Low-dose oral contraceptives in adolescents: how low can you go?

CONTEXT: The use of combined oral contraception (COC) before the accrual of peak bone mass in adolescents is common. Despite the tendency to prescribe lower ethinyl estradiol concentrations so as to reduce thromboembolic complications, concerns have developed as to whether low-dose COC provides sufficient estrogen supplementation for adequate adolescent bone development. OBJECTIVE: This paper reviews the available literature on bone mineral density (BMD) and low-dose COC in adolescents in an effort to determine whether adult-oriented recommendations for the lowest tolerated estrogen dose should apply to adolescent populations. DESIGN: A MEDLINE search of all English-language literature (1966 to January 2008) was performed using the terms "adolescent," "oral contraception," and "BMD." Bibliographies were reviewed to extract additional relevant sources. Articles were selected based on pertinence to BMD changes in association with low-dose (20 microg ethinyl estradiol) hormonal contraception with emphasis on adolescent study groups. RESULTS: A limited number of studies examining 20-microg preparations in adolescents have demonstrated a significantly smaller mean percentage BMD acquisition in COC groups vs untreated controls. Bone mineral density decreases appeared to positively correlate with early gynecological age of first COC use and treatment duration. CONCLUSIONS: Loss of bone mass as a result of hormonal contraceptive use may have serious long-term implications in the adolescent population, who have yet to achieve peak bone density. Both age at first COC use and cumulative estrogen dose appear to be important factors in determining skeletal development in adolescents. Further studies are warranted to inform specific prescribing practices for this population.

Accommodative intraocular lenses: short-term visual results of two different lens types.

PURPOSE: To compare the ability of two types of accommodative intraocular lenses (IOLs) to provide uncorrected near and distance visual acuity (VA) after cataract surgery. METHODS: A total of 108 eyes of 75 patients underwent cataract surgery by phacoemulsification and IOL implantation either bilaterally or monocularly with one of two types of accommodative IOLs: the AT-45 lens (69 eyes) or the 1-CU lens (39 eyes). Patients were followed for up to 1 year after cataract surgery. Near VA was measured through the distance correction to obtain the true near vision effect of the accommodating IOL. RESULTS: Uncorrected distance VA of 20/30 or better was achieved by 84.6% of the bilaterally implanted 1-CU patients and 73.6% of the bilaterally implanted AT-45 IOL patients 1 year following surgery. Uncorrected near VA of J1 or better was achieved by 42% of the patients with the bilateral 1-CU implant and 36.8% of the patients with the bilateral AT-45 implant. For J3 or better near acuity, the values were 92.3% for the bilateral 1-CU patients and 84.2% for the bilateral AT-45 patients at 1 year. A total of 54% of the eyes with 1-CU implants underwent a mild myopic shift (<1.0 D), 21% had a mild hyperopic shift, and 45% of the eyes were emmetropic at 1 year. CONCLUSIONS: Both accommodative IOLs provided good near and distance vision postoperatively. The 1-CU IOL appears clinically to provide slightly better uncorrected distance and distance-corrected near VA than the AT-45 lens.

[Post-voiding contraction: evidence and characterization in other 250 urodynamic studies]. / Post-voiding contraction (PVC): evidenza e caratterizzazione in oltre 250 indagini urodinamiche.

We report our experience on PVC detection in 250 consecutive urodynamic evaluations in female patients. We emphasize the absence of evident correlations between the post-voiding contractions (PVCs) and their amplitude and the urodynamic features. We suggest a possible relation between the PVCs and two clinical features: enuresis (80% of cases associated with PVC) and mixed urinary incontinence (61.5%). Defining PVC as an improper form of detrusor instability, probably generated by a reduction of pelvic muscle tone, we underline the role performed by an urodynamic investigation defining urethral sphincter as well pelvic floor activity, this procedure being justified by the notorious interdependence between perineal and detrusorial activity.

[Possibility of prenatal ultrasonic diagnosis of growth defects in fetal long bones. Report of a case]. / Possibilità di diagnosi ecografica precoce di difetti di accrescimento delle ossa lunghe fetali. Descrizione di un caso.

Recent advances in echographic diagnosis and its application during the first three months of pregnancy provide a direct method for assessment in both normal and pathological pregnancies. Given their frequency, the study was focused on the congenital structural anomalies of fetal limbs. The possibility of the repetition of these malformations in the same patient is very high, ranging from 2-25%. It is therefore extremely important to use echographic monitoring during pregnancy in order to observe and measure with great precision the lengths of the limbs and individual bones in fetuses at risk at an early stage of their development.

[Surgical treatment of unrepairable vesicovaginal fistulas]. / La terapia chirurgica delle fistole vescico-vaginali non riparabili.

The authors discuss different types of urinary diversion as the therapy of unrepairable vesico-vaginal fistulas. They also describe the therapy performed in their experience and underline that, at the moment, rectal bladder is to be considered the best solution.

Vaginal administration of gemeprost for preoperative cervical dilatation in non pregnant patients.

The use of Gemeprost vaginal suppositories has been evaluated in a trial for induction of the cervical dilatation in non pregnant women. 30 voluntary patients, 22 nulliparous and 8 pluriparous, had to be subjected to biopsy of the endometrium; 24 were treated for the control of sterility and 6 for menstrual perimenopausal disorders. The biopsies of the sterility control were effected in the second half of the cycle, generally without having recourse to narcosis. A single Gemeprost pessary containing 1 mg of 16, 16-dimethyl-trans-delta 2 PGE1 methyl ester was intravaginal administered, deeply into the posterior fornix, 3 hours before the biopsy. The success rate was 86.66 (26 pts.) with an average dilatation of 5.38 H (Hegar) +/- 0.75 SD. For 4 patients (13.33%) having a dilatation less than 4 H, it was necessary to complete the dilatation mechanically. All the observed side effects presented a modest intensity: cephalalgia 6.6% (no. 2), gastralgia 3.3% (no. 1), vaginal burning 6.6% (no. 2). No significant variation of vital function parameters was recorded. In conclusion this type of preparation of the cervix has permitted us to achieve a more gradual dilatation and to prevent the traumata of the cervico-isthmic system due to forced mechanical dilatations by the exclusive use of Hegar's dilators.

Echopatterns of the ovarian dermoid tumor.

The authors report the ovarian dermoid echopatterns observed in 189 cases. The ultrasonic key of the diagnosis is a particular "pearly-gray" colour. The early diagnosis by USG gives the Gynecologist some advantages in: a) avoiding the operation in those cases of small mass; b) making a pfammenstiel incision in the surgical operation; c) trying a conservative surgery.

Integrated techniques in the identification of ovarian tumors.

This work is intended to be an effort to standardise the diagnostic iter of ovarian pathology. This protocol is carried out with a clinical examination and later by USG and celioscopy. It tests the management of functional and endometriosic cysts and the other ovarian pathologies.