More on how to remove a Chinese IUD

Abstract

Size does matter and Homeopathic treatment of premenstrual symptoms Madam I am somewhat concerned that in the same issue of the Journal as the statistical paper entitled 'Size does matter' 1 there was an Overview on 'Homeopathy treatments for premenstrual symptoms' 2 which may be considered to have depended on evidence that contradicted the statistical paper. I would be grateful for your opinion as to the reliability of the one clinical trial by Yakir et al. 3 , which was cited as evidence in favour of homeopathy. I would like to make clear that my motivation is not to discredit homeopathy. 1. The Overview refers to the 'recent' trial by Yakir et al. It was actually carried out in 1992-1994 and not published until 2001. 2. The Overview refers to there being 20 women in the study but actually only 19 completed the study. 3. The Yakir et al. study claims 90% of the homeopathy group had improvementactually it was 91%, i.e. even more favourable to homeopathy than was claimed. 4. Yakir et al. set an arbitrary improvement level of 30% of the menstrual distress questionnaire to determine effectiveness of therapy resulting in three of the placebo group improving. However, Figure 2 shows that five of the placebo group had improved. 5. While claiming homeopathy effective they admit under Outcomes that, 'the between group difference ... fell just short of statistical significance'. 6. The study certainly suggests the possibility that homeopathy is effective so why no larger-scale trial 9 years later? My main concern is that our Journal has given credibility to the effectiveness of homeopathy in the management of premenstrual syndrome on the basis of inadequate evidence. What do you think?

A 10-year experience in removing Chinese intrauterine devices

“…Most physicians practicing in North America consider removal of an IUD to be a simple office procedure. However, removing a Chinese IUD can be a challenge, particularly for physicians who are not experienced in removal of these types of IUD [6,7]. The findings of the present study show that IUDs inserted in China were more difficult to remove than IUDs inserted in Canada.…”

Chinese IUD removal techniques in a Chinese population in central Italy

“…A review of the literature disclosed no relevant information about the removal of these devices in Faculty of Family Planning and Reproductive Health Care (FFPRHC) and Royal College of Obstetricians and Gynecologists (RCOG) guidance documents, National Guidelines Clearing House or the WHO publication Improving Access to Quality Care in Family Planning -Selected Practice Recommendations for Contraceptive Use, 2002 [15].…”

The stringless IUCDs of Shanghai: An educational tale

“…A search in the medical literature by the authors of this manuscript revealed that there have only two references in the English language on how to remove this IUCD (Stillwell 2003;Khan 2003), although there was information on 'Google' by a Hong Kong gynaecologist including diagrams on how to remove and fit such a contraceptive device. To remove a Shanghai ring, Khan (2003) helpfully suggested using a rigid uterine hook and/or the Rocket IUD removing forceps.…”

“…To remove a Shanghai ring, Khan (2003) helpfully suggested using a rigid uterine hook and/or the Rocket IUD removing forceps.…”