Lack of tubal occlusion by intrauterine quinacrine and tetracycline in the primate

The effects of slow- and fast-releasing quinacrine pellets and tetracycline tablets on the genital tracts of 20 cynomolgus monkeys was evaluated. After surgical implantation of the pellets, the primates were observed for three months. No signs of toxic effects to the drugs were observed during the three-month period and on autopsy. Histopathological evaluation of the fallopian tubes, cervix, ovaries and uterus (except the endometrium) indicated they were all within normal limits. In no case were the uterotubal junctions obstructed. Endometrial changes were more frequent for quinacrine-treated monkeys. The results of the study point to the need for additional research regarding the optimal dose and duration of quinacrine administration.     

Open laparoscopy for tubal occlusion in the female

Open laparoscopy was performed in 630 patients seeking permanent contraception for health reasons. Various electric and mechanical tubal occlusion methods were utilized. With few exceptions, uterine curettage was performed at the end of the laparoscopic procedure. Curettage revealed unexpected findings in 10 cases. Laparoscopic exploration of the peritoneal cavity showed pathologic findings in 10% of the patients. There were no intraoperative complications related to open laparoscopy. Fourteen patients (2%) underwent immediate laparotomy, to manage unexpected findings in six and to correct complications of unipolar tubal cautery technique in eight. Postoperative complications possibly related to open laparoscopy were limited to minor wound infection in 0.3% and febrile reaction of short duration in 0.1% of the cases. Two sterilization failures occurred in the series, both following unipolar techniques employing coagulation and resection. Many patients have now been followed for 5 or more years without noticeable increases in complaints of uterine bleeding and/or pelvic pain. The data indicate that open laparoscopy is a suitable means of performing tubal sterilization in the female.

---

Resumen Se hicieron laparoscopias abiertas a 630 pacientes que deseaban anticoncepción permanente por razones de salud. Se utilizaron varios métodos eléctricos y mecánicos de oclusión tubaria. Con pocas excepciones, se hizo raspado uterino al final del procedimiento laparoscópico. En 10 casos, el raspado reveló diágnosticos no sospechados. La exploración laparoscópica de la cavidad peritoneal mostró patología en 10% de las pacientes. No hubo complicaciones interoperatorias relacionadas con las laparoscopias abiertas. A catorce pacientes (2%) se les hizo una laparotomía inmediata, para manejar patología inesperada en seis y para corregir complicaciones de la técnica unipolar de cauterización tubaria en ocho. Las complicaciones post-operatorias, posiblemente relacionadas con la laparoscopia abierta, estuvieron limitadas a infecciones menores en la herida en un 0,3% y a reacción febril de corta duración en un 0,1% de los casos. Hubo dos fracasos de esterilización en la serie, ambos a continuación de técnicas unipolares, empleando coagulación y reseción. Muchas pacientes han tenido un seguimiento de 5 o más años sin aumentos considerables de quejas por sangrado uterino y/o dolor pelviano. Los datos indican que la laparoscopia abierta es una forma conveniente para hacer esterilización tubal en las mujeres.

---

Resumé Une laparoscopie a été effectuée sur 630 malades à la recherche d'une contraception permanente pour des raisons de santé. Diverses méthodes d'occlusion électrique et mécanique ont été utilisées. A quelques exceptions près, un curettage utérin a été effectué à la fin de l'operation de laparoscopie. Le curettage a donné lieu à des constatations inattendues dans 10 cas. L'exploration laparoscopique de la cavité péritonéale a conduit à des observations pathologiques chez 10% des malades. II n'y a pas eu de complication: intra-opératoires liées à la laparoscopie ouverte. Quatorze malades (2%) ont subi une inattendues dans 10 cas. L'exploration laparoscopique de la cavité péritonéale a conduit à des observations pathologiques chez 10% des malades. II n'y a pas eu de complication: intra-opératoires liées à la laparoscopie ouverte. Quatorze malades (2%) ont subi une laparotomie immédiate, pour traiter des complications de la technique de cautérisation tubaire unipolaire chez les huit autres. Les complications post-opératoires pouvant être liées à la laparoscopie ouverte ont été limitées à une infection mineure de la plaie dans 0,3% des cas et à une réaction fébrile de courte durée dans 0,1% des cas. Deux défauts de stérilisation se sont produits dans la série, tous deux après des techniques unipolaires utilisant la coagulation et la résection. De nombreux malades sont aujourd'hui suivis depuis plus de 5 ans ou davantage sans augmentation notable des doléances concernant une hémorragie utérine et/ou une douleur pelvienne. Les résultats indiquent que la laparoscopie ouverte est un moyen adéquat d'effectuer la stérilisation tubaire chez la femme.

     

Comparative effects of intrauterine instillation of analogues of quinacrine and tetracycline on uterine morphology in the rat

Currently, intrauterine instillation of quinacrine hydrochloride is used to induce closure of the uterotubal junction in women, thus constituting a chemical method of sterilization. Questions regarding the safety of this drug have been raised. The purpose of the present study is to screen other drugs for their sterilizing potential by comparing quinacrine-induced changes in uterine morphology in the rat which have previously been correlated with decreased fertility with the changes induced by other drugs. The drugs tested include quinacrine-like compounds, namely chloroquine, primaquine and trimethoprim; and tetracycline and its analogues which are known sclerosing agents. The quinacrine-like drugs were relatively ineffective in producing uterine lesions similar to those of quinacrine, but like quinacrine, chloroquine and primaquine showed some toxicity. Tetracycline and its analogues produced quinacrine-like morphologic changes in the rat uterus and showed no toxicity for the doses tested. These results prompt further testing of tetracycline and its analogues as sterilizing agents.     

An economic comparison of female sterilization of hysteroscopic tubal occlusion with laparoscopic bilateral tubal ligation

Background

This study compares the expected 5-year costs for permanent sterilization in women between nonincisional hysteroscopic tubal occlusion with the Essure® system performed in an office setting and laparoscopic bilateral tubal ligation (LBTL).

Study Design

An economic decision tree is used to predict outcomes and costs to compare these two procedures from a US Medicaid perspective over a 5-year time horizon.

Results

Expected costs are $2367 for Essure® and $3545 for LBTL (Essure® saves $1178 or 33% of LBTL costs). Sensitivity analyses show Essure® has lower expected costs across all values considered. If the cost for a LBTL procedure were to decrease by 20% and the cost for Essure® to increase by 20%, Essure® would have still have lower expected costs.

Conclusion

Office-based sterilization for women using Essure® can lead to substantial cost savings over 5 years compared to LBTL. This conclusion is robust to varying analytic inputs.     

Clinical evaluation of quinacrine hydrochloride for sterilization of the human female

Sixty women seeking sterilization were treated with 1 gm of quinacrine in 7 ml of sterile water applied via a Kahn cannula with an olive tip held against the cervix. The tubal closure rate by hysterosalpingogram and/or pregnancy was 44%. In view of the need for multiple applications of this drug and some of the potential problems of the method as yet not clarified, widespread clinical trials are not warranted. However, further testing may resolve the current limitations and risks of the method to yield a useful clinical technique.     

Comparison of the efficacy of intrauterine diclofenac and ibuprofen pellets as adjuvants to quinacrine nonsurgical female sterilization

To investigate relative efficacy of intrauterine diclofenac and ibuprofen as adjuvants to intrauterine quinacrine for nonsurgical sterilization, a total of 900 women were systematically allocated to 2 monthly insertions of pellets of diclofenac (75 mg) or ibuprofen (55.5 mg) as adjuvants to intrauterine quinacrine (216 mg) in a rural private practice in West Bengal, India. All women were prescribed oral contraceptives for three month from first insertion. In the middle of the study increased care was taken to insert pellets at the fundus. There was no statistically significant difference found in cumulative life-table pregnancy failure rates at 36 months for women receiving diclofenac (2.7±0.82) or ibuprofen (3.4±0.89). Taking care to insert pellets at the fundus resulted in a decline of failures at 24 months from 4.4±0.92 to zero. Intrauterine administration of pellets of quinacrine (216 mg) plus diclofenac (75 mg) or ibuprofen (55.5 mg) with 3 months' oral contraception provides acceptable efficacy if pellets are inserted to the fundus.

---

Resumen A fin de investigar la eficacia relativa de diclofenac e ibuprofen intrauterinos como adyuvantes de la quinacrina uterina para la esterilización no quirúrgica, se asignó sistemáticamenete un total de 900 mujeres a 2 inserciones mensuales de bolitas de 75 mg de diclofenac o de 55,5 mg de ibuprofen como adyuvantes de 216 mg de quinacrina intrauterina en un consultorio rural privado de Bengala Occidental, India. A todas las mujeres se les recetaron anticonceptivos orales durante tres meses desde la primera inserción. A mediados del estudio se prestó especial atención a la inserción de las bolitas en el fondo. No se determinó ninguna diferencia estadísticamente significativa en las tasas de fallo de las tablas de vida acumulativas a los 36 meses en el caso de las mujeres a las que se había recetado diclofenac (2,7±0,82) o ibuprofen (3,4±0,89). El cuidado en la inseción de las bolitas en el fondo originó una disminució de los fallos a los 24 meses, de 4,4±0,92 a cero. La administración intrauterina de bolitas de 216 mg de quinacrina más 75 mg de diclofenac o 55,5 mg de ibuprofen con 3 meses de anticonceptivos orales proporciona una eficacia aceptable si las bolitas se insertan en el fondo.

---

Resumé Lors d'une étude conduite dans le cabinet médical dune zone rurale au Bengale occidental (Inde) en vue de déterminer l'utilité relative du diclofénac et de l'ibuprofen en tant qu'adjuvants à la quinacrine, tous administrés par voie intrautérine pour la stérilisation non chirurgicale, on a pratiqué sur un total de 900 femmes, à 1 mois d'intervalle, 2 insertions de pellets contenant soit 75 mg de diclofénac soit 55,5 mg d'ibuprofen en tant qu'adjuvants à 216 mg de quinacrine. Des contraceptifs oraux ont été prescrits à toutes les femmes pendant les trois mois qui ont suivi la première insertion. Au milieu de la période d'étude, on a veilé plus particulièrement à insérer les pellets au fond de la cavité. On n'a constaté aucune différence statistiquement significantive dans les taux d'échec par grossesse sur les tables de survie cumulées à 36 mois, que les femmes aint recu du diclofénac (2,7±0,82) ou de l'ibuprofen (3,4±0,89). En prenant soin d'insérer les pellets au fond de la cavité, il a été possible de ramener le taux d'échecs à 24 mois de 4,4±0,92 à zéro. L'administration par voie intrautérine de pellets de 216 mg de quinacrine, plus 75 mg de diclofénac ou 55,5 mg d'ibuprofen, accompagnée d'une contraception orale pendant 3 mois est d'une utilité acceptable si les comprimés sont insérés au fond de la cavité.

     

Technical failures in female sterilization using the tubal ring: a case-control analysis

To delineate characteristics of women predisposing to sterilization technical failures, we performed an analysis of 20 technical failures that occurred during tubal ring procedures and 80 control ring procedures matched on planned surgical approach and study site. None of the women had recently been pregnant (interval procedures). The odds ratios (ORs) were elevated for women wearing an IUD in the three months prior to sterilization (OR = 5.0, 90% confidence interval [CI] 2.2, 11.2) and for women with a history of spontaneous abortion (OR = 4.3, 90% CI 1.8, 9.8). A history of pelvic inflammatory disease (PID) and/or current evidence of PID was strongly associated with technical failure (X2 = 25.0, p less than 0.001). The combined effect of any two of these three factors increased the risk synergistically. We examined these factors prospectively and confirmed the elevated risks (relative risk [RR] = 5.0, 5.5 and 22.7 for recent IUD wearing, spontaneous abortion history and history/evidence of PID, respectively). The prospective analysis also found that previous abdominal surgery is associated with technical failure (RR = 6.7).     

Chemical occlusion of monkey oviducts with quinacrine: antagonism and reversal with estrogen.

This study was undertaken to investigate possible mechanisms of action of D-norgestrel as a contraceptive agent after the results of large clinical trials on postcoital contraception with D-norgestrel were known. Previously, in a total of 4,631 patients with 41,802 months of use, a general failure rate of 3.5 and a corrected failure rate of 1.7 was observed. In this communication, the action of 400 mcg D-norgestrel was investigated when taken orally by a total of six subjects on day 12, days 10 and 12, days 8, 10, 12 of the cycle, on the 2nd and 4th day, and on the 2nd, 4th and 6th day after the LH-peak. Karyopyknotic index, cervical function, Spinnbarkeit and crystallization of cervical mucus, serum levels of 17β-estradiol, progesterone and LH were studied daily from the 8th day of the cycle. Preovulatory application of the contraceptive agent resulted in the inhibition of peripheral parameters of the menstrual cycle. Furthermore, midcycle elevation of LH was found inhibited and reduced in subjects treated in the follicular phase. Neither preovulatory nor postovulatory application of the progestagen appeared to interfere with the luteal phase of the cycle. It is concluded that one of the possible main actions of this contraceptive agent has to be sought in the inhibition of peripheral function of the menstrual cycle.     

Association of perforation of the appendix with female tubal infertility

Although perforation of the appendix is considered a risk factor for female tubal infertility, the epidemiologic evidence supporting this relation is inconsistent. Risk factors for tubal infertility were compared for 121 women with documented primary tubal infertility attending in vitro fertilization clinics in Toronto, Canada, from July to December 1998 and 490 controls who were pregnant during the same time period. Self-administered questionnaires and review of medical records were used to assess exposures. The authors found that neither history of acute appendicitis nor perforation of the appendix was a statistically significant risk factor for tubal infertility. The crude odds ratio for perforated appendicitis was 3.4 (95% confidence interval (CI): 0.9, 12.9), and the adjusted odds ratio was 1.4 (95% CI: 0.3, 6.2). In addition to increased age and annual income, cigarette smoking (odds ratio (OR) = 2.0, 95% CI: 1.2, 3.2), history of endometriosis (OR = 6.0, 95% CI: 2.8,12.8), and history of pelvic inflammatory disease (OR = 6.0, 95% CI: 2.8, 12.8) were significantly associated with tubal infertility in multivariate analysis. These data do not provide substantial evidence that perforation of the appendix is an important risk factor for female tubal infertility.     

Changes of plasminogen activator in human uterine tissue induced by intrauterine contraceptive devices

Potassium thiocyanate-extractable uterine plasminogen activator activity was determined to be highest in the endometrium surrounding intrauterine devices (IUDs). Such activity was significantly higher than that encountered in control endometrium or in the endometrium remote to IUDs. As in control cases, extracted endometrial activity fluctuated during the intermenstrual ovarian cycle. It was highest in the pre- or periovulation part of the cycle, and it rose again prior to menstruation. These peaks of activity seem to correspond to times in the cycle when metrorrhagia and abnormal menstruation are usually encountered. Possible implications of the myometrial and endometrial patterns of plasminogen activator in control and IUD-exposed uterine tissue are discussed.     

Changes in menstrual blood loss after four methods of female tubal sterilization

One-hundred females requesting tubal sterilization were included in this study. They were enrolled into 4 groups, each n = 25. They were allocated to a particular method of sterilization on a randomized basis. The four modalities used were: laparoscopic Falope ring application, bipolar electrocoagulation, Hulka clip application and Pomeroy tubal ligation via minilaparotomy. The menstrual blood loss (MBL) was quantitatively estimated, using the alkaline hematin method, prior to sterilization and after 3, 6 and 12 months. No significant changes in MBL were observed after the four sterilization techniques. Moreover, they did not differ significantly in this context.     

Interleukin-6 and tumor necrosis factor-alpha concentrations in the intrauterine cavity of postmenopausal women using an intrauterine delivery system releasing progesterone. A possible mechanism of action of the intrauterine device.

Intrauterine devices (IUD) provide effective contraception. The current study evaluates the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in the intrauterine fluid of postmenopausal women using an intrauterine delivery system releasing progesterone (IDS-P). Intrauterine fluid was obtained by lavage, and IL-6 and TNF-alpha were analyzed using an enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed with a one-way analysis of variance (ANOVA). Intrauterine fluid IL-6 levels were 33.6 vs 6.09 pg/sample IDS-P vs no IDS-P (p = 0.0301). Intrauterine TNF-alpha levels for women using the IDS-P were higher than in nonusers, but the differences did not reach statistical significance. IL-6 and TNF-alpha levels were increased in the intrauterine cavity of postmenopausal women with an IDS-P. These data suggest that secreted cytokines could be a potential mechanism of IUD contraceptive efficacy.     

Trichomonas vaginalis in vaginal smears of women using intrauterine contraceptive device.

To detect the association between the use of an intrauterine contraceptive device (IUCD) and the presence of Trichomonas vaginalis (Tv), vaginal smears of 1110 women were examined cytologically. Among 45 IUCD users, 10 women were positive for Tv (22.22%). Forty six of 1065 non-users were also positive for Tv (4.32%). There was a significant correlation between the use of IUCD and the presence of Tv (p < 0.05). The data also indicated that the prolonged use (> or = 3 years) of copper-IUCD may promote the growth of Tv in the vaginal mucosa. This result will be a clue to diagnose asymptomatic patients for Tv.     

Lung lesions induced by intratracheal instillation of vanadium pentoxide powder in rats

To clarify acute toxicity and histopathological changes in the lung after exposure to V2O5 powder, rats (SD, male, n=66) were observed for 4 weeks after an intratracheal administration of V2O5 powder (geometric mean diameter 0.31 microm, geomertic standard deviation sigmag=2.19) at three doses (0.88, 3.0, 13.0 mg/kg body weight). The histopathological lung lesions were developed dose-dependently, and characterized by exudative inflammation, injury of alveolar macrophages, and swelling and mucous degeneration in the broncho-bronchiolar epithelia. Growth rate of the V2O5 powder-instilled rat was also retarded dose-dependently. The V2O5 powder used was composed of not coagulated but well dispersed particles consisting of vanadium pentoxide of more than 99.8% (w/w) with vanadium tetraoxide of less than 0.2%. The V2O5 powder was found to be 8 times more soluble in an artificial biological fluid "Gamble's solution" than in a pure water. From the present findings as well as those from the related literature, it was inferred that the histopathological lesions induced by the intratracheally instilled V2O5 powder are caused not only by the V2O5 particles per se but also by vanadium ions dissolved from the particles into the lung fluid.     

女性输卵管不孕症与盆腔沙眼衣原体感染关系状况分析

目的:了解不孕妇女盆腔沙眼衣原体(CT)感染的情况及其与输卵管性不孕症的关系。方法:对68例腹腔镜术中发现有输卵管炎症的不孕妇女盆腔积液行CT检测;对60例同期术中发现无输卵管炎症的手术患者盆腔积液行CT检测作为对照。结果:不孕组CT感染率(52.94%),极显著高于对照组CT感染率(13.33%),差异有统计学意义(P<0.01)。结论:CT感染是导致不孕症的重要原因之一。     

三种诊断输卵管末端黏连梗阻方法对比

目的探讨子宫输卵管造影、B型超声（B超）诊断输卵管末端黏连梗阻的准确性。方法回顾分析2002年4月至2005年12月在本院因输卵管造影提示输卵管末端黏连梗阻而行腹腔镜检查治疗的63例病人的临床资料，采用与腹腔镜检查相对照的方法，比较子宫输卵管造影、B超诊断输卵管末端黏连梗阻的准确性。结果子宫输卵管造影诊断输卵管末端黏连梗阻与腹腔镜诊断符合阳性符合率80．2％（89／111），假阳性率19．8％（22／111）。子宫输卵管造影诊断输卵管通畅与腹腔镜诊断阴性符合率86．7％（13／15），假阴性率13．3％（2／15）。B型超声诊断输卵管梗阻积水与腹腔镜诊断阳性符合率95．0％（38／40），假阳性率5．0％（2／40）。B型超声未发现输卵管异常与腹腔镜诊断阴性符合率48.8％（42／86），假阴性率51．2％（44／86）。结论子宫输卵管造影可作为诊断输卵管黏连梗阻的一线方法，B型超声诊断输卵管积水的准确率较高，腹腔镜检查可明确诊断，决定不孕症的治疗方案。     

已婚女性人工流产术后放置宫内节育器的影响因素分析

目的:调查分析已婚女性人工流产术后放置宫内节育器(IUD)的影响因素。方法:选取行人工流产手术的已婚育龄女性542例为研究对象,其中术后放置IUD 209例,未放置IUD 333例,分析影响其放置IUD的因素。结果:年龄、文化程度、孕产次数、对IUD知晓率、末次分娩时间、能够承担IUD放置费用、近3年无生育需求的已婚女性在人工流产术后更容易选择放置IUD。结论:影响已婚女性人工流产术后放置IUD的最主要因素是生育需求,其次是放置IUD的费用、产次、年龄以及对相关知识的知晓度。     

Antifertility effects of human sperm antigen in female rats.

The sperm antigens responsible for inducing infertility were identified by Western blot technique using sera from an infertile woman with circulating antisperm antibodies. The 80 Kda was prepared from human sperm by extraction with 0.05% sodium deoxycholate in 0.01 M Tris-HCl buffer, pH 8.4 and fractionation with ammonium sulphate. The supernatant after 40% saturation ammonium sulphate extraction was separated by gelpermeation chromatography, using HPLC (Protein PAK 125 column) and FPLC (superose 12 column) systems. The homogeneity of the protein was established by SDS-PAGE and its molecular size was estimated to be 80 Kda and its isoelectric point was 4.5. The purified protein upon active immunization in female rats caused infertility in 100 percent animals. The data suggest that 80 Kda human sperm antigen has the potential for use as a contraceptive vaccine.