The effect of a copper intra-uterine contraceptive device on the microbial ecology of the female genital tract

Bacteria isolated from 108 intra-uterine contraceptive devices (IUCD) removed from patients with pelvic inflammatory disease (PID), haemorrhage, pregnancy and from asymptomatic women, and from the genital tracts of 66 healthy controls not wearing an IUCD, were studied. No significant differences were found in the types of micro-organisms or isolation rates from IUCDs removed from women in the various clinical groups. The isolation rate of anaerobic bacteria from IUCDs removed from asymptomatic wearers was significantly lower than that from controls, with the exception of the isolation rate of actinomyces which was significantly higher in IUCD wearers and A. israelii was recovered only from IUCDs. The isolation rates of the different bacterial species varied with the duration of the device in utero. The presence of a copper IUCD altered the bacterial flora of the female genital tract. The insertion of such a device and the ecological changes that follow play a crucial role in the development of PID.     

A double-blind,crossover, randomized dose-comparison trial of granisetron for the prevention of acute and delayed nausea and emesis in children receiving moderately emetogenic carboplatin-based chemotherapy

Background Granisetron is a safe and effective prophylaxis for nausea and vomiting associated with moderate to highly emetogenic chemotherapy. Few trials have been conducted to determine the optimal effective dose of granisetron in children with cancer. The objective of this report was to compare two doses of granisetron in patients with optic pathway tumors receiving moderately emetogenic doses of carboplatin. Patients and methods In this double-blind, crossover, randomized study, antiemetic efficacy and tolerability of two dose levels (10 and 40 μg/kg) of granisetron in the prevention of acute and delayed nausea/emesis were compared in children and young adults. A total of 18 patients (13 boys) aged 1–23 years (median 7.7 years) treated with a moderately emetogenic dose of carboplatin were randomly assigned to receive either 10 or 40 μg/kg of slow granisetron intravenous (i.v.) infusions at alternating cycles of chemotherapy in a blinded fashion until the end of the study period or until their chemotherapy regimen ended. In this way, the patients acted as their own controls. Results Patients in the granisetron 10 and 40 μg/kg groups received 104 and 121 cycles of chemotherapy, respectively. There was no significant difference in antiemetic efficacy in terms of nausea and emesis between the dose groups in the first 5 days of chemotherapy. The treatment was well tolerated. Conclusion We conclude that granisetron 10 and 40 μg/kg have comparable efficacy in controlling carboplatin-induced acute and delayed nausea/emesis and is well tolerated in children and young adults.     

Malignant Struma Ovarii: A Case Report

We present a case of a 40-yr-old woman diagnosed with a primary malignant struma ovarii. The patient was admitted with the complaint of pelvic pain and a large pelvic mass in the mid-portion of lower abdomen on gynecological examination. Pre-operative tumor markers and routine biochemistry were unremarkable. She was treated with total abdominal hysterectomy and right salpingo-oopherectomy. Post-operatively, she was diagnosed with a malignant struma ovarii through the usage of histopathological criteria similar to the guidelines for primary thyroid gland disease. The patient was subsequently performed left salpingo-oopherectomy and retroperitoneal pelvic lympadenectomy for re-staging. Although, left ovary and lymph nodes were histopathologically normal, she was offered thyroidectomy but she refused to accept the offer. Thyroglobulin level was monitored in the post-operative period. She is free of the disease for 18 months.     

Effects of irrigation temperature on heat control in vitro at different drilling depths

Purpose: Thermal injury during implant bed preparation has a major influence on implant osseointegration and survival. This study investigated the effectiveness of the temperature of the saline solution used for heat control during drilling.
Material and methods: Fresh frozen edentulous segments of bovine mandibles were sectioned into 12 × 6 cm pieces. Thermoresistors were placed 0.5 mm from the drilling cavity walls, at depths of 3, 7, and 12 mm. Signals from the three thermoresistors were analyzed using ORIGIN 5.0 software.
Results: The maximum temperatures during drilling without irrigation were 50.9, 47.4, and 38.1°C at depths of 3, 7, and 12 mm, respectively. With irrigation using saline at 25 and 10°C, the maximum temperatures at a depth of 12 mm were 37.4 and 36.3°C, respectively. All other measurements with both 25 and 10°C saline were below body temperature.
Discussion and conclusion: This experimental in vitro study showed that more heat was generated in the superficial part of the drilling cavity than at the bottom. Therefore, external irrigation at room temperature can provide sufficient cooling during drilling. Lower temperature saline was more effective in cooling the bone, and irrigation of the site should be continued between the drilling steps.     

Reproductive failure and antisperm-antibody production among prostitutes.

Reproductive failure and anti-sperm antibody (ASA) production among prostitutes were investigated. A questionnaire including the subject's age, years of prostitution, date of most recent birth, number of children and contraceptive method used at the beginning of prostitution were asked of 109 prostitutes, but only 53 agreed to complete the questionnaire. ASA was detected by ELISA in the prostitutes (n = 109) and in the control group (n = 40) sera. The tests revealed a high ASA rate (43.1%) among the prostitutes. The difference in the incidence of ASA between controls (5%) and the prostitutes (43.1%) was highly significant (p less than 0.01). It was found that ASA positivity incidence in 27 prostitutes who had never use any contraception method and who became infertile within 9.3 years (average) was 61.3%. These results may be explained by repeatedly inoculations with multiple sperm antigens and/or microorganisms.     

High-output left ventricular failure after dextran use in an operative hysteroscopy.

High-output left ventricular failure occurred in a patient after a difficult case of hysteroscopic lysis of adhesions using dextran as a distension medium. The excessive dissection in the uterine wall, the long duration of the operation, and the large volumes of dextran probably caused intravasation of dextran into the systemic circulation inducing a significant shift of fluids from the third space. This was possibly assisted by the large volume of fluids given intravenously in a 45-kg patient initiating the reported sequence of events.