Biomedical subjects

Martin C Sowter

Publications and source records attributed to Martin C Sowter.

3 recordsLinked to original sources

PubMed2004

Ectopic pregnancy: an update.

PURPOSE OF REVIEW: This review discusses recent publications that investigate the epidemiology, diagnosis and treatment of ectopic pregnancy. RECENT FINDINGS: Transvaginal ultrasound is being used with increasing confidence for the diagnosis of ectopic pregnancy, and methotrexate now has an established role in the treatment of ectopic pregnancy. No serum markers have been found that can reliably differentiate intrauterine from extrauterine pregnancy. As more experience has been gained with medical therapy, it is apparent that it is possible to identify a subgroup of women in whom it is unlikely to succeed. The use of adjunctive therapy such as mifepristone does not appear to increase the effectiveness of methotrexate. Screening for ectopic pregnancy in at-risk women has been suggested, but it may be of only limited value. In the surgical management of ectopic pregnancy the effect on fertility of salpingotomy and salpingectomy remains uncertain, although recent cohort studies suggest that salpingotomy may be associated with a better subsequent intrauterine pregnancy rate than salpingectomy. A number of case reports of pregnancies at unusual sites continue to be published, but in the last 2 years there has been a dramatic increase in the number of caesarean scar pregnancies reported. SUMMARY: Medical therapy now has an established role in the treatment of ectopic pregnancy, but it is clear that careful patient selection is essential. In the surgical management of ectopic pregnancy the effects of salpingotomy and salpingectomy on subsequent fertility are uncertain and need further investigation.

Abortifacient Agents, Nonsteroidal↗

PubMed2003

New surgical treatments for menorrhagia.

CONTEXT: Hysterectomy is a common and effective treatment for menorrhagia but is associated with substantial post-operative convalescence time and morbidity. In the early 1990s endometrial resection or ablation became a well-established day-case alternative for the surgical treatment of menorrhagia. Both endometrial resection and ablation require general anaesthesia, a high level of skill in hysteroscopic surgery, and can be long procedures. More recently, various new techniques have been developed that can be done in an outpatient setting under local anaesthesia and with a low risk of complications. The effectiveness of most new second-generation ablation technologies has not been confirmed in randomised trials and it is possible that these techniques will not prove to be as effective or as safe as originally thought. STARTING POINT: Massimiliano Pellicano and colleagues (Am J Obstet Gynecol 2002; 187: 545-50) compared a second-generation ablation technique, thermal destruction of the endometrium with a heated-water-filled silicone balloon with hysteroscopic endometrial resection. 82 women were randomised and followed up for 2 years. Thermal destruction was quicker than hysteroscopic resection, and was associated with a similar level of postoperative satisfaction and reintervention rate. This study suggests that thermal destruction is as effective a technique as endometrial resection. WHERE NEXT? Many second-generation ablation techniques are now available. Some may prove more effective than others, but much larger studies are needed to address safety. The development of progestagen-releasing intrauterine devices, which provide effective treatment for menorrhagia and are also an effective and reversible form of contraception, may mean that the uptake of second-generation surgical ablation techniques is less widespread than some proponents of these new technologies suggest.

Catheter Ablation↗

PubMed2003

LH levels in women with polycystic ovarian syndrome: have modern assays made them irrelevant?

OBJECTIVE: To determine whether using newer monoclonal rather than polyclonal assays for measuring luteinising hormone (LH) alters the predictive value of LH and LH/follicle-stimulating hormone (FSH) ratios for polycystic ovarian syndrome. DESIGN: Prospective cohort study. SETTING: Fertility and Reproductive Endocrinology Clinic within a New Zealand Teaching hospital. POPULATION: Seventy-eight women presenting with oligomenorrhoea or hirsutism and polycystic ovaries on pelvic ultrasound and 59 volunteer controls with ultrasonically normal ovaries and a regular menstrual cycle. METHODS: Serum LH concentrations were measured using a polyclonal radio-immunoassay (Amerlex-M, Johnson & Johnson) and two monoclonal immunometric assays (Immulite, DPC; Cobas Core, Hoffman La Roche). The proportion of women with an elevated serum LH concentration in each group was calculated using both current local laboratory reference intervals and a new reference range derived from our control group. The LH/FSH ratios for women in both groups were also calculated using the three different LH assays. MAIN OUTCOME MEASURES: LH concentrations and LH:FSH ratios measured using polyclonal and monoclonal immunoassays. RESULTS: Using the local laboratory normal range, a significantly higher proportion of women had an elevated LH when measured with a polyclonal assay (23.1%) than when measured with a monoclonal assay (12.8% Core, 6.4% Immulite) (P < 0.05). LH/FSH ratios were significantly lower when monoclonal assay was used and receiver-operator characteristic curves suggest that LH/FSH ratios of 1 or lower provide the most reliable separation of women with polycystic ovarian syndrome from controls when these assays are used. CONCLUSIONS: Clinicians should be aware that the use of monoclonal LH assays will result in significantly lower measured LH levels and LH/FSH ratios in women with polycystic ovarian syndrome than previously used polyclonal assays. Account should be taken of the assay type used, when using endocrinological parameters in the diagnosis of polycystic ovarian syndrome, or the identification of women who have LH hypersecretion.

Adult↗