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Biomedical subjects

Ray Garry

Publications and source records attributed to Ray Garry.

22 records · Page 2Linked to original sources
PubMed2002

Pelvic pain scores in women without pelvic pathology.

STUDY OBJECTIVE: To assess the presence of and quantify pelvic pain in a group of women without demonstrable pelvic pathology as confirmed by laparoscopy. DESIGN: Prospective observational study (Canadian Task force classification II-2). SETTING: District general hospital. PATIENTS: One hundred forty-three consecutive women undergoing laparoscopy for sterilization, infertility investigation, or assessment of pelvic pain. INTERVENTION: Laparoscopy. MEASUREMENTS AND MAIN RESULTS: Women were asked to complete a questionnaire including a visual analog score for four different types of pelvic pain (dysmenorrhea, pelvic pain, dyspareunia, rectal pain) and three quality of life assessments. Forty-three women were excluded due to pelvic pathology. In the 100 remaining women, mean pain scores (maximum 10) were dysmenorrhea 3.77, pelvic pain 1.75, dyspareunia 1.54, and rectal pain 1.07. Quality of life assessment was no different from that in a healthy population in whom the instruments were validated. CONCLUSION: Pelvic pain, principally dysmenorrhea, is common in women of reproductive age. Pain scores may be used to compare treatments for pelvic pain and provide useful information for preoperative counseling.

Adolescent↗
PubMed2002

The benefits and problems associated with minimal access surgery.

The place of minimal access surgery (MAS) in current gynaecological practice remains controversial. As a consequence, MAS techniques have been subject to a significant amount of prospective, evidence-based assessment. The ultimate results of these comparative trials will undoubtedly have a profound impact on the future direction of our speciality. It is timely, therefore, to review the currently available data. Evidence from 2195 patients in 23 randomised clinical trials of five different treatment modalities (ectopic, ovarian cysts, myomectomy, colposuspension and hysterectomy) clearly demonstrates that uncomplicated MAS procedures produce patient friendly benefits, at least in the short term. No matter what operation is performed, the laparoscopic approach is associated with less pain, shorter hospital stay and shorter recovery. These immediate patient-orientated benefits are a generic consequence of replacing the manoeuvres of open surgery through laparotomy incisions with minimal access. These benefits must be offset against significant disadvantages. Minimal access surgery procedures always require the use of expensive, high technology equipment and usually take longer to perform. Such procedures may be more costly than current open procedures and costs will, in part, be dependent on the amount of disposable equipment employed. Patients undergoing MAS procedures may be at risk of new and/or increased risk of traditional complications. The longer-term results of most MAS procedures have not yet been determined. These potential benefits and disadvantages of MAS require that each procedure is carefully and individually assessed. This paper seeks to review the current evidence.

Evidence-Based Medicine↗
PubMedDate not supplied

The surgical management of menorrhagia.

Surgical treatment of menorrhagia is likely to be both successful and satisfactory to the patient. Correct diagnosis of the cause of menorrhagia is essential, and management should be directed to the specific cause of the problem. The question of which treatment is best is a complex one and involves balancing patient wishes, expected outcomes, complications, cost-effectiveness and quality of life issues. For the subset of women in whom dysfunctional uterine bleeding is diagnosed, the literature suggests that there is a hierarchy of treatments that, in descending order for both efficacy and patient acceptability, are: (i) hysterectomy; (ii) endometrial ablation (either first- or second-generation); (iii) the levonorgestrel intrauterine system; and (iv) medical treatments. All four of these options should be discussed with the patient and the relative advantages and disadvantages considered before a treatment decision is made. For patients in whom a pathological cause is diagnosed, specific treatments should be aimed at removal of the lesion and observation of the effect on menstrual status. In addition to the treatment options above, specific treatments such as hysteroscopic, laparoscopic or open excision of the lesion need to be considered. For interventional radiological procedures such as uterine artery embolization, further study is recommended before it can be considered as a safe and effective treatment for menorrhagia.

Arteries↗