abdominal delivery.

A retrospective analysis of perinatal information of 7,924 confinements in the calendar year of 1994 was performed to determine whether fetal sex was a significant risk factor for fetal distress in labour leading to abdominal delivery. The sex of the fetus (male) was a significant, independent, risk factor for Caesarean section (odds ratio = 1.26, 95% CI = 1.05 to 1.50). This increase was wholly attributable to the increased risk of having fetal distress in labour (odds ratio = 1.76, 95% CI = 1.32 to 2.34). Male fetuses are at higher risk of developing fetal distress during labour.

Cesarean Section↗
PubMed1996

Iatrogenic cardiac tamponade during pregnancy.

A 26-year-old primigravida who presented to us with threatened preterm labour which was suppressed successfully with sulindac, was found to have a pericardial effusion. Pericardiocentesis was performed because of evidence of right ventricular compression. However, it was complicated by inadvertent puncture of the left ventricle causing cardiac tamponade, and hypovolaemic shock shortly afterwards. An emergency pericardiotomy was performed to rescue the patient.

Adult↗
PubMed1995

The perception of the menopause and the climacteric among women in Hong Kong and southern China.

BACKGROUND: A lack of awareness of the long-term consequences of the menopause may be a major contributing factor to the low demand for hormone replacement therapy in Hong Kong and China. Most Chinese women suffer few acute menopausal symptoms, and it was our hypothesis that they had little knowledge of the risks of developing either osteoporosis or cardiovascular disease as a result of estrogen deficiency. METHODS: A prospective study was conducted among 200 Chinese women of all ages living in Hong Kong or southern China. A structured questionnaire was used to examine their perception of the menopause and the climacteric. RESULTS: While 96% of women from Hong Kong and 73% from southern China could define the menopause, none in either group were aware of the problems of either osteoporosis or cardiovascular disease in post-menopausal women. Only 8% of women from Hong Kong and 4% from southern China knew that hormone replacement therapy could be used to treat postmenopausal women. CONCLUSIONS: The results of this study confirm a relative lack of understanding of the climacteric in both groups of Chinese women. As menopausal symptoms are also infrequent in this population, most women will not have the need to consult a physician and will therefore not have the option of taking hormone replacement therapy to prevent the long-term effects of estrogen deficiency. Considering the sizes of the populations involved, the potential for reducing morbidity and mortality through improved education about the menopause is considerable.

Adult↗
PubMed1995

The effect of percutaneous oestrogen replacement therapy on Lp(a) and other lipoproteins.

OBJECTIVES: To determine the effect of percutaneous oestrogen replacement therapy on lipoprotein (a) and other plasma lipoproteins. METHODS: Open longitudinal prospective study conducted at the hormone replacement clinic of the Prince of Wales Hospital, New Territories, Hong Kong. Thirty women who had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign gynaecological conditions were treated with 1.5 mg of percutaneous 17 beta-oestradiol gel applied daily for a period of 12 consecutive months. Measurements of plasma lipoproteins were made before the commencement of treatment and repeated at 6- and 12-month intervals. RESULTS: There was a significant reduction in the concentrations of Lp(a) during the first 6 months of treatment, with median values falling from 7.87 mg dL-1 to 6.16 mg dL-1 (P = 0.004, 0-6 months). During the second 6 months, the median concentration increased to 9.38 mg dL-1, (P = 0.072, 6-12 months), which did not significantly differ from the baseline level (P = 0.545, 0-12 months). Significant reductions in the concentrations of apoprotein A-I (apo A-I), apoprotein B (apo B), high density lipoprotein cholesterol (HDL-C), and HDL3-C were also present after 6 months (P = 0.043, 0.049, 0.028, 0.013, respectively), but there were no differences between the baseline values of these lipoproteins and those at the completion of the study (P = 0.948, 0.244, 0.839, 0.117 respectively). Drug compliance was maintained throughout the study, with similar mean oestradiol concentrations at 6 and 12 months. CONCLUSIONS: The percutaneous administration of 17 beta-oestradiol has variable short term effects on plasma lipoproteins which are not maintained over a longer duration of treatment. By avoiding the 'first pass' effect on the liver, this method of delivery does not appear to produce the sustained changes in lipoproteins seen with oral treatment.

Administration, Cutaneous↗
PubMed1995

Calcium supplementation and bone mineral density in postmenopausal women using estrogen replacement therapy.

Both estrogen and calcium have been shown to be of benefit in reducing the incidence of osteoporosis in postmenopausal women. It has been suggested that estrogen promotes the intestinal absorption of calcium, and this effect may especially benefit postmenopausal women with a low dietary intake of calcium. The purpose of this study was to examine the effect of calcium supplementation on the bone mineral density (BMD) of postmenopausal women using estrogen replacement therapy. BMD measurements were made over 12 months in two groups of postmenopausal women, one having treatment with estrogen alone, and the second having estrogen and 1000 mg of supplemental calcium each day. There was no significant reduction in BMD between the two groups over the 12-month study period. Those in the group having supplemental calcium had a significant increase in BMD at the femoral neck (p = 0.023), but not in other areas of the femur nor in the lumbar spine. The results of this study suggest that the addition of supplemental calcium may improve the bone mass of postmenopausal women using estrogen who have a low dietary calcium intake. This benefit appears to be more pronounced in corticocancellous than in trabecular bone, and may therefore have a greater effect on the femoral neck than the lumbar spine.

Absorptiometry, Photon↗
PubMed1995

A prospective study of the microbiological environment of the genitourinary tract in Hong Kong Chinese women during pregnancy.

Microbiological colonization of the genitourinary tract in pregnancy is associated with an increased risk of preterm labour and delivery. In our population, the risk of preterm labour is relatively low, and the purpose of this study was to examine the microbiological environment of the genitourinary tract to determine whether it differed from that reported in populations where the rate of preterm delivery is higher. A prospective study was made in 367 unselected women between 16 and 24 weeks' gestation. Although the rate of colonization with Candida species was higher than in most other studies (30.2%), colonization with Gardnerella, Group B Streptococcus, Trichomonas and Chlamydia was uncommon (1.9%, 0.8%, 0.6% and 3.5% respectively). Significant bacteriuria was also uncommon, occurring in only 4.9% of cases. The results of this study confirmed a relatively low incidence of colonization of the genitourinary tract in this population of women with a low incidence of preterm delivery. These findings suggest that low levels of colonization may be related to a low incidence of preterm delivery in our patients.

Adult↗
PubMed1995

Sonographic assessment of the vaginal vault following hysterectomy.

OBJECTIVE: A prospective study to determine the sonographic appearance of the vaginal vault following hysterectomy. METHODS: A transvaginal sonographic examination of the vaginal vault on the third postoperative day. Follow-up to determine the incidence of postoperative morbidity. RESULTS: An accurate sonographic examination of the vaginal vault was possible in 66/71 cases (92.9%). Fluid collections were visible in 28/66 cases (42.4%), and measured up to 41.1 cm2 in the transverse plane and 30.2 cm2 in the sagittal plane. There was no correlation between the presence of a collection and indices of postoperative morbidity. CONCLUSION: Collections of fluid at the vaginal vault are common after hysterectomy, but do not usually contribute to postoperative morbidity.

Exudates and Transudates↗
PubMed1995

Detection of fetal Y-specific DNA from the cervix.

Detection of fetal Y-specific DNA by polymerase chain reaction was performed on cervical samplings obtained from 24 patients who underwent first trimester suction termination of pregnancy. The results were compared with the fetal gender determined by Y-sequence polymerase chain reaction on the fetal parts. Fourteen male pregnancies were identified. Correct predictions were made in two (14.3%) from the cervical swabs and three (21.4%) from the trans-cervical samplings. The failure of isolation of fetal cells from the cervix was not related to the gestation of sampling.

Base Sequence↗
PubMed1994

A prospective study of the frequency of acute menopausal symptoms in Hong Kong Chinese women.

A prospective study was conducted amongst Hong Kong Chinese women to determine the incidence of acute menopausal symptoms following surgical menopause. Cases where a laparotomy was performed for other indications were used as controls. Hot flushes and sweating developed in 8/33 (24.2%) and 6/33 (18.2%), respectively, of those women having had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Whilst vasomotor symptoms were more frequent in those women who had undergone a surgical menopause than in the controls, women in this population were shown to suffer fewer symptoms than has been demonstrated in Caucasian women. Although this study does not help to explain why such differences exist, the relative absence of symptoms may contribute to the low demand for hormone replacement therapy in Hong Kong and other countries where climacteric symptoms are relatively infrequent.

Adult↗
PubMed1994

The influence of obstetric workload on cesarean section rate.

The cesarean section rate in a busy obstetric unit was studied in relation to the monthly confinement rate. A total of 30,825 births over a period of 5 years were analyzed. There was a negative correlation between the emergency cesarean section rate and the unit workload (correlation = -.498, 2 tailed p = 0.0001) whilst there was no relationship between workload and the elective cesarean section rate. This suggested that the unit may reach a certain saturation level as far as the emergency cases were concerned during the busy periods. However, there was no evidence that the perinatal outcome was affected by this variation in emergency cesarean section rate.

Cesarean Section↗
PubMed1994

Spontaneous abortion: a medical approach to management.

The conventional management of spontaneous abortion is surgical evacuation of the uterus to prevent complications which may arise from retained products of conception (POC). This procedure is not without complications and also demands operating theatre resources. The purpose of this study was to determine the efficacy of a medical approach to the management of spontaneous abortion using the prostaglandin analogue, gemeprost. From an initial 212 women presenting with spontaneous abortion, 4 groups were defined according to what they required in the way of initial management. A group of 20 women were excluded from conservative medical management at presentation because they were bleeding heavily and judged to be unsuitable. Sixty women initially required no further management other than determining that they had a complete abortion using transvaginal sonography (TVS). The 132 women were treated with the prostaglandin analogue, gemeprost. Sixty were judged to need no further management afterwards and were initially discharged. The remaining 72 women underwent evacuation of retained products of conception (ERPC) after the gemeprost treatment as medical evacuation of the uterus appeared to had been incomplete. In each of these 4 groups so defined, there was 1 case where an ERPC was required after the patients have been discharged because of complications attributable to retained POC. We therefore found that no ERPC was necessary in the management of 118 out of 212 (55.6%) women who presented with spontaneous abortion. This has important implications in patient management and economical use of hospital resources.

Abortifacient Agents, Nonsteroidal↗
PubMed1994

Transvaginal sonography and the conservative management of spontaneous abortion.

Once a diagnosis of early pregnancy failure has been made, it is normal gynaecological practice to proceed to evacuation of any retained products of conception. In many cases, however, there may be little residual tissue within the uterus, and the patient may be exposed to an unnecessary operative procedure. The purpose of this study was to use sonographically derived measurements of the uterine cavity to select cases suitable for conservative management. Of 50 women presenting with a diagnosis of spontaneous abortion, 32 were chosen for non-operative treatment based upon their uterine cavity measurements. In all of these cases, bleeding had ceased within 2 weeks of selection and the pregnancy test had become negative. There were no subsequent complications. In our opinion, sonographic examination of the uterus allows the selection of those cases which can safely be managed conservatively.

Abortion, Spontaneous↗