Clearly, the ability to search full-text articles would be highly desirable. Handsearching of printed articles is, however, very labour-intensive. We propose an alternative strategy that makes use of ...computer software commonly referred to as a desktop search engine. There are several free desktop search engines available (eg, Copernic Desktop Search, Google Desktop, Yahoo! Desktop Search) that can index files on the computer hard disk and provide almost instantaneous searching of not only the filename, but the full text contained in commonly used files (eg, PDFs, Word, Excel, and PowerPoint).3
Objective
To identify patient characteristics which affect outcome after hysteroscopic myomectomy for submucous fibroids.
Design
Prospective observational study.
Setting
A university teaching ...hospital.
Sample
One hundred and twenty‐two consecutive patients treated by hysteroscopic myomectomy for submucous leiomyoma over a period of almost eight years.
Methods
Hysteroscopic electroresection of the leiomyoama using a continuous flow resectoscope.
Main outcome measures
The avoidance of further surgery and patient satisfaction.
Results
The average age of the patients at the time of their surgery was 424 years. A total of 194 fibroids were removed. The mean follow up period was 2.3 years (range 1–7.6). Of those asked, 71.4% were satisfied with the results of surgery. Sixteen women required further surgery for fibroids, and six ultimately underwent hysterectomy. Survival analysis showed that the risk of further surgery was 21% at four years after the myomectomy, and 0% thereafter. Univariate regression analysis suggested that outcome was significantly better in older women, and in cases where the uterus was equivalent in size to I 6 weeks of gestation, the fibroid was I 3 cm in diameter and mainly intracavitary, and the proce‐ dure time was I 20 minutes. The influence of hormonal pre‐treatment and the number of fibroids excised was not statistically significant. After multivariate regression analysis, only overall uterine size and the position of the fibroid being removed were found to significantly influence the success of surgery.
Conclusions
Hysteroscopic myomectomy is an effective way to manage patients with symptomatic submucous leiomyomata, particularly when the uterus is not grossly enlarged and the fibroid(s) are mainly inside the uterine cavity.
This paper considers a leaky aquifer system comprising an unconfined aquifer, a confined aquifer, and a confining layer (the aquifer’s roof). The unconfined aquifer terminates at the coastline, the ...confined aquifer and its roof extend under the sea for a certain distance. The aquifer’s submarine outlet is covered by a thin layer of sediment (referred to as the “outlet-capping” hereafter) with properties dissimilar to the aquifer. Previous studies either neglected the leakage through the aquifer’s roof or the outlet-capping. This paper considers both effects and gives an analytical solution to describe the tide-induced head fluctuation in the aquifer system. For aquifers with zero or infinite offshore length, or with impermeable roof or outlet-capping, or without the outlet-capping, existing solutions in the literature are obtained. We defined the threshold value for the offshore aquifer length, which was found to be less than 5
km for typical coastal aquifer systems. For an aquifer with its offshore length greater than the threshold, the inland head fluctuation becomes insensitive to variations of this length and the outlet-capping’s leakance. The leakage through the offshore roof decreases the threshold value. When the offshore confined aquifer is short, the inland head fluctuation increases with the outlet-capping’s leakance. In this case negative phase shift occurs near the coastline only for aquifers with small leakages through the offshore roof and the outlet-capping. In general, the combined actions of the tidal loading, the leakage and length of the offshore roof, and the leakage of the outlet-capping lead to complex, non-monotonic dependency of the inland head fluctuation on the aquifer parameters.
Does endometrial resection help dysmenorrhea? Molnár, Béla G.; Baumann, Ralf; Magos, Adam L
Acta obstetricia et gynecologica Scandinavica,
March 1997, Letnik:
76, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Background. Menorrhagia is a common symptom and is often associated with dysmenorrhea. Methods. The effect of transcervical resection of the endometrium (TCRE) on dysmenorrhea associated with ...menorrhagia was investigated in a prospective study. Ninety consecutive women were monitored before surgery and for a period of up to 12 months after resection. The amount of pelvic pain experienced was scored daily on a scale of 0–3, and was timed in relation to menstruation.
Results. There was a significant decrease in the level of pain experienced during menstruation and overall during the menstrual cycle (p <0.001), but not in the premenstruum. The effect on pain was immediate and was maintained throughout the follow‐up period of the study. The presence of adenomyosis or leiomyomata in the surgical specimen did not influence the beneficial effect on pain.
Conclusions. Based on these findings, dysmenorrhea during menstruation should not be a contraindication to transcervical endometrial resection in women with menorrhagia.
Diagnostic laparoscopy is a common procedure performed in many hospitals worldwide to investigate infertile women. However, morbidity and cost prevent it being considered a first-line diagnostic ...tool. If out-patient culdoscopy could replace in-patient laparoscopy then a major component of the cost of investigations could be avoided. We studied ten consecutive infertile patients who had laparoscopy under general anaesthesia and another ten patients who had culdoscopy under local anaesthesia in The One Stop Fertility Clinic (OSFC) in The Royal Free Hospital in London. The costs for each patient from both groups was calculated and compared. We found that out-patient investigation in an OSFC produced a saving of over £350 per case or 28% to the hospital compared with in-patient investigation. Although there were other factors which may influence the costs of out-patient culdoscopy, it did provide noticeable savings to the healthcare system.
Finesse, not local anaesthesia Gambadauro, Pietro; Magos, Adam
BMJ,
04/2010, Letnik:
340, Številka:
7752
Journal Article
Recenzirano
The take home message of the systematic review and meta-analysis on local anaesthesia during outpatient hysteroscopy is misleading. 1 The conclusion, "Injectable, preferably paracervical, ...administration of local anaesthetic should be used for women undergoing hysteroscopy as outpatients to reduce the amount of pain experienced," is based on five randomised trials, two of which found paracervical blocks to be ineffective. 2 3 The benefit reported in the three other studies was clinically modest, two showing a one point reduction in pain on a 10 point scale.
