Minerva

Minerva

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7085.986 (Published 29 March 1997) Cite this as: BMJ 1997;314:986

Should postmenopausal women having non-gynaecological laparotomies have their ovaries removed? A “debate” series of articles in Human Reproduction (1997;12:201-6) argues that this might cut mortality from ovarian cancer, but the downside is that the ovaries continue to produce androgens after they have stopped producing oestrogens, and these androgens may be needed after the menopause to maintain libido and possibly to help preserve bone.

Most surgeons believe that patients with fractured hips should be operated on as soon as possible after admission to hospital. Several research studies, however, have suggested that mortality is lower among patients whose operation is delayed until the second day (Archives of Internal Medicine 1997;157:483-4).This allows attention to be paid to any dehydration or other medical conditions. Yet again the answer should lie in properly designed randomised trials.

The same uncertainty applies to another surgical condition, the atherosclerotic popliteal aneurysm. A review in the British Journal of Surgery (1997;84:293-9) quotes a comment that the lesion is “a sinister harbinger of sudden catastrophe” and concludes that elective surgical reconstruction is the treatment of choice for patients with symptoms but that controversy continues about the best management of patients without symptoms–and that the answer can come only from randomised trials. …

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