996
this practice has not been widespread: most donated product is . usable and greatly appreciated. Soviet physicians have made their needs known and we have tried to respond within the contraints of the United States Humanitarian Assistance Program. There is no question that all humanitarian efforts so far by all western nations can be legitimately criticised for being inadequate. At the same time, it should be recognised that a problem that developed over a century will not be "cured" overnight. The enormity of the difficulties by necessity regulates humanitarian assistance programmes to little more than tokens unless they are rapidly followed up by programmes in education and technical assistance, as well as professional and institutional partnerships. Department of Anesthesiology, Hospital and Medical Center,
Children’s
ROBERT K. CRONE
Seattle, Washington 98105, USA
Abortion
across
countries
SiR,—In your Feb 22 note (p 485), you report controversy about the issue of abortion in Ireland. In Catholic countries like Ireland and Poland, it is very difficult to procure an abortion. In Ireland, about 4000 women with unwanted pregnancy go to Britain every year for terminations. A similar pattern of cross-countries abortion is seen in Hong Kong. Abortion has been legal there since 1973 and the number of legal abortions increases every year. A study by the Family Planning Association showed that 1 in 5 women aged 15-45 had one or more abortion, which were lawful in 50%, illegal in 20%, and were done in China in 30%. In 1990, 21 114 legal abortions were officially recorded. Abortion in China is easy to obtain and consent from two doctors is not required. There is no upper limit for gestational age, unlike the 24 weeks’ limit in Hong Kong and many parts of the world. Fetuses of 7-8 months can be aborted and some are clearly viable at birth. Some women have abortions if the sex of the fetus is not what they want (girls are usually discriminated against). Shenzhen is the usual choice for abortion since it is only a few minutes walk across the Hong Kong border. There is no waiting list and there is no need for parental consent if you are a minor. Patients are not asked why they want an abortion, and preoperative counselling is not provided. The operation is usually done in a regional hospital with local anaesthesia or with none. The woman can return home on the same day, and the fee is small-[ 40 for first-trimester and £ 100 for second/third trimester. Although abortion is widely practised in China for population control, complications
are not uncommon.
Postoperative pelvic
infection is fairly frequent and the uterine evacuate is not examined histologically, so ectopic pregnancy can be missed. Because minimum analgesia is used, patients experience intense pain on dilatation, and cervical damage can result from forceful dilatation. Little advice is given about contraception. The psychological effects of abortion should not be underestimated, especially if the procedure is done in another country, and the mother can encounter prejudice on her return home. To prevent cross-countries abortion and its complications, we need to provide a more efficient abortion service, but this should be in accordance with local standards and laws. The provision of an adequate contraceptive service is most important. Department of Obstetrics and Gynaecology, Hospital, Hong Kong
Queen Mary
S. K. LAM
Assessment of arteriovenous haemodialysis fistulas SIR,-Dr Nonnast-Daniel and colleagues (Jan 18, p 143) report use of colour doppler ultrasonography (CFDU) in the assessment of arteriovenous fistula (AVF) for haemodialysis. We agree that this should be the method of choice in such evaluations provided that the technique is available, a view also recorded in the
publications in radiology.’ Patients with chronic renal failure have high morbidity and deserve non-invasive investigations. Nevertheless, simple duplex sonography, which is cheaper and probably more widely available than CFDU,has been used for several years in the assessment of A VF. 2.3 CFDU, however, allows a
rapid interpretation on AVF than does duplex sonography and might therefore save time. We believe that it is important to calculate the blood-flow volume in AVF. This can be done very easily by duplex sonography and thus allows objective evaluation of fistula function. In 58 normal, well established Brescia-Cimino fistulas we found a mean bloodflow volume of 593 (SD 310) ml/min, whereas in 17 with severe stenosis needing correction it was 168 (62) ml/min (p
this practice has not been widespread: most donated product is . usable and greatly appreciated. Soviet physicians have made their needs known and we have tried to respond within the contraints of the United States Humanitarian Assistance Program. There is no question that all humanitarian efforts so far by all western nations can be legitimately criticised for being inadequate. At the same time, it should be recognised that a problem that developed over a century will not be "cured" overnight. The enormity of the difficulties by necessity regulates humanitarian assistance programmes to little more than tokens unless they are rapidly followed up by programmes in education and technical assistance, as well as professional and institutional partnerships. Department of Anesthesiology, Hospital and Medical Center,
Children’s
ROBERT K. CRONE
Seattle, Washington 98105, USA
Abortion
across
countries
SiR,—In your Feb 22 note (p 485), you report controversy about the issue of abortion in Ireland. In Catholic countries like Ireland and Poland, it is very difficult to procure an abortion. In Ireland, about 4000 women with unwanted pregnancy go to Britain every year for terminations. A similar pattern of cross-countries abortion is seen in Hong Kong. Abortion has been legal there since 1973 and the number of legal abortions increases every year. A study by the Family Planning Association showed that 1 in 5 women aged 15-45 had one or more abortion, which were lawful in 50%, illegal in 20%, and were done in China in 30%. In 1990, 21 114 legal abortions were officially recorded. Abortion in China is easy to obtain and consent from two doctors is not required. There is no upper limit for gestational age, unlike the 24 weeks’ limit in Hong Kong and many parts of the world. Fetuses of 7-8 months can be aborted and some are clearly viable at birth. Some women have abortions if the sex of the fetus is not what they want (girls are usually discriminated against). Shenzhen is the usual choice for abortion since it is only a few minutes walk across the Hong Kong border. There is no waiting list and there is no need for parental consent if you are a minor. Patients are not asked why they want an abortion, and preoperative counselling is not provided. The operation is usually done in a regional hospital with local anaesthesia or with none. The woman can return home on the same day, and the fee is small-[ 40 for first-trimester and £ 100 for second/third trimester. Although abortion is widely practised in China for population control, complications
are not uncommon.
Postoperative pelvic
infection is fairly frequent and the uterine evacuate is not examined histologically, so ectopic pregnancy can be missed. Because minimum analgesia is used, patients experience intense pain on dilatation, and cervical damage can result from forceful dilatation. Little advice is given about contraception. The psychological effects of abortion should not be underestimated, especially if the procedure is done in another country, and the mother can encounter prejudice on her return home. To prevent cross-countries abortion and its complications, we need to provide a more efficient abortion service, but this should be in accordance with local standards and laws. The provision of an adequate contraceptive service is most important. Department of Obstetrics and Gynaecology, Hospital, Hong Kong
Queen Mary
S. K. LAM
Assessment of arteriovenous haemodialysis fistulas SIR,-Dr Nonnast-Daniel and colleagues (Jan 18, p 143) report use of colour doppler ultrasonography (CFDU) in the assessment of arteriovenous fistula (AVF) for haemodialysis. We agree that this should be the method of choice in such evaluations provided that the technique is available, a view also recorded in the
publications in radiology.’ Patients with chronic renal failure have high morbidity and deserve non-invasive investigations. Nevertheless, simple duplex sonography, which is cheaper and probably more widely available than CFDU,has been used for several years in the assessment of A VF. 2.3 CFDU, however, allows a
rapid interpretation on AVF than does duplex sonography and might therefore save time. We believe that it is important to calculate the blood-flow volume in AVF. This can be done very easily by duplex sonography and thus allows objective evaluation of fistula function. In 58 normal, well established Brescia-Cimino fistulas we found a mean bloodflow volume of 593 (SD 310) ml/min, whereas in 17 with severe stenosis needing correction it was 168 (62) ml/min (p
