Comparison of plasma hormone changes using a "conventional" and a "paper" pill formulation of a low-dose oral contraceptive

Two formulations of a low-dose oral contraceptive (Microgynon: 150 microgram of levonorgestrel [NG] +30 micrograms of ethynylestradiol [EE2]) were studied. The first was the "conventional" pill; the second was a "paper" pill prepared by evaporation of aliquots of a solution of the component steroids onto squares of edible cellulose separated by perforations, similar to a sheet of postage stamps. The effects of the two formulations on plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17beta-estradiol (E2), and progesterone were compared. Samples of blood were obtained from five women during a treatment period on the "conventional" pill and from five on the "paper" pill. When possible, blood samples were also obtained from a "control" cycle of each of these female subjects. Plasma LH, FSH, E2, and progesterone levels were determined by specific radioimmunoassay methods during control and treatment periods and NG and EE2 levels during treatment periods. Eight-hour plasma profiles for NG and EE2 at the beginning and in the later stage of the treatment periods were obtained and these samples were also analyzed for LH, FSH, E2, and progesterone. Results showed that with one exceptcrogynon were equally effective in suppressing ovulation. As in a previous study, FSH levels appeared to be one of the most sensitive indices of suppression.     

Removal of a broken silastic catheter with a "snare"-catheter in a neonate

Silastic central catheters inserted peripherally are used in neonatology since more than 20 years. Typical complications include catheter associated infection, thrombosis and malposition. Pericardial effusion, fracture and embolisation are rare. We report the case of a female newborn with congenital diaphragmatic hernia. A silastic catheter was inserted in the left cubital vein. The catheter ruptured when the obviously occluded lumen was flushed with saline. A 15 cm long catheter fragment located in the right ventricle and pulmonary artery was removed after cardiac catheterization with a "Snare"-catheter.     

The "Easy" Way to Have a Baby

The aim of this article is to alert nurses, in settings which primarily serve natural families, that adoptive families have many of the same needs. These needs often go either unrecognized or unmet. It is hoped that this article will encourage nurses in these and other settings to assess the needs of the adoptive family and to intervene where appropriate.     

Comparison of "instrument-associated" and "spontaneous" obstetric depressed skull fractures in a cohort of 68 neonates

OBJECTIVE: A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a "ping-pong" fracture. This study aimed to look at differences between "spontaneous" and "instrument-associated" depressed skull fractures. STUDY DESIGN: This retrospective, case-control analysis included every neonate who was admitted with a depressed skull fracture between 1990 and 2000. Cases after a spontaneous vaginal delivery, elective cesarean delivery, or cesarean delivery that was performed during labor without previous instrument use were classified as "spontaneous" (n = 18 cases). Cases after a delivery in which forceps or a vacuum cup had been used either successfully or unsuccessfully were classified as "instrument-associated" (n = 50 cases). Continuous data were analyzed with 2-tailed unpaired t tests; chi 2 analysis was used for nominal data. A probability value of <.05 was considered statistically significant. RESULTS: Fifty depressed skull fractures were associated with an instrument delivery, and 18 depressed skull fractures were classified as "spontaneous." The only obstetric parameter that differed significantly between the 2 groups was the length of the active phase. Among the 68 neonates, 15 neonates underwent prolonged second stage, forceps or manual head rotation, or forceps use during elective cesarean delivery. All "instrument-associated" cases were caused by forceps application or sequential instrument use; depressed skull fractures never occurred after isolated vacuum extraction. Every type of forceps was involved. Intracranial lesions were significantly more frequent in the instrument-associated group (30% vs 0%; P = .02). Two infants sustained persistent severe motor disabilities. CONCLUSION: Depressed skull fractures occur in the setting of spontaneous and operative deliveries, although the incidence is higher in the latter case. Depressed skull fractures that are associated with instrumental deliveries are significantly more likely to be associated with intracranial lesions. Persistent disabilities are rare.     

"Nongynecologic" surgical procedures performed on a gynecologic oncology service

One thousand fifty-eight patients had major surgery in a community-based, university-affiliated gynecologic oncology service. Of these, 233 underwent a total of 275 "nongynecologic" surgical procedures. Two hundred twenty patients suffered from gynecologic malignancies, whereas 13 had surgery for benign disorders. Eighty-two procedures were performed on the gastrointestinal tract, 44 on the urinary tract, and 149 on extrapelvic lymph nodes. Except for ovarian carcinoma and benign conditions the majority of gastrointestinal or urinary tract operations were preceded by radiation therapy. When the nongynecologic operation was necessitated at a time subsequent to initial therapy of the malignancy, a high incidence of recurrent disease was discovered. Of the 275 procedures, reoperation because of early or late complications was necessary in only 8 instances. Only one postoperative death was caused by complications of surgery. Other mild postoperative complications were transient and responded to routine noninvasive care. The complication rate and morbidity of nongynecologic surgical procedures performed on a gynecologic oncology service are low and should encourage gynecologic oncologists to continue their present comprehensive approach to patient care.     

Presentation of a new IUD: the "Ombrelle 250"

The Ombrelle 250 is a new copper IUD designed and produced in France. Its plastic support has the overall shape of an open umbrella. A copper wire with a surface of 250 sq mm is wrapped around the vertical arm of a T. The device is characterized by great flexibility. 497 devices were inserted by 3 gynecologists between January 1975-October 1982. 134 patients were aged 29 or under, 270 were 30-40, and 93 were 40 or over. 29 had no children, 132 had 1 child, and 336 had 2 or more children. Several women using the device had risk factors for IUD use, including 22 who had experienced expulsions of previous devices, 9 who became pregnant while using IUDs, and 35 who had IUDs removed for poor tolerance. 5 had had ectopic pregnancies, 6 had diabetes, 1 had corticotherapy, and 2 had cervical-isthmic disproportions. At the end of the 3rd study year, the number of cycles of use was 13,768 while 13.5% of patients had been lost to follow-up. The cumulative failure rate after 36 months was .9% and the Pearl index was .4/woman year. 5 pregnancies occurred including 1 extrauterine pregnancy and 1 pregnancy in a woman previously becoming pregnant while using a copper IUD. 4 total or partial expulsions were observed for a rate of .6/woman year at 12 months and a cumulative net expulsion rate of .6 after 3 years. 1 of the 4 expulsions was in a woman who had previously expelled a device. The net removal rate for pain and bleeding was 1.9/100 woman years at 12 months, and the cumulative rate at 3 years was 4/100 woman years. 16 other devices were removed for medical reasons during the 3 years, for a cumulative net removal rate of 2.8% at 3 years. 5 removals were done for endometritis or upper genital infections. Study of 66 endometrial biopsies obtained during IUD removals showed no anomalies apart from 2 cases of endometritis. The continuation rate was 87% at 2 years and 83.9% at 3 years. 16 devices were removed to permit pregnancy. 11 of 14 women followed up for at least 3 months became pregnant.     

Benign ovarian serous tumors: a re-evaluation and proposed reclassification of serous "cystadenomas" and "cystadenofibromas"

OBJECTIVE: Serous cystadenomas and cystadenofibromas of the ovaries are currently regarded as neoplasms and are considered the most common ovarian neoplasms. The purpose of this study is to determine what proportion of benign serous tumors contain an epithelial proliferation (the hallmark of a neoplastic process in nearly all other sites) that can be considered neoplastic as opposed to reactive in nature. METHODS: An unselected series of 113 ovarian serous tumors (76 serous cystadenomas and 37 serous cystadenofibromas) were histologically evaluated. A 1-mm in diameter area of epithelial proliferation was considered potentially neoplastic. RESULTS: Eight tumors (7%) displayed at least 1 mm of epithelial proliferation (1% of serous cystadenomas and 19% of serous cystadenofibromas). CONCLUSION: The vast majority of benign serous tumors may not be bona fide epithelial neoplasms, but rather, may represent cystically dilated glandular inclusions (cystadenomas) and fibromas with epithelial inclusions (cystadenofibromas). A recently published study evaluating clonality in serous cystadenomas found that the vast majority are polyclonal and thus supports this hypothesis. These findings have important implications for the pathogenesis of ovarian cancer, for the distribution of ovarian neoplasms, and for the interpretation of molecular biological studies of ovarian tumors.     

The "white" cervix: a new anatomo-clinical entity?

The authors describe a very particular histologic pattern of the cervical epithelium. Many types of histologic lesions are involved and are almost always found in association one with another. This particular histologic pattern is characterized principally by well-differentiated epithelium, immature, with early necrosis of the superficial layers, associated with metaplastic endocervicitis. In addition to this particular association, there is a remarkable finding: this histologic pattern was found consistently in fifteen cases selected uniquely from their appearance at colposcopy. Could this be a new anatomic-histologic entity?     

Clinical evaluation of a "hand pump" vacuum delivery device

OBJECTIVE: To evaluate the clinical performance of a hand-held vacuum delivery system. METHODS: Between December 1999 and September 2000, a prospective audit was undertaken of all vacuum deliveries performed at Derby City General Hospital. RESULTS: In this period, 3296 deliveries occurred, of which 317 (9.6%) were by vacuum. Of these, data were collected on 300 (94.6%), 78 deliveries with the hand-held vacuum and 222 with standard vacuum. There were no differences in the demographic profiles, indication, gestational age at delivery, or birth weights between the two groups (P >.05 in all instances). In all types of delivery, nonrotational and rotational, the hand-held vacuum performed comparably to its contemporaries with no increase in delivery "failures" being noted. There were no differences in the extent or frequency of maternal injuries between the instruments, and other than transient scalp abrasions, there were no significant fetal injuries. CONCLUSION: The hand-held vacuum delivery system is a functionally effective addition to the practitioners' "armory," providing an alternative to the standard metal and silastic cups.