The histopathologic patterns of cervical lesions and visual inspection with acetic acid on excised uterine cervices.

The histologic patterns of cervical lesions as detected by visual inspection of the cervix with acetic acid (VIA) method were studied in 162 excised uterine cervices. There were 103 cervices of previous histologically confirmed cervical neoplasia treated by loop electrosurgical excision procedure (LEEP) or hysterectomy (group 1) and 59 cervices of hysterectomy specimens without known cervical pathology (group 2). Each freshly received cervix was examined with naked eye, photographed, 4% acetic acid applied, and then reexamined with naked eye for any color changes. Then it was rephotographed, divided spatially into 12 segments like on a face of a clock, processed to produce hematoxylin and eosin-stained glass slides, and histologically examined. The raised dull white changes, positive VIA, were highly correlated with the higher grade of cervical intraepithelial neoplasia (CIN) (CIN 2 + CIN 3). In group 1, the sensitivity of the acetic acid in detecting high-grade CIN was 98.6%, the specificity was 82.4%, the positive predictive value was 91.9%, and the negative predictive value was 96.6%. The flat white changes, negative VIA, were mostly correlated with CIN 1-koilocytosis. This study found that the validity of the VIA technique in detecting high-grade CIN was acceptable.

A T2S cross-reactive material (compound W) in hyperthyroid patients with trophoblastic disease.

In a previous study we observed increased serum levels of a 3,3'-diiodothyronine sulfate (T2S)-like material (compound W) in women who received human chorionic gonadotropin (hCG) treatment. In the present study we assessed serum compound W values in 113 women (total serum sample: 190) with trophoblastic disease, in 7 normal nonpregnant women during the menstrual cycle and 7 women given hCG treatment in the course of in vitro fertilization. Fifty-three women with trophoblastic disease had serum free thyroxine (FT4) concentrations greater than 3.0 ng/dL with suppressed serum thyrotropin (TSH) levels; 61 had FT4 values less than 3.0 ng/dL with a mean TSH of 0.83 mU/L. Mean (+/- SE) compound W concentrations in the high FT4 group were significantly higher than in the low FT4 group (76 +/- 8.1 vs. 21 +/- 1.7 ng T2S equivalent, p < 0.001) There were significant correlations between serum hCG and compound W concentrations (r = 0.472, p < 0.001), serum FT4 and hCG (r = 0.503, p < 0.0001) and serum FT4 and compound W (r = 0.585, p < 0.0001). In nonpregnant women serum compound W levels increased from 7.5 +/- 8 ng/dL at the end of the menstrual period to 15 +/- 1.7 ng/dL 21 days after the last menstrual period. Finally, a single dose of hCG (10,000 USP units, intramuscularly) increased mean (+/- SE) serum compound W levels from 12.8 +/- 2.3 to 64 +/- 9.7 ng/dL and 54 +/- 12 ng/dL at 9 and 16 days, respectively. These results indicate that hCG and perhaps luteinizing hormone (LH) increase serum compound W concentrations in women. The mechanism and significance presently are unclear.

An HIV-infected woman with choriocarcinoma presenting with a nasal mass.

Gestational choriocarcinoma metastasized to the nasal mucosa is extremely rare. An HIV-infected woman with choriocarcinoma presenting with a nasal mass is reported. The clinical findings are compared with a previous reported case. She responded to multiagent chemotherapy and has obtained complete remission. The role of HIV infection is also discussed.

Preevacuation serum CA 125 in complete hydatidiform mole.

Studies on CA 125 in hydatidiform mole are limited. The objective of this study was to measure the preevacuation serum CA 125 level in patients with complete hydatidiform mole and to determine whether it could predict the later development of persistent trophoblastic disease. Preevacuation serum CA 125 levels were immunoradiometrically measured in 69 patients with histologically confirmed complete hydatidiform mole. The mean (range) serum CA 125 level was 63.7 (10.5-404.7) U/ml. Using 35 U/ml as the cutoff point, the elevated CA 125 levels were observed in 53.6% (37/69) of the patients. The mean serum CA 125 level of patients who later developed persistent trophoblastic disease was not significantly higher than that of those who had benign course (78.9 vs 52.6 U/ml, P > 0.05). In conclusion, the preevacuation serum CA 125 level was elevated in about half of patients with complete hydatidiform mole and it could not be used to predict the subsequent development of persistent trophoblastic disease.

Recurrence of cervical carcinoma following radical hysterectomy and pelvic node dissection.

The aim of this report is to review the clinical pattern of the recurrent cases. From May 1969 to December 1988, 200 patients with cervical carcinoma stage IB were treated with radical hysterectomy and pelvic node dissection at the Department of Obstetrics and Gynaecology, Ramathibodi Hospital, Mahidol University. One hundred and eighty-two patients were included in this study. Twenty-one patients (11.5%) developed recurrent cervical carcinoma. Most of the recurrence were diagnosed within 3 years after surgery. The most common recurrent site was pelvic sidewall. Patients' complaint and abnormal physical findings accounted for 81 percent of the first evidence. Treatment of recurrences was radiation in 15, chemotherapy in 3 and symptomatic treatment in the remaining three. Nine patients died of the recurrent tumor. The median time from recurrence to death was 24 months (range 12-65). The majority of the deaths occurred in the first three years after detection of recurrence. Radiation may be beneficial in treatment of recurrent tumor and in regional control of tumor after surgery.

A three-year study of the copper-7 minigravigard intrauterine contraceptive device in nulliparous women.

PIP: For a study on the side effects of the Copper 7 Minigravigard IUD, physicians at the Family Planning Center in Siriraj Hospital in Bangkok, Thailand inserted this IUD in 99 nulliparous women between 17-32 years old after performing a pelvic examination and a Papanicolaou smear between February 1983-January 1986. The women returned for reexaminations on the 3rd, 6th, and 12th months following insertion. After the 1st year, they returned annually. 2% of the women experienced enough post insertion pain that they required a mild analgesic. 17% experienced no pain. 5 women became pregnant and the IUD was subsequently removed. 4 woman delivered full term, health infants, while the 5th experienced a spontaneous abortion 1 week after removal of the IUD. The 1 year pregnancy rate stood at 3% which was higher than the 1.7% rate for a study of the Copper T 200. The expulsion rate stood at 6% during the 1st year, while it climbed to 8% in the 2 remaining years. Due to excessive bleeding and/or pain, physicians had to remove 4.5%, 7.6%, 8%, and 9.1% of the IUDs at 3, 6, 12, and 24 and 36 months respectively. In the study of the Copper T 200, the removal rate was higher (10.7%). No cases of pelvic inflammatory disease occurred. At the end of 2 and 3 years, 30.8% and 18.2% of the women still had the IUD. This 3 year study showed the advantages of the Copper-7 Minigravigard IUD to be simple insertion with minimal pain.^ieng

A comparative study of topical anesthesia for laparoscopic sterilization with the use of the tubal ring.

A study of 300 women undergoing sterilization via standard or open laparoscopy was conducted at Siriraj Hospital in Bangkok, Thailand; one aspect of the study was designed to determine whether application of topical anesthesia to the fallopian tubes reduces the degree of pain experienced by the patient. The use or nonuse of topical anesthesia was randomized for all cases. Overall, data from this study indicate that application of topical anesthesia to the fallopian tubes tends to diminish surgical pain of patients sterilized by use of either the standard laparoscopy or the open laparoscopy approach and that pain in the recovery period is also reduced for open laparoscopy patients.

A prophylactic supplementation of iron and folate in pregnancy.

The supplementation of iron and folic acid were studied in 567 pregnant women with 18 and 26 weeks of gestation. Sixty mg and 180 mg of iron were given daily to pregnant women of group I and group II respectively while 180 mg of iron and 5 mg folic acid were given to group III. The Hb values increased significantly in group II and III after supplementation for 1 1/2 months, however if supplementation was extended for 3 months, highly significant increase in Hb levels were observed in all these groups. These findings indicated that in supplementation for a shorter period, i.e. 1 1/2 months at least 180 mg of iron was needed, and only 60 mg of iron was sufficient to increase Hb levels for a supplementation of 3 months. Vitamin B12 deficiency was not detected in pregnant women both before and after supplementation with iron and iron plus folate for 3 months. It was suggested therefore that perhaps it was not necessary to supplement vitamin B12 to Thai pregnant women. In this study 15% of pregnant women had low serum folate with normal red cell folate level, and a greater number of women with low serum folate concentrations were observed after supplementation with iron alone for 3 months. However, increased serum folate and red cell folate levels after supplementation with 5 mg folic acid indicated that some pregnant women needed folate supplementation in preventing folic acid deficiency during pregnancy.

Three neuroleptanalgesia schedules for laparoscopic sterilization by electrocoagulation.

Women undergoing interval laparoscopic electrocoagulation sterilization were randomly assigned to one of three neuroleptanalgesia regimens. The 299 women received either morphine (10 mg)/droperidol (2.5 mg)/atropine (0.3 mg) or pethidine (100 mg)/droperidol (2.5 mg)/atropine (0.3 mg) or pethidine (100 mg)/droperidol (2.5 mg). A significantly higher proportion of anesthesia complications were recorded in the morphine group. The amount of pain experienced by the women was similar in the three groups, as were the rates of early follow-up complications and complaints. The neuroleptanalgesia regimen containing pethidine/droperidol/atropine appears to be the safest and most effective of the three considered here.

Experience with the Copper-7 and Copper-T intrauterine devices at Siriraj Hospital in Bangkok, Thailand.

PIP: A report of 2 studies focusing on the 2 year performance of Copper-7 (Cu-7) and Copper-T (Cu-T) IUDs is presented with particular reference to the characteristics of the users. 198 women had the Cu-7 IUD inserted and 200 women had the Cu-T inserted while menstruating or immediately after menstruation. In both devices, the copper wire had the same surface area. Of the sociodemographic and reproductive characteristics of the study groups, only the age and parity distributions were significantly different. The median age for the Cu-7 users was 26.8 years compared to 31.5 years for the Cu-T group. A median of 2.2 live births for the Cu-7 group is lower than for the Cu-T users (3.2 live births). Performance of the 2 devices did not differ significantly, over the study period. The net cumulative continuation rates were 68.6/100 Cu-7 users and 78.2/100 Cu-T users. At the end of 1 year, the gross cumulative pregnancy rate with the device in place was the same for both groups, .6/100 women. After 2 years, 2 additional Cu-7 users became pregnant, and the gross cumulative pregnancy rate was 2.3/100 women; the Cu-T rate remained the same. The pregnant women in the Cu-7 group were under 30 years of age. The gross cumulative expulsion rates at the end of 1 year were 5.0/100 Cu-7 users and 1.8/100 Cu-T users; after 2 years, the rates were 5.7/100 Cu-7 users and 2.5/100 Cu-T users. The majority in both groups were under 30 years old. For both groups, discontinuation of the IUDs because of pain was more frequent than for bleeding. The gross cumulative discontinuation rates of removals for bleeding/pain were 4.1/100 Cu-7 users and 2.4/100 Cu-T users at 1 year and 7.1/100 Cu-7 users and 5.7/100 Cu-T users after 2 years. 81.3% of these discontinuations occurred in women under 30 years old for the Cu-7 group compared to only 45.5% of the women discontinuing the Cu-Ts. The age-parity effect is difficult to specify due to the infrequency of events. However, younger less parous women, which was a higher proportion of the Cu-7 group, did have a higher incidence of expulsions and Cu-7 removals for pain/bleeding. The Cu-T group had a much higher proportion of women with previous IUD experience. The results suggest that the Cu-7 is as effective as the Cu-T device in minimizing the incidence of pregnancy, expulsion, and bleeding/pain removal.^ieng

Postpartum sterilization by operating-room nurses in Thailand.

A training project to assess the performance of experienced operating room nurses as operators in postpartum sterilization was conducted in 1977-1978. The results for over 1000 nurse-operated clients and a comparison group of approximately 300 physician-sterilized clients show that nurses achieved comparable success with physicians in postpartum sterilization, as judged by clinical and attitudinal follow-up. No serious complications were recorded in either group. Minor infections in both groups were treated routinely. A stitch abscess for one nurse-operated client resulted in hospitalization; the client was released after 3 days. The clients in both groups returned to routine chores at home rapidly, and client satisfaction with the procedure was virtually unanimous in each group. This study lends support to the use of nurses in performing contraceptive surgery. The need for increased service coverage in this area is of high priority, and nurses provide a readily available and easily trained cadre of support staff.

Return of ovarian function and endometrial morphology in women treated with norethisterone oenanthate: a pilot study.

A comparative pilot study was undertaken in three centers to determine the time of return of ovulation after the injection of the steroidal contraceptive norethisterone oenanthate (NET-OEN). The effect of the compound on the endometrium and some properties of cervical mucus were also assessed. Increases in plasma progesterone levels suggested that ovulation resumed in all six women in Bahia within 60 days of injection of NET-OEN, whereas in Bangkok and New Delhi only two women in each center ovulated within this time. The difference in the time of return of ovulation between women in Bahia (mean time 42 days) and those in Bangkok and New Delhi (92.5 days) was statistically significant. Follicular function returned earlier than luteal function: all six women in Bahia and Bangkok and five of the six in New Delhi showed evidence of follicular activity within 60 days. All endometrial biopsies, obtained at a time of increased progesterone production, were secretory and suggested that administration of the gestagen did not exert a prolonged suppression of endometrial activity. In general, changes in cervical mucus were consistent with variations in plasma steroid levels.

Laparoscopic electrocoagulation and tubal ring techniques for sterilization: a comparative study.

From August 1975 through May 1976, a comparative study was made of the effects of sterilization by standard electrocoagulation and tubal ring application techniques. The two techniques were randomly assigned to 300 patients. Results show that standard electrocoagulation and tubal ring procedures can easily and safely be performed on an outpatient basis, using local anesthetics and analgesics. Rates of surgical complications for both techniques were clinically acceptable, although tubal risk patients had a higher rate. Pain during the procedure and during the immediate recovery period was more severe for tubal ring patients. Despite the higher incidence of surgical complications and pain associated with the ring, many physicians prefer this method of sterilization because it eliminates the possibility, inherent in electrocoagulation, of inadvertent serious electrical burns.

Use of a low-dose oral contraceptive preparation: report of a study.

PIP: A study was carried out among 100 healthy married women using the low-dose oral contraceptive (OC) Ovostat E, also known as Ovostat 28, comprised of 1.0 mg lynestrenol and 0.05 mg ethinylestradiol, and confined to the 1st 12 cycles. Patients were divided into 2 groups: 1) 35 who had never taken OCs or had discontinued 3 months prior to the study, and 2) 59 who were taking OCs prior to the study. All were seen 1 month after the initial visit and thereafter once every 3 months, and were told to record their bleeding patterns. Average age of group 1 was 24 and of group 2 was 26. All had at least 1 living child. No pregnancies occurred, bleeding patterns were not unusual although there was a high incidence (4.9%) of light breakthrough bleeding or spotting in the 1st (21.9%) and 2nd (14.6%) cycle of group 1. No significant differences in the side effects between the 2 groups was noted except for nausea (10% higher in group 1 during the 1st 4 cycles). Incidence of headache increased in group 1 but markedly decreased in group 2. Weight and blood pressure showed no significant change. At the end of the year 78 women were still on medication (others had dropped out for personal or medical reasons). In general, side effects were no different from those with normal dose OCs. Although breakthrough bleeding existed in group 1, it was mild and well tolerated and could be avoided by starting the patient on a high dose preparation a few months before starting the low dose OC. Ovostat E is found to offer increased safety resulting from the low dose of active constituents.^ieng