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1.  Fertility patterns after appendicectomy: historical cohort study 
BMJ : British Medical Journal  1999;318(7189):963-967.
Objective
To examine fertility patterns in women who had their appendix removed in childhood.
Design
Historical cohort study with computerised data and fertility data for this cohort and for an age matched cohort of women from the Swedish general population. The cohorts were followed to 1994.
Setting
General population.
Participants
9840 women who were under 15 years when they underwent appendicectomy between 1964 and 1983; 47 590 control women.
Main outcome measures
Diagnoses at discharge. Distributions of age at birth of first child among women with perforated and non-perforated appendix and women who underwent appendicectomy but were found to have a normal appendix compared with control women by using survival analysis methods. Parity distributions at the latest update of the registry were also examined.
Results
Women with a history of perforated appendix had a similar rate of first birth as the control women (adjusted hazard ratio 0.95; 95% confidence interval 0.88 to 1.04) and had a similar distribution of parity at the end of follow up. Women who had had a normal appendix removed had an increased rate of first births (1.48; 1.42 to 1.54) and on average had their first child at an earlier age and reached a higher parity than control women.
Conclusion
A history of perforated appendix in childhood does not seem to have long term negative consequences on female fertility. This may have important implications for the management of young women with suspected appendicitis as the liberal attitude to surgical explorations with a subsequently high rate of removal of a normal appendix is often justified by a perceived increased risk of infertility after perforation. Women whose appendix was found to be normal at appendicectomy in childhood seem to belong to a subgroup with a higher fertility than the general population.
Key messagesA history of perforated appendix in childhood does not seem to have an adverse effect on female fertilityThe current recommendations of a liberal attitude to exploration in women with suspected appendicitis cannot be justified on the grounds of pervention of infertility
PMCID: PMC27821  PMID: 10195964
2.  Population based case-control study of sick leave in postmenopausal women before diagnosis of hyperparathyroidism 
BMJ : British Medical Journal  1998;317(7162):848-851.
Objective: To analyse sick leave in women at risk of primary hyperparathyroidism before its diagnosis.
Design: Case-control study nested within a screened cohort of postmenopausal women. Cases were women with hyperparathyroidism without prior knowledge of their disease and no traditional symptoms or complications. Controls were women from the screened population without hyperparathyroidism.
Setting: Population based screening within a Swedish community.
Subject: 48 case-control pairs of women aged 55-70 years.
Main outcome measure: Sick leave during the 5 years before diagnosis.
Results: Total duration of sickness benefits was longer in the cases than controls, and this discrepancy included sick leave on full time or half time and for periods of longer than a week. Cases had an increased risk of sick leave more than half of the investigated time compared with controls (odds ratio 12). Doctors’ certificates showed that the overrepresented sick leave in the cases related mainly to cardiovascular diseases.
Conclusion: Asymptomatic mild primary hyperparathyroidism in postmenopausal women is accompanied by a previously unrecognised morbidity, which has consequences for clinical management of the disorder and its impact on the health economy.
Key messages Primary hyperparathyroidism mainly affects postmenopausal women, many of whom lack classic symptoms and complications of the disorder and are currently considered suitable for conservative follow up Postmenopausal women with asymptomatic primary hyperparathyroidism drew more sickness benefit than matched controls during the 5 years before the diagnosis Cardiovascular diseases were the main cause of sick leave The duration of sick leave was not correlated with age or serum calcium concentration Mild undiagnosed hyperparathyroidism in postmenopausal women is linked with previously unrecognised ill health of importance to the clinical and economic impact of the disorder
PMCID: PMC31094  PMID: 9748176

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