Low-dose aspirin has a moderate chemopreventive effect on adenomas in the large bowel.

OLIC ACID AND ITS DERIVATIVES (folate) are essential nutrients in humans and play an important role in nucleotide synthesis and methylation reactions. 1 Folate deficiency leads to macrocytic anemia, and abundant evidence indicates that even in well-nourished western populations, folate supplementation reduces the risk of neural tube defects. 2 Considerable epidemiological evidence suggests that a low-folate diet is associated with an increased risk of colorectal neoplasia, 3-5 particularly in concert with alcohol, which can antagonize the metabolism of folate. 6,7 Much animal data support an antineoplastic effect of folate. However, in some animal studies, folate deficiency protects against, and supplementation increases, experimental carcinogenesis. 3 For editorial comment see p 2408.

This paper presents the results of a retrospective study of the costs associated with laparoscopically assisted vaginal hysterectomy (LAVH) before and after implementation of a clinical pathway developed by the authors (Table 1). Forty patients underwent LAVH before and 84 patients after the clinical pathway was adopted. The 2 groups were similar in age and incidence of chronic disease or pelvic adhesions. Implementation of the LAVH clinical pathway resulted in an 8.1% decrease in the total cost of the procedure (P ϭ .03). Especially significant were a 56% decrease in laparotomy costs, a 55% decrease in treatment costs, and a 51% decrease in drug costs (P Ͻ.01 for all). After clinical pathway implementation, the mean operating time for LAVH decreased from 186 minutes to 140 minutes (25%, P Ͻ.01). The mean time patients were under anesthesia decreased from 204 minutes to 160 minutes (22%, P Ͻ.01), and the average length of hospital stay was reduced from 6.9 days to 4.1 days (P Ͻ.01). Postoperative antibiotic use decreased from 15% to 3.6% (P Ͻ.02). Requirements for postoperative intravenous fluids, intravenous injections 48 hours after surgery, and incidence of complications did not change significantly. GYNECOLOGYVolume 58, Number 8 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT This prospective, observational study compared nulliparous women and parous women who had vaginal hysterectomy. The subjects were 365 consecutive women who were scheduled to undergo vaginal hysterectomy at La Conception Hospital between 1994 and 2000 and who met the following study criteria: no pelvic prolapse, no previous pelvic surgery, and clinical and physical suitability for vaginal surgery. Fifty-two of these women were nulliparous and 293 were multiparous (90 had one child, and 203 had more than one). The 2 groups were similar in age, body mass index, uterine weight, planned oophorectomy, and indications for surgery. No difference was seen between groups in the mean length of hospital stay (6.63-6 days). There was a significant increase in operating time for nulliparous women (mean, 95 min) compared with multiparous women (79.9 min; P Ͻ.01). Also, nulliparous women had a significantly higher complication rate. Eight percent of women in the nulliparous group and 2% in the multiparous group experienced excessive bleeding (P Ͻ.03). Two women in each group required a transfusion (n ϭ 2), and 2 nulliparous and 3 multiparous women needed a secondary vaginal procedure to control bleeding. There was no significant difference between the groups in the rate of pelvic abscess or hematoma (3 [6%] in nulliparous women vs. 5 [2%] in multiparous women). Three procedures, 2 in nulliparous women and 1 in a multiparous woman, were converted to abdominal surgery. Overall, successful vaginal hysterectomy was performed in 96.2% of nulliparous women and 99.7% of multiparous women. ABSTRACTThis study was conducted to determine the difference in outcome of tension-free vaginal tape placement under local or regional anesthesia, which enables the surgeon to ...

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