A critical assessment of generic substitution for the obstetrician-gynecologist.

In the past decade, generic drugs have increased in market share severalfold. There are drugs used in obstetrics/gynecology that are of concern with regard to generic substitution, because they are believed to be well tested and essentially not dangerous. The present review is mainly of the use of generics in oral contraception and assisted reproduction. It seeks to answer the question, whether cost advantages, great or slight, offered by the generics are well worth the attendant need for increased vigilance by clinicians and, possibly, taking care of increased side effects or even mishaps resulting from lack of effectiveness (or excessive "effectiveness"). The discussion is based on the concepts of bioavailability and therapeutic equivalence.

Neugebauer-Le Fort operation for vaginal prolapse. A review of 38 cases.

Thirty-eight patients with varying degrees of vaginal wall prolapse were operated on using the Neugebauer-Le Fort technique. Their ages ranged from 59 to 90 years. Grand multiparity (> 4) was relatively uncommon (26%). Symptoms were present for more than two years in over half of the women. Serious medical conditions requiring preoperative attention were present in 55% of patients. If the uterus was present, dilation and curettage (D&C) was performed prior to the operation. Intraoperative complications were virtually absent; however, minor postoperative complications occurred in 30% of the patients. None of these complications were related to surgery or altered discharge plans. There were no deaths. No recurrences of prolapse were reported among 30 patients who were followed.