RESUMEN
This consensus statement has been developed by the Thai Interest Group for Endometriosis (TIGE) for use by Thai clinicians in the diagnosis and management of endometriosis. TIGE is a group of clinical and academic gynaecologists with a particular interest in endometriosis. Endometriosis is an oestrogen-dependent inflammatory disease which causes chronic symptoms such as dysmenorrhoea, chronic pelvic pain, dyspareunia and subfertility, and it is common in reproductive-age women. There is limited overall data on its prevalence in different clinical settings in Thailand, but it is clear that the disease causes significant problems for patients in terms of their working lives, fertility, and quality of life, as well as placing a great burden on national healthcare resources. Decisions about selecting the appropriate treatment for women with endometriosis depend on many factors including the age of the patient, the extent and severity of disease, concomitant conditions, economic status, patient preference, access to medication, and fertility need. Several hormonal treatments are available but no consensus has been reached about the best option for long-term prevention of recurrence. Bearing in mind differences in environment, genetics, and access to the healthcare system, this treatment guideline has been tailored to the particular circumstances of Thai women.
Asunto(s)
Endometriosis , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/terapia , Estrógenos/uso terapéutico , Femenino , Humanos , Dolor Pélvico/etiología , Dolor Pélvico/terapia , Opinión Pública , Calidad de Vida , Tailandia/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the association between success and the benefit of repeated intrauterine insemination (IUI) cycles among women of different age groups. MATERIAL AND METHOD: A retrospective analysis of 466 IUI cycles from 221 patients treated in afertility center of a university hospital between 2005 and 2013. The female age was stratified as younger than 35 years, 35 to 40 years, and older than 40 years old. The outcomes were the biochemical pregnancy rate, clinical pregnancy rate, live birth rate, and miscarriage rate. Kaplan-Meier analysis of the suitability cycle in each age group was also performed. RESULTS: The average age ofpatients was 35.2±4.6 years (range 21 to 49 years). The overall biochemical pregnancy rate was 18.6%. The biochemical pregnancy rate significantly decreased with advancing female age groups (27.6%, 12.8%, and 7.1% infemale age group younger than 35 years, 35 to 40 years, and older than 40 years respectively, p = 0.008). The other pregnancy outcomes were not different among female age groups. In all age groups, the increment of the cumulative biochemical pregnancy rate was observed up to four cycles. CONCLUSION: The biochemical pregnancy rate of IUI cycle decreased with advancingfemale age; however clinical pregnancy rate, live birth rate, and miscarriage rate were not different among female age groups. We recommend performing up to four insemination cycles before proceeding to IVF/ICSI cycle.
Asunto(s)
Fertilización In Vitro/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Índice de Embarazo , Adulto , Factores de Edad , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Tailandia/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To determine the effectiveness of preoperative parecoxib sodium injection for pain relief after laparoscopic gynecologic surgery. MATERIAL AND METHOD: A prospective double-blind, randomized study was conducted in 268 patients who underwent laparoscopic gynecologic surgery at Vajira Hospital between November 1, 2010 and March 31, 2011. The patients were randomly allocated into two groups to receive either single intravenous 40 mg parecoxib (treatment group; n = 133) or normal saline (control group; n = 135) 30 min before surgery. The degree of postoperative pain was assessed every 2 h in the first 8 h postoperation, then every 4 h until completion of 24 h by using a verbal rating scale. Total consumption of meperidine over a 24-h period and the adverse events relevant to parecoxib sodium were also recorded. RESULTS: Mean pain scores at all measured times in the treatment group were insignificantly lower than those in the control group (p = 0.106). The mean 24-h postoperative meperidine consumption in the treatment group was significantly lower compared to that in the control group (26.3 +/- 28.1 mg and 39.1 +/- 34.6 mg, respectively, p = 0.001). The proportion of patients requiring meperidine in the treatment group was significantly lower than that in the control group (58.6% and 70.3%, respectively, p = 0. 045). No serious adverse events were observed in both groups. CONCLUSION: Preoperative parecoxib sodium significantly reduced postoperative meperidine requirement and consumption, while insignificantly declined the pain scores. Serious adverse events were not encountered
Asunto(s)
Inhibidores de la Ciclooxigenasa/administración & dosificación , Procedimientos Quirúrgicos Ginecológicos , Isoxazoles/administración & dosificación , Laparoscopía , Dolor Postoperatorio/tratamiento farmacológico , Adolescente , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Inyecciones Intravenosas , Meperidina/uso terapéutico , Persona de Mediana Edad , Dimensión del Dolor , Atención Perioperativa , Estudios Prospectivos , Tailandia , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To determine the results of laparoscopic lymphadenectomy in gynecologic oncology patients. MATERIAL AND METHOD: Medical records of 31 gynecologic oncology patients who underwent laparoscopic lymphadenectomy between November 1, 2004 and February 28, 2007 were retrospectively reviewed. RESULTS: The median age of the study population was 47 years (range 24-77 years). Sixteen patients (51.6%) had endometrial cancer while 15 (48.4%) had ovarian malignancy, with median numbers of resected pelvic and paraaortic nodes of 12 (range 3-30 nodes) and 1 (range 1-3 nodes). The groups of lymphadenectomy only, lymphadenectomy with total laparoscopic hysterectomy, and lymphadenectomy with laparoscopic assisted vaginal hysterectomy had median blood losses of 100 ml (range 30-220 ml), 350 ml (range 100-800 ml), and 200 ml (range 150-400 ml) respectively. Accidental injuries of common iliac artery and large bowel occurred in two patients, all of whom were converted to a laparotomy for correcting the damaged sites. Overall, the median duration for postoperative recovery was three days (range 2-8 days). CONCLUSION: The results suggest that surgical staging for gynecologic malignancies can be adequately performed through laparoscopic surgery, with benefit in terms of early postoperative recovery.