More and more women of childbearing age are sporting lumbar tattoos. Irrespective of your attitude to the practice, does this preclude her from having an epidural in labour?
Kuczkowski from California, where a fifth of the population have some “epidermal enhancement” believe a lumbar tattoo is not a contraindication to neuraxial analgesia (Arch Gynecol Obstet 2006;274:310-2). It is suggested that pigmented areas are best avoided and Touhy needles used routinely to circumvent possible tattoo puncture-related complications.
19 September, 2006
Tamoxifen and infertility
Tamoxifen citrate is sometimes used empirically in the treatment of unexplained infertility. The rationale for using an anti-oestrogen is unclear but rebound endogenous ovarian stimulation has been suggested, unencumbered by scientific proof.
Now a study by Shokeir (Arch Gynecol Obstet 2006;274:279-83) shows that tamoxifen has no benefit in improving pregnancy rates in infertile women. In fact, there was a statistically significant decrease in conception rates in those taking tamoxifen compared to placebo. This effect may have been mediated by altered cervical mucus or endometrial suppression - either way tamoxifen for infertility is bad news.
Now a study by Shokeir (Arch Gynecol Obstet 2006;274:279-83) shows that tamoxifen has no benefit in improving pregnancy rates in infertile women. In fact, there was a statistically significant decrease in conception rates in those taking tamoxifen compared to placebo. This effect may have been mediated by altered cervical mucus or endometrial suppression - either way tamoxifen for infertility is bad news.
The Journals in August
The articles pouring out of the American journals are impressive. There seems a flood of data on lifestyle, diet, exercise and smoking. There is also a serious self-examination of their public health needs and their ability to provide these.
There is a strong tension between the medical profession, the legislation and big pharma. There seems no resolution in sight. The UK NHS is also being seriously re-examined, with private care being more and more debated as a “partner” in providing the needs of its citizens, while the medical governing bodies are realigning themselves.
JASS tries to keep out of politics but doesn't always manage to do so!
One point about the hormonal replacement trials. The differences that are being uncovered are exceedingly small. The RUTH trial summarised this month confirms this. We are talking in points of one percent differences in outcomes. What concerns me is the lack of data from women starting HRT at their menopause and then continuing - not women aged 68 on a trial. And what about quality of life measures? I know the problems of global scores, but that is what it's all about in the end.
Please visit www.jassonline.com for information about JASS for GPs or tell your Family Physician friends about it.
There is a strong tension between the medical profession, the legislation and big pharma. There seems no resolution in sight. The UK NHS is also being seriously re-examined, with private care being more and more debated as a “partner” in providing the needs of its citizens, while the medical governing bodies are realigning themselves.
JASS tries to keep out of politics but doesn't always manage to do so!
One point about the hormonal replacement trials. The differences that are being uncovered are exceedingly small. The RUTH trial summarised this month confirms this. We are talking in points of one percent differences in outcomes. What concerns me is the lack of data from women starting HRT at their menopause and then continuing - not women aged 68 on a trial. And what about quality of life measures? I know the problems of global scores, but that is what it's all about in the end.
Please visit www.jassonline.com for information about JASS for GPs or tell your Family Physician friends about it.
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