PubMed · 12141069
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Ken Meehan. 2002. A chronic, enlarging patch.. https://pubmed.ncbi.nlm.nih.gov/12141069/
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OBJECTIVES: To compare the effectiveness of endometrial thermal ablation and the levonorgestrel intrauterine system (LNG-IUS) in the management of menorrhagia. STUDY DESIGN: Fifty women attending a gynaecology clinic at a District General Hospital in south-west England were randomised to either surgical treatment using thermal ablation (Thermochoice, Gynecare) or medical treatment using a LNG-IUS (Mirena, Schering Healthcare). A pictorial menstrual chart was completed pre-insertion/operatively and again at 6 months post-insertion/operatively. Non-parametric tests (Mann-Whitney) were used for statistical analysis. RESULTS: Follow-up analysis was possible in 23 women in the Thermochoice group and 21 women in the Mirena group. The menstrual scores were slightly higher in the Thermochoice group (median 101) than the Mirena group (median 75) (P=0.025) pre-insertion/operatively but this difference was lost post-insertion/operatively (P=0.689) with median menstrual scores of 27 for the Thermochoice group and 19 for the Mirena group, respectively. CONCLUSION: Both Thermochoice endometrial ablation and a Mirena LNG-IUS are equally effective in the management of menorrhagia. The choice of treatment should be tailored to the woman's needs and preferences.
Single case reports indicate that components of dental alloys accumulate in the adjacent soft tissue of the oral cavity. However, data on a wider range of dental alloys and patient groups are scarce. Therefore, the aim of the present study was to examine the metal content of oral tissues adjacent to dental alloys showing persisting signs of inflammation or other discoloration (affected sites) and of healthy control sites with no adjacent metal restoration in 28 patients. The composition of the adjacent alloys was analyzed and compared to the alloy components in the affected sites. Tissue analysis was performed using atomic absorption spectroscopy. Alloy analysis was performed with energy-dispersive X-ray analysis. In the affected sites, the metals Ag, Au, Cu, and Pd prevailed compared to control sites, reflecting the frequency distribution of single metals in the adjacent alloys. In most cases (84%), at least one of the analyzed metals was a component of the alloy and also detected in the tissue. Metal components from almost all dental cast alloys can be detected in adjacent tissue.
HISTORY AND PHYSICAL EXAMINATION: A 60-year old woman presented with osteoporosis. Because clinical symptoms did not improve after treatment, further diagnostic procedures were performed in order to further characterize the metabolic bone disease. The patient reported loss of weight,nonspecific gastrointestinal symptoms (recurrent abdominal pain),and constipation. The diet history revealed a milk intolerance. Several family members were suffering from autoimmune diseases. During physical examination the patient exhibited clinical signs of osteoporosis(back pain, change of stature), but otherwise no pathological findings. LABORATORY FINDINGS: The technical examinations showed low bone mineral density at the spine. The routine laboratory examination (including serum calcium, phosphorus, alkaline phosphatase)was normal. However, further testing revealed low concentrations for 25-hydroxy-vitamin D, folic acid, vitamin B 12, an increased IgA and significantly elevated antigliadin antibodies and antiendomysial antibodies. Histopathological examination of the duodenal mucosa was in accordance with the diagnosis celiac sprue. The histopathologic examination of a transiliac bone biopsy exhibited high bone turnover, osteopenia, but no osteomalacia. DIAGNOSIS AND THERAPY: Therefore, the diagnosis of celiac sprue with metabolic bone disease was established. Treatment with gluten-free diet and supplementation of calcium and vitamin D was initiated. CONCLUSION: This case demonstrates that careful diagnostic evaluation of patients with osteoporosis is necessary,because therapeutic consequences are the result.