The effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery: a double-blinded randomized controlled trial.

OBJECTIVES: To compare the effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery and the amount of postoperative analgesic dosage. METHODS: The trial included 45 females who had undergone operations during the period December 2014 to October 2015. The patients were block randomized based on operating time (<2 and ≥2 hours). The intervention group (n=23) was treated with postoperative intraperitoneal gas drain and the control group (n=22) was not. The mean difference in scores for shoulder, epigastric, suprapubic, and overall pain at 6, 24, 48 hours postoperatively were statistically evaluated using mixed-effect restricted maximum likelihood regression. The differences in the analgesic drug usage between the groups were also analyzed using a Student's t-test. The data were divided and analyzed to two subgroups based on operating time (<2 hours, n=20; and $2 hours, n=25). RESULTS: The intervention had significantly lower overall pain than the control group, with a mean difference and 95% confidence interval at 6, 24, and 48 hours of 2.59 (1.49-3.69), 2.23 (1.13-3.34), and 1.48 (0.3-2.58), respectively. Correspondingly, analgesic drug dosage was significantly lower in the intervention group (3.52±1.47 mg vs 5.72±2.43 mg, P<0.001). The three largest mean differences in patients with operating times of ≥2 hours were in overall pain, suprapubic pain at 6 hours, and shoulder pain at 24 hours at 3.27 (1.14-5.39), 3.20 (1.11-5.26), and 3.13 (1.00-5.24), respectively. These were greater than the three largest mean differences in the group with operating times of <2 hours, which were 2.81 (1.31-4.29), 2.63 (0.51-4.73), and 2.02 (0.68-3.36). The greatest analgesic drug requirement was in the control group with a longer operative time. CONCLUSION: The use of intraperitoneal gas drain was shown to reduce overall postoperative pain in benign gynecologic laparoscopic surgery. The effects were higher in patients who had experienced longer operating times.

Effect of Andrographis paniculata Extract on Triglyceride Levels of the Patients with Hypertriglyceridemia: A Randomized Controlled Trial.

BACKGROUND: Hypertriglyceridemia is one of the risk factors for cardiovascular disease, and reduction oftriglyceride (TG) level is recommended in clinical practice guidelines for the treatment. Recently, andrographolide, a main active compound of Andrographispaniculata has been shown to possess hypolipidemic effects in animals. OBJECTIVE: To investigate the TG-lowering effects of A. paniculata extract (APE) in patients with hypertriglyceridemia (TG ≥ 150 mg/dL) using gemfibrozil treatment as the reference. MATERIAL AND METHOD: A randomized controlled clinical trial was carried out in sixty subjects with hypertriglyceridemia. They were divided into three groups and treated with low dose of APE (APE-L, andrographolide 71.64-72.36 mg/day), high dose of APE (APE-H, andrographolide 119.64-120.36 mg/day), and gemfibrozil 300 mg/day. The treatments were conducted for 8 weeks. Guidance on lifestyle modifications was provided. RESULTS: The primary endpoint was the mean difference ± SD (95% CI) in TG levels (baseline from the end of treatment), which were -3 ± 125.6 (-59.1, 58.5), 41.6 ± 86.3 (1.2, 82), and 57.1 ± 94.9 (12.7, 101.6) in the APE-L, APE-H, and gemfibrozil groups, respectively. APE-H 120 mg/day and gemfibrozil 300 mg/day caused a significant reduction of TG level (P = 0.0442 and 0.0145, respectively) when compared to the baseline. There was no notable difference in the safety or tolerability among the treatment groups. CONCLUSION: In patients with modest hypertriglyceridemia with lifestyle intervention, APE-H reduced the TG level comparable to the effect of gemfibrozil 300 mg/day. APE treatment was as tolerable as gemfibrozil treatment. Hence, Andrographis paniculata might be used as an alternative medicine in treating hypertriglyceridemic patients.

Incidence of and risk factors for febrile morbidity after laparoscopic-assisted vaginal hysterectomy.

BACKGROUND: The purpose of this study was to assess the incidence of and risk factors for postoperative febrile morbidity after laparoscopic-assisted vaginal hysterectomy (LAVH). METHODS: This retrospective study was carried out using the medical records of women with benign gynecologic conditions who underwent LAVH between June 2007 and May 2012 at Srinagarind Hospital in Thailand. Data were collected to assess baseline patient characteristics, occurrence of body temperature ≥38°C on two occasions at least 6 hours apart in the 24 hours following the surgical procedure, and possible risk factors related to postoperative febrile morbidity. RESULTS: In total, 199 women underwent LAVH during the study period. They had a mean age of 46±6 years, a mean body mass index of 24.0±3.2 kg/m(2), a mean surgical duration of 134±52 minutes, median estimated blood loss of 200 mL, a mean total hospital stay of 5±2 days, and a mean postoperative hospital stay of 3±2 days. Postoperative febrile morbidity was documented in 31 cases (15.6%). The cause of postoperative fever was unknown in most cases, with only two cases having an identifiable cause. The risk of postoperative febrile morbidity was highest in women treated with more than two antibacterial agents and with a regimen of more than 3 days. CONCLUSION: This study shows a moderately high rate of febrile morbidity after LAVH, for which the main risk factors were use of multiple drugs and doses for antibiotic prophylaxis.

A modified LAVH to reduce urinary tract injuries: 102 consecutive case-series at Srinagarind Hospital, Khon Kaen University.

OBJECTIVE: To describe the technique and results of modified laparoscopically assisted vaginal hysterectomy (LAVH), especially, on the urinary tract injury. MATERIAL AND METHOD: One hundred two patients scheduled for modified LAVH between November 2007 and December 2010 were enrolled. RESULTS: The majority of patients were middle-aged. The median parity was two; 16 patients were nulliparous. Among the 39 patients who had undergone prior abdominal or pelvic surgeries, eight had a prior cesarean delivery. The majority of LAVH indication was leiomyoma with complications. The median uterine weight was 300 g (range 120 to 1,450 g). The median operating time was 105 min (range 50 to 365 min). One patient had repeated laparoscopic uterine artery electrocoagulation 12 hours after surgery. Two patients were re-admitted with pelvic inflammatory disease (PID) two to three weeks post-operatively. No bowel or urinary tract injuries were detected during intra- and post-operation. CONCLUSION: The modified LAVH presented here was a technique that showed a low incidence of urinary tract injury.

Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy: a randomized controlled trial.

OBJECTIVE: To compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions. DESIGN: A prospective, randomized, controlled trial. MATERIALS AND METHODS: Between April 2010 and March 2011, 50 Thai patients with strong indications for hysterectomy--with uterine sizes ≤16 weeks of gravid uterus and with no contraindications for open or laparoscopic surgeries--were randomly assigned for LAVH or TAH. MAIN OUTCOME MEASURES: Intraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization. RESULTS: Intraoperative blood loss was significantly less in the LAVH group (median 120 mL [range 50-300]) than in the TAH group (median 250 mL [105-800]) (median difference 130 mL, p <.001, 95% confidence interval [CI] 55-200). The LAVH group required significantly less postoperative morphine sulfate administration (median 3 mg [range 0-12]) than the TAH group (15 mg [6-24]) (median difference 9 mg, p <.001, 95% CI 9-12). The hospital stay for the LAVH group (median 3 days; range 2-7) was significantly shorter than that of the TAH group (median 4 days; range 4-5) (median difference 2 days, p <.001, 95% CI 1-2). The operating time was comparable between the 2 groups (median 100 minutes; range 50-240) for the LAVH and 115 minutes (range 60-200) for the TAH group (median difference 5 minutes, p =.592, 95% CI -15-25). There were no conversions from a LAVH to a laparotomy. CONCLUSIONS: The LAVH has advantages over the TAH in that in the former there is less intraoperative blood loss, less postoperative morphine requirement, and a shorter duration of postoperative hospital stays.

The levels of lycopene, alpha-tocopherol and a marker of oxidative stress in healthy northeast Thai elderly.

An imbalance between oxidative stress and antioxidant capacity has been proposed to play an important role in the development and progression of chronic diseases in the elderly. The present study was carried out to investigate correlation between the serum antioxidants (lycopene and alpha-tocopherol) and malondialdehyde (MDA), a marker of oxidative stress in the healthy Thai elderly. The 207 healthy subjects aged 60-91 years old (72 males and 135 females) in Khon Kaen province, Thailand were enrolled in this study. They were interviewed by questionnaires about smoking habit. Serum lycopene and alpha-tocopherol levels were determined by high performance liquid chromatography (HPLC). MDA was measured by thiobarbituric assay. Serum lycopene and alpha-tocopherol levels in the elderly were 0.27 micromol/L (95% CI = 0.23-0.31) and 22.10 micromol/L (95% CI = 20.99-23.22), respectively. Males had significant lower serum lycopene and alpha-tocopherol levels than females (p<0.001). Of 72 males, 31.94% are current smokers whereas 1.4% of 135 females are current smokers. Current smokers had significantly lower serum lycopene (0.17 +/- 0.11 micromol/L) than current non-smokers (0.28 +/- 0.27 micromol/L) (p=0.0439) but level of alpha-tocopherol had non significance (p=0.210). Moreover, the current smokers had higher MDA malondialdehyde level (1.55 +/- 0.10 micromol/L) than the current non-smokers (1.35 +/- 0.04 micromol/L) (p=0.094). Thus, dietary antioxidant supplementation from local fruits and vegetables may have a beneficial role in the prevention of chronic diseases at high-risk oxidative stress such as smoking in these elderly.

Sexuality after total abdominal hysterectomy in Srinagarind Hospital.

OBJECTIVE: To determine the effects on sexuality after Total Abdominal Hysterectomy (TAH) in north-eastern Thai women. DESIGN: Prospective descriptive study. SETTING: Srinagarind Hospital, Faculty of Medicine, Khon Kaen University from December 2004 to May 2006. MATERIAL AND METHOD: 80 married women, equal or less than 45 years old, which indicated for TAH with or without unilateral salpingo-oophorectomy. All patients had to attend the first questionnaire before surgery. The second and third questionnaires would be collected by mail in 3 and 6 months after surgery. MAIN OUTCOME MEASURES: Frequency of dyspareunia, sexual desire, coitus, masturbation, and the quality of sexuality after TAH. RESULTS: The frequency of dyspareunia was decreased from 91.25% before TAH to 5% in 6 months after TAH (95% CI 1.19-1.61, p < 0.05). The frequency of sexual desire was increased from 55% before TAH to 88.75% in 6 months (95% CI 0.22-0.61, p < 0.05). The frequency of coitus was increased from 38.75% before TAH to 96.25% in 6 months after TAH (95% CI 0.54-0.98, p < 0.05). Normal sexual relations were increased from 53.8% before TAH to 85% in 6 months after TAH (95% CI 0.20-0.47, p < 0.05). CONCLUSION: Sexuality was significantly improved overall after TAH and these might be the strong positive effects of TAH on sexual function.