An integrated care pathway for menorrhagia across the primary-secondary interface: patients' experience, clinical outcomes, and service utilisation.

Background: "Referral" characterises a significant area of interaction between primary and secondary care. Despite advantages, it can be inflexible, and may lead to duplication.

Objective: To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led evidence based care.

Has pelvimetry a role in current obstetric practice?

Radiological pelvimetry is still requested in some centres before planned vaginal delivery for breech presentation or following a previous caesarean section. In a retrospective review of the utilisation of pelvimetry in 167 cases in our department, 103 (62%) and 64 (38%) had pelvimetry in the postnatal and antenatal periods respectively. Antero-posterior inlet and outlet diameters were inadequate in 19.

The long-term effectiveness of endometrial laser ablation: a survival analysis.

Objectives: To assess the long-term effectiveness of endometrial laser ablation and factors that predict long-term outcome.

Setting: A university teaching hospital.

Study Design: Postal questionnaires were sent to all women who underwent endometrial laser ablation between 1992 and 1998.

The effect of the learning curve on the duration and peri-operative complications of laparoscopically assisted vaginal hysterectomy.

Background: Hysterectomy is the commonest elective major gynecological operation and the laparoscopic approach is increasingly an option. We evaluated the influence of the learning curve on the duration of surgery and also the peri-operative complications.

Methods: A retrospective study of the case records of patients who had laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy between August 1993 and July 1997.

Laparoscopic laser treatment for endometriosis.

The advent of the use of laparoscopy and lasers in gynaecology has added a further option for the treatment of endometriosis. This study is a retrospective review of the notes of 28 women who had endometriosis treated laparoscopically with an Nd:YAG laser. Results were assessed by subjective reporting of symptoms.

Long-term survival after chemotherapy with cisplatinum, adriamycin and cyclophosphamide for carcinoma of the ovary.

Forty six patients with FIGO Stage II, III, and IV ovarian cancer received treatment with cisplatinum, adriamycin and cyclophosphamide. After a minimum follow-up time of 60 months 13 patients remain free of recurrence. The overall 5-year survival is 39% and the median survival is 39 months.

The role of second-look laparotomy in the management of patients with stage II, III and IV ovarian cancers following chemotherapy with cisplatin, adriamycin and cyclophosphamide.

Twenty-eight patients underwent a second-look laparotomy on completing triple agent chemotherapy with cisplatin, adriamycin and cyclophosphamide. The adequacy of the primary debulking procedure and the stage of tumour were the most significant factors associated with a good prognosis. Grade and histological type of tumour had no effect on survival rates.

Treatment of stages II, III and IV primary surface epithelial ovarian cancers by maximum bulk tumour reduction and combined chemotherapy with cyclophosphamide, doxorubicin and cisplatin.

Forty-six patients with Stages II, III and IV ovarian cancer received treatment with cyclophosphamide, doxorubicin and cisplatin. Patient response to therapy was assessed 6 weeks after the cessation of therapy. Thirty-three patients (72%) were in complete response and six (13%) had a partial response to treatment.

A study of cryosurgery and the CO2 laser in treatment of carcinoma in situ (CIN III) of the uterine cervix.

The results of laser and cryosurgical treatment in 106 patients with histologically proven carcinoma in situ of the uterine cervix (CIN III) are presented. Seventy-one patients were treated with the laser and in 63 of these further follow-up with colposcopy and cytology failed to show any abnormality. This represents an initial success rate of 89%.

Topical 5-fluorouracil in the treatment of vaginal intraepithelial neoplasia.

The effectiveness of 5-fluorouracil (Efudix) in the treatment of vaginal intraepithelial neoplasia was assessed in 14 patients diagnosed with the condition between January 1980 and December 1982. All patients received a standard dose of 2.5 g 5-fluorouracil cream once weekly for at least 10 consecutive weeks; mean duration of treatment was 12 weeks (range 10-20 weeks).

The effects of halothane on pregnant and nonpregnant human myometrium.

Strips of myometrium were obtained at operation from eight nonpregnant and ten pregnant patients. The tissues were immediately suspended in a muscle bath and induced to contract isometrically with K2SO4 in the presence and absence of halothane (0.5 to 2.

Halothane and calcium interaction in isolated pregnant and postpartum rat myometrium.

Isolated strips of mid-pregnant and postpartum rat myometrium were rendered functionally Ca2+-free by exposure to a Ca2+-free modified Krebs-bicarbonate solution containing 1 mM EGTA. The muscle strips were then exposed to 2.25 mM Ca2+ for periods of 15 to 600 seconds for the mid-pregnant tissues and one 120-second period for the postpartum tissues.

Halothane and isometric contractions of isolated pregnant rat myometrium.

The effects of halothane on isometirc contractions of isolated pregnant uterine muscle strips were evaluated in tissue obtained from 13 midpregnant rats. Peak developed tension was depressed in a dose-related manner at halothane concentrations above 0.8 vol per cent, but was not affected at lower halothane concentrations.