Conservative treatment of an immature ovarian teratoma with gliomatosis peritonei.
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Biomedical subjects
Publications and source records attributed to K V Chia.
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Missed abortions are a common occurrence and represent a heavy gynaecological emergency workload to both medical and nursing staff. The conventional method using vacuum aspiration of uterus is associated with morbidity and mortality. Medical termination of pregnancy is accepted as a safe and effective alternative method. However, medical evacuation of uterus in missed abortions had not been fully investigated. In this study we hope to examine the efficacy of medical methods for terminating missed abortions. Mifepristone and misoprostol prescribed to 100 women with an ultrasonically confirmed missed abortion was compared with 100 women who had surgical evacuation under general anaesthesia for their missed abortion. The disparity in complications between medical and surgical groups was not significantly different (Student's t-test, P=0.5). This study showed medical evacuation of missed abortion to be an effective, safe and cost-effective, alternative to surgical evacuation of the uterus and is particularly suited to women not wanting hospital admission or a surgical procedure under general anaesthesia. It represents an option of management that can be less intrusive and gives the woman some control but is both safe and effective.
Menorrhagia is associated with considerable health consequences. First-line therapy is medical, but when this proves unsuccessful a surgical procedure is often undertaken. It is estimated that as many as one in five women will have a hysterectomy before the age of 60 years. While a curative procedure this is a major operation with both morbidity and mortality associated with it. More conservative procedures have therefore been sought. Balloon therapy was developed in 1994 and it was introduced to Royal Bolton Hospital in 1998. Initially offered under general anaesthesia, an overall a success rate of 91% was achieved in this study, with amenorrhea in 18% of cases. Dysmenorrhea was improved in 60% of patients. Twenty-eight patients received outpatient therapy, under a paracervical block. All patients were given voltarol pretreatment. Subjectively the procedure was well tolerated by most, and objectively 89% of patients rated the procedure as acceptable. Sixty-one per cent of patients would be happy to undertake the procedure again under local anaesthesia. Findings from this study would indicate that balloon ablation does provide an effective, less invasive, alternative treatment for menorrhagia. Despite limited numbers, it would also seem appropriate, in selected patients, to offer this therapy as an outpatient procedure.
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This study showed the efficacy of large loop excision of the transformation zone (LLETZ) in the management of cervical intraepithelial neoplasia (CIN). Eighty-three women with abnormal cervical cytology were recruited. Colposcopic examination and directed punch biopsy were performed and the women had LLETZ therapy as an outpatient procedure. There were 2 cases of microinvasive cervical carcinoma that were missed by directed punch biopsy, the diagnosis being made after the patients underwent LLETZ treatment. There was a large disparity in the histological analysis between directed punch biopsy and LLETZ specimen. This disparity would not have been detected if the women were treated by ablative methods. In women with cervical dysplasia, LLETZ procedure is preferred as the whole excised lesion can be examined histologically and diagnostic error is reduced.
Twin interlocking is a rare complication that has a high fetal mortality and morbidity rate. We report a successful outcome of locked twins at 32 weeks gestation following spontaneous labor.
A novel protocol is described which has been developed for immunotherapy in unexplained recurrent miscarriage. This is based on a single intravenous infusion with isolated placental trophoblast plasma membrane vesicle preparations. Clinical experience gained with this approach is described. A total of 16/21 (76%) patients who subsequently had pregnancies have now achieved a live birth or are currently pregnant at greater than 28 weeks gestation.
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Investigations have been performed in 80 couples with unexplained recurrent spontaneous abortions and no live birth (1 degree RSA), as well as in 33 couples with unexplained RSA following one live birth (2 degrees RSA), compared with control couples with no history of repeated early pregnancy failure. A significant bias towards a family history was given for 1 degree RSA women. Elevated total serum IgE levels and tissue-reactive autoantibodies were not significantly more prevalent in the RSA groups, and both 1 degrees and 2 degrees RSA patients had a similar incidence of serum lymphocytotoxic antibody. HLA typing indicated a trend towards parental HLA sharing which did not achieve clear significance at any locus, whereas there was significant apparent HLA-B locus homozygosity for 1 degree RSA women. An elevated prevalence of HLA-A2, B12 haplotypes was also noted for 2 degrees RSA, which may indicate some form of linkage disequilibrium in this population. These results, overall, did not provide evidence to identify a major subgroup of unexplained RSA patients.