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Biomedical subjects

W Prendiville

Publications and source records attributed to W Prendiville.

32 records · Page 2Linked to original sources
PubMed1989

Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia.

The paper describes the technique of 'LLETZ' (large loop excision of the transformation zone), a new method of management for women with an abnormal cervical smear which offers the advantages of conization with those of local destruction. A large loop of thin wire forms a diathermy electrode that allows deep excision of the transformation zone with minimal tissue damage. The tissue removed can be examined histologically. The technique was used to investigate and treat 111 women with abnormal smears referred to the Bristol Royal Infirmary during 1986. Microinvasive disease was revealed in one woman where it was not suspected by cytology or colposcopic examination. Of 102 women followed up for at least 1 year by cytology, colposcopy and, where appropriate, histology, two women were found to have residual/recurrent cervical intraepithelial neoplasia.

Cervix Uteri↗
PubMed1988

The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials.

Recent claims that routine active management of the third stage of labour increases rather than decreases maternal and neonatal morbidity have prompted us to conduct a systematic review of the relevant controlled trials. In this paper we have analysed data derived from a total of nine published reports of controlled trials in which an oxytocic drug was compared with either a placebo or no routine prophylactic. Oxytocic drugs used routinely appear to reduce the risk of postpartum haemorrhage by about 40% (typical odds ratio 0.57, 95% confidence interval 0.44-0.73) implying that for every 22 women given such an oxytocic, one postpartum haemorrhage could be prevented. The available data are insufficient to assess the possible effects of this policy on the incidence of retained placenta, hypertension and other possible adverse effects.

Clinical Trials as Topic↗
PubMed1988

Choice of oxytocic preparation for routine use in the management of the third stage of labour: an overview of the evidence from controlled trials.

Prophylactic use of oxytocics reduces the risk of postpartum haemorrhage by about 40%. The analysis presented in this paper assesses which oxytocic preparation is associated with the least risk of postpartum haemorrhage and examines the relative effects of different preparations on the length of the third stage, the risk of manual removal of the placenta, blood pressure and other side-effects. A mixture of oxytocin and ergometrine (Syntometrine) appears to be the safest and most effective prophylactic of the alternatives which have been compared, but the quality of the evidence is not satisfactory. There is scope for a randomized comparison of Syntometrine with oxytocin to obtain unbiased and more precise estimates of their relative effects on postpartum haemorrhage, blood pressure and unpleasant side-effects.

Clinical Trials as Topic↗
PubMed1986

A low voltage diathermy loop for taking cervical biopsies: a qualitative comparison with punch biopsy forceps.

Twenty patients attending a colposcopy clinic because of a cytological suspicion of dyskaryosis were entered into a 'paired' biopsy study. A low voltage diathermy loop biopsy and a punch biopsy were taken from the cervix of each patient. In a second 'unpaired' study loop biopsies taken from 20 patients were compared with punch biopsies taken from 20 different patients. The length and depth of the loop biopsies were greater than those of the punch biopsies. There was no difference in the amount of artefactual damage. These findings held for both the paired and the unpaired studies. We conclude that biopsies taken with the low voltage diathermy loop are more likely to reveal microinvasive disease.

Biopsy↗
PubMedDate not supplied

The management of first trimester miscarriage by general practitioners in Ireland.

A single shot questionnaire was sent to 500 general practitioners, with 39 per cent valid response, to audit first trimester miscarriage management. With threatened miscarriage 60 per cent were cared for at home (10 per cent of these had ultrasound) and 40 per cent were transferred to hospital. The miscarriage rate was 14 per cent-61.7 per cent had no symptoms (of these 42.2 per cent had a positive pregnancy test), 24.4 per cent had threatened miscarriage with 11.6 per cent incomplete and 2.3 per cent complete. The general practitioner is ideally placed to develop initial clinical management strategies and direct access to ultrasound would be helpful.

Abortion, Spontaneous↗
PubMedDate not supplied

Patient satisfaction following transcervical resection of the endometrium.

Menorrhagia affects 20-30% of healthy women, many of whom undergo hysterectomy. In recent years, transcervical resection of the endometrium (TCRE) has become an alternative surgical option. This observational study assesses patient satisfaction following TCRE. The case notes of 55 patients who had a TCRE in the Coombe Womens' Hospital, Dublin, in 1992 were reviewed. Patients were sent a postal questionnaire at an interval ranging from 3 to 15 months post TCRE. 49 patients responded, of whom 76% were satisfied with TCRE. Thirty one per cent experienced amenorrhoea, 55% hypomenorrhoea, and 14% had no change in menstrual blood loss. Twenty two per cent required subsequent treatment. The complication rate was 11% (2 uterine perforations, 3 endometritis, 1 laparoscopic wound infection). We conclude that TCRE is an effective and safe treatment for menorrhagia, and is associated with a high rate of patient satisfaction.

Cervix Uteri↗
PubMedDate not supplied

Management of an abnormal smear.

Women with a smear that suggests the presence of moderate or severe dyskaryosis should be referred for colposcopic examination. This article outlines briefly the principles of colposcopy and treatment of these abnormalities using large loop excision of the transformation zone.

Carcinoma in Situ↗
PubMedDate not supplied

Ovarian cancer screening.

PURPOSE: This review presents the current knowledge on ovarian cancer screening (OCS) together with a cumulative evaluation of the efficacy across diverse screening approaches based on up-to-date results. MATERIALS AND METHODS: An electronic literature search was conducted targeting reports on the effectiveness of the various screening strategies. RESULTS: Twenty-two prospective studies, 18 cohorts and 4 randomised control trials (RCTs) were retrieved. Where possible, sensitivity, specificity and predictive values, as well as the number needed to treat for each cancer (NNT) and each stage I disease [NNT (I)] detected are reported. CONCLUSION: The multimodal approach that incorporates CA125 as a primary and ultrasound as a secondary test appears to be superior to other strategies. However, the conclusive end-point that would provide the acceptable level of evidence for the introduction of screening should be a reduction in mortality. Up-to-date, there is no such evidence to justify this.

Adult↗
PubMedDate not supplied

Management of an abnormal smear: 2.

While large loop excision of the transformation zone is not a difficult technique, important principles must be considered to avoid complications. This article presents practical advice to deal with most circumstances that may arise. Postoperative protocols and efficacy are also covered.

Analgesia↗