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The data for this study is based on 403 women undergoing dilatation and curettage and representing all aspects of an average clinic population cross-section in age parity and health. This method (dilatation and curettage) is extensively used for detection of cancer of the corporeal endometrium. Exposure of the cervix and vaginal fornices was the biggest problem in terms of applying the technique. There were basic contraindications to office curettage including intact hymen marked obesity of the patient leading to difficult positioning inebriation etc. Generally the patients agreed that the operation was less painful than the extraction of a tooth. 91% of the patients did not have any complications. There were 2 uterine perforations and one cervical laceration.

Objective: To find out the frequency of bacteriuria associated with Foley catheterization after gynecological and Obstetric (cesarean section) surgery and to analyze the factors associated with bacteriuria. Methods: This is a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of one of the four functional units for a period of one year (1st January 2007 to 31st December 2007) were collected in all postoperative women who had undergone major gynecological surgery (like abdominal hysterectomy, laparatomy, vaginal hysterectomy etc) and cesarean sections in obstetrics. Charts were reviewed and relevant clinical findings and bacteriological studies of catheter tip culture and sensitivity were noted. Results: There were total 390 major operations (both Gyne & Obs) during the study period. In obstetrics there were a total of 211 cesarean section. Files obtained were 186. Urine and catheter tip culture were obtained in 165 out of 186 cases. Positive culture was found in 76 out of 165 (46%). In gynecology, there were 179 major operations, out of which 130 files were obtained. Urine and catheter tip culture reports were available in 121 cases and 56 (46%) were found to be positive. In cesarean section, duration of catheterization was not associated with increased bacteriuria (p=0.926), while in gynecological surgery there was significant impact of catheterization duration on bacteriuria (p=0.042). In gynecological surgery, increasing patients' age had important impact on bacteriuria (p=0.0004). Overall 46% had positive catheter tip culture. The most common organisms isolated were E coli, Enterococcus fecalis and Staph aureus. Conclusion: This study establishes that Foley catheter was associated with increased risk of bacteriuria in postoperative women following obstetrical and gynecological surgery. Key words: Bacteriuria, Foley catheterization, Catheter tip culture and sensitivity doi:10.3126/njog.v3i1.1437 NJOG 2008 May-June; 3(1): 35 - 38

The results of a series of 305 consecutive office curettages are presented. The patients were subjected to the procedure because of either menometrorrhagia functional sterility amenorrhea premenstrual tension or abnormal breast hyperplasia. 5 early cases of adenocarcinoma were discovered. Only 2 patients had untoward reactions to the procedure which were temporary. Curettage provided valuable information regarding the etiology of the symptoms. Office curettage when performed by a trained gynecologist is a safe and useful procedure.

Aspiration curettage was compared with conventional dilatation and curettage to determine the efficacy of each in diagnosing endometrial cancer. Since 1946 at Roswell Park Memorial Institute 301 patients had both aspiration curettage and conventional dilatation and curettage. It was found that aspiration curettage is an entirely safe procedure is equal to conventional dilatation and curettage in diagnostic accuracy and is invaluable in diagnosing recurrent activity in the postradiation inoperable group of cases.

Aspiration curettage proved acceptable to patients and medical staff when incorporated into a busy outpatient practice. The diagnostic reliability of curettings obtained was shown to be 93.5 per cent accurate. In all patients where mucus only is obtained, where symptoms persist or recur, or when aspiration curettage is too distressing, conventional curettage is mandatory.An evaluative study of diagnostic aspiration curettage in an outpatient setting is presented. Curettage without analgesia was performed on 208 patients. 93.5% of the diagnoses were confirmed to be accurate. The majority of the diagnostic errors involved the inability to obtain adequate samples. Conventional curettage is mandatory when mucus only is obtained, when symptoms persist, or when aspiration curettage is too distressing. Patients who required diagnostic curettage preferred the aspiration curettage procedure. Aspiration curettage is considered a safe, acceptable procedure, and its use on an outpatient basis will expedite diagnosis.

A technique for diagnostic curettage that can be performed in a physicians office is described. The procedure is performed in the usual manner except that anesthesia is not used. There is a certain degree of pain involved with the method at 3 stages of the operation but is considered bearable if the patient is warned and is trusting. The procedure does not permit a complete examination of the lateral structures proximal to the rectum. The technique should be performed on ly by a specialist and is not recommended for diagnosis of young nulliparous women.

IN Europe and Asia, legal abortion has been performed in relation to demographic and socioeconomic considerations, inadequate contraceptive programs, the desire to protect women from illegal aborti...

This study compares the efficacy in early pregnancy of prostaglandin (PG) F2alpha and PGF2alpha analogue, ICI 74,205 (racemic 20-ethyl-PGF2alpha). The study involved 19 patients of which 10 were treated with ICI 74,205 and 9 with PGF2alpha. The duration of amenorrhoea varied from 38-64 days. 2 patients in each group were found to be nonpregnant at the time of treatment. 6 patients received one analgesic injection and 4 required 2 injections. Follow-up was done at 5, 7, 10, 14, 21, and 30 days after treatment. Results were: 1) 7 pregnant patients receiving PGF2alpha aborted and 6 of the eight receiving ICI 74,205 aborted, 2) the two patients who failed to abort within 14 days were treated by conventional curettage, 3) the patients receiving PGF2alpha were assessed to have aborted more quickly than those receiving ICI 74,205, and 4) evacuation of the uterus was performed in 4 patients (for bleeding in 3 patients receiving ICI 74,205, and for suspected faulure in 1 treated with PGF2alpha). Vaginal blood-loss persisted for 5-21 days in patients in whom evacuation was not performed. 2 patients receiving ICI 74,205 and 4 receiving PGF2alpha vomited; all patients experienced moderate to severe uterine cramps. This study confirms the efficacy of the PGs in inducing early abortion. The side effects were a source of discomfort in most patients but blood-loss was not excessive.

A mortality of 22% is reported for 50 cases of septic abortion complicated by hypotension. Patients were treated by a variety of medical managements, and 44 underwent surgery. 38% were subjected to hysterectomy based on the following indications: 1) unresponsive septic, hypotension, large uterus; 2) intrauterine douche with necrosis; and 3) anuria. Experience with this series indicated the following procedural principles: 1) hourly recording of blood pressure and urinary output; 2) gram-stained smears from cervix; 3) infusion of intravenous fluids and antibiotics geared to combat gram-negative organisms and Clostridium welchii (vasopressor may be required for patients in deep shock); and 4) surgical treatment to remove the source of infection and toxicity. Rationale for clinical management is discussed.

Among surgeons, the opinion regarding the advisability of incidental appendectomy as a routine procedure during other intra-abdominal operations is diverse. Many surgeons are dogmatic in their stand for or against, while others vary depending upon the circumstances in the individual case. Allen 1 is of the opinion that incidental appendectomy should not only be considered as an elective procedure but also as a prophylactic one. He favors removal of the normal appendix in the course of another operation provided that appendectomy can be performed through the incision already in use, if the patient's general health and operative condition are good, and if, in the surgeon's judgment, the procedure can be performed without threat, including wound soilage. Recent literature favors incidental appendectomy as a routine procedure, especially during gynecological and obstetrical surgery. 2-4 Taniguchi and Kilkenny 2 reviewed a series of 532 appendices removed incidental to other pelvic surgery in women.

Altogether 143 patients had minor gynaecological operations performed under general anaesthesia in the outpatient department. This method proved to be very acceptable to patient, gynaecologist, and anaesthetist. No complications occurred requiring admission to hospital, and the short recovery time confirmed the safety of early discharge from hospital. This procedure had a beneficial effect on the waiting list, and expensive beds were used more efficiently for major surgical cases. It is recommended that this procedure should be more widely practised, provided that the patients are adequately screened.