RESUMEN
OBJECTIVE: To assess pain and patient satisfaction with office-based hysteroscopic sterilization. DESIGN: This prospective, observational study was designed to assess patient pain perception and satisfaction with office-based hysteroscopic sterilization using the Essure device (Conceptus, Mountain View, CA). SETTING: Faculty practice office at an inner-city urban medical center. PATIENT(S): Women seeking hysteroscopic sterilization. INTERVENTION(S): Office hysteroscopic sterilization under local anesthesia. MAIN OUTCOME MEASURE(S): Pain assessed at the time of the procedure by a 0-10 visual scale and satisfaction by a 1-5 scale. RESULT(S): From June 2003 to June 2006, 209 patients were recruited. The mean scores for average procedural pain, most procedural pain, and average menstrual pain were 2.6+/-2.1, 3.3+/-2.5, and 3.6+/-2.6, respectively. Standardized pain scores revealed that 149 subjects (70%) experienced average pain that was less than or equal to the pain experienced with their menses. Mean satisfaction rating for the procedure was 4.7+/-0.71. CONCLUSION(S): Office-based hysteroscopic sterilization performed with local anesthesia alone is well tolerated, and patients are satisfied with this method for permanent sterilization.
Asunto(s)
Histeroscopía , Dolor Postoperatorio/diagnóstico , Satisfacción del Paciente , Esterilización Reproductiva/efectos adversos , Esterilización Reproductiva/métodos , Adulto , Dispositivos Anticonceptivos Femeninos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Histeroscopía/efectos adversos , Histeroscopía/estadística & datos numéricos , Visita a Consultorio Médico , Dimensión del Dolor , Satisfacción del Paciente/estadística & datos numéricos , Percepción , Proyectos de Investigación , Esterilización Reproductiva/rehabilitación , Esterilización Reproductiva/estadística & datos numéricosRESUMEN
BACKGROUND: Group A Streptococcus is an aerobic gram-positive bacteria known to cause cutaneous infections. Invasive infections can lead to toxic shock syndrome with multiorgan failure and mortality rates of 25-48%. CASE: A healthy, young woman developed necrotizing fasciitis, myonecrosis, and toxic shock syndrome after an elective medical termination of pregnancy. This patient had confirmed group A Streptococcus on blood cultures and underwent surgical debridement. After aggressive surgical treatment, below-the-knee amputation, and antibiotic therapy, the patient survived. CONCLUSION: This case demonstrates the need for prompt recognition and treatment of necrotizing fasciitis/toxic shock syndrome.