Page 47

No. 151

Authors :

Preutthipan S, Herabutya Y.

Title :

Vaginal misoprostol for cervical priming before operative hysteroscopy: A randomized controlled trial.

Source :

Obstetrics and Gynecology. 96(6):890-4, 2000(Dec).

Keywords :

Misoprostol, Operative hysteroscopy, Cervical priming

Abstract :

Objective : To investigate the effectiveness of vaginal misoprostol for cervical priming before operative

hysteroscopy and to assess the cervicouterine complications related to cervical dilatation and hystero-

scopic surgery in nulliparous women. Methods: One hundred fifty-two women with definite intrauterine

lesions were randomly assigned to receive either 200 mug vaginal misoprostol or placebo. Cervical

response and outcome and complications of opera-tive hysteroscopy were assessed. Results: Thirty-five

subjects were needed in each arm to detect a type I error of 0.01 with a power of 0.99. The mean cervical

dilatation estimated by Hegar dilator was significantly different between the treated group (7.3 +/- 0.7 mm)

and the control group (3.8 +/- 1.1 mm, P <.001). In the misoprostol group, 55 (75.3%) patients needed

cervical dilation, compared with 75 (94.9%, P =.001) in the placebo group. The median time of cervical

dilation to Hegar number 9 was significantly shorter in the treated group (40 seconds) compared with the

control group (120 seconds, P <.001). The mean operative time was significantly shorter in the treated

group (36.4 +/- 10.9 minutes) compared with the control group (45.9 +/- 14.2 minutes, P <.001). Cervical

tears occurred in nine (11.4%) patients in the control group and in one (1.4%, P =.018) in the misoprostol

group. Creation of a false tract was more common in the control group. Two uterine perforations occurred

in the placebo group. Conclusion: Vaginal misoprostol applied before operative hysteroscopy reduced the

need for cervical dilation, facilitated hysteroscopic surgery, and minimized cervical complications.

No. 152

Authors :

Preutthipan S, Linasmita V.

Title :

Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi

Hospital.

Source :

Journal of the Medical Association of Thailand. 83(1):42-6, 2000(Jan).

Keywords :

Intrauterine adhesions, Hysteroscopic adhesiolysis, Reproductive outcome

Abstract :

We reported the reproductive outcome of 65 patients with varying degrees of IUAs who underwent

hysteroscopic adhesiolysis between August 1994 and December 1996 at Ramathibodi Hospital. Of the

65 patients treated, 29 had mild adhesions, 26 had moderate adhesions, and 10 had severe adhesions.

Adhesions were lysed with hysteroscopic scissors in 25, with biopsy forceps through hysteroscope in 10,

with electrosurgery using a monopolar probe in 22 patients, and with resectoscope in 8 patients. The mean

duration of the procedure was 15 +/- 2.1 minutes. The mean follow-up was 12 +/- 1.4 months. Of the 44

patients who originally presented with secondary amenorrhea, 40 (90.9%) have normal menses, 4 (9.1%)

have hypomenorrhea. Of the 6 patients who had hypomenorrhea, 5 (83.3%) have normal menses. Cyclic

abdominal pain disappeared after treatment in all patients. Of the 45 patients with IUAs and infertility, 16

(35.6%) conceived. Two (20%) of the infertile patients with initially severe adhesions conceived.

Of the 5 patients with RPL treated, delivered a full term baby and the other delivered a premature baby at 29

weeks of gestation. All 18 patients who delivered, had live births. Adhesion reformation was absent in

patients with initially mild and moderate adhesion but occurred in 2 out of 10 (20%) patients with severe

adhesions. These two patients initially suffered from secondary amenorrhea but reported hypomenorrhea

after surgery. Both of them had tuberculosis of the genital tract. There were no serious complications

occurring in all 65 procedures. All 65 patients were discharged a few hours after the operation.

No. 153

Authors :

Puavilai S, Kunavisarut S, Vatanasuk M, Timpatanapong P, Sriwong ST, Janwitayanujit S, Nantiruj K,

Totemchokchyakarn K, Ruangkanchanasetr S.

Title :

Ocular toxicity of chloroquine among Thai patients.

Source :

International Journal of Dermatology. 38(12):934-7, 1999(Dec).

Keywords :

Antimalarials, Dermatology

Abstract :

Background Chloroquine has been prescribed for the treatment of Various diseases. The most serious side-

effect of chloroquine is retinopathy. The frequency of occurrence or retinopathy varies from 0.001 to

40% depending on the criteria used. The purpose of this study was to evaluate the incidence of ocular

toxicity from chloroquine treatment among Thai patients. Methods A retrospective study was carried

out in patients treated with chloroquine at Ramathibodi Hospital over the past 10 years (1987-1997).

Patients eligible for review were followed by ophthalmic examination by an ophthalmotogist for at least

6 months after starting treatment. Results One hundred and fifty-five patients were studied. Nineteen were

men and 136 were women. They ranged in age from 10 to 70 years. Most patients received 250 mg of

chloroquine per day. The duration of treatment varied from 6 months to 14 years, and the cumulative

dose of chloroquine ranged from 26 to 1771 g. Fourteen patients (9%) had only corneal deposition, while

22 (14.2%) developed retinopathy. There were no correlations between corneal deposits or retinopathy and

age, sex, duration of treatment, or cumulative dose of chloroquine. Conclusions The present study confirms

the finding reported by Mackenzie (Am J Med 1983; 75 (Suppl 1A): 40-45) that retinopathy is not related

to the duration of treatment and cumulative dose of chloroquine. Based on our finding that retinopathy can

be detected as early as 9 months after starting chloroquine therapy, we recommend routine ophthalmic

examination before treatment and every 6 months thereafter.