Topical anesthesia for gynecologic procedures.

Topical benzocaine 20% gel was evaluated for its ability to reduce pain associated with several common gynecologic procedures. In the first phase of the investigation, designed to determine the efficacy of the gel, 40 women received it before one or more of five procedures (cervical biopsy, intrauterine device insertion, endocervical curettage, paracervical block, and tenaculum placement). These women reported significantly less pain than 42 control subjects (P less than .05 to P less than .0005). In the second phase of the study, a placebo gel was compared in a blind fashion with 20% benzocaine gel in 63 study subjects and 64 control women undergoing procedures similar to those in the first part of the study. The modal pain rating by both physician and patient was "none" in the study group for all procedures except endocervical curettage, for which the rating was "mild"; ratings were "mild" or "moderate" in the control group. Compliance with respect to keeping follow-up visits was significantly greater in the study group. These data indicate that benzocaine 20% significantly reduces the pain experienced by patients after many gynecologic procedures performed vaginally.

The impact of third-party payment cutbacks on the private practice of psychiatry: three surveys.

Recent cutbacks in private insurance benefits and publicly funded health programs are threatening the access of Americans, particularly the poor and the disabled, to private psychiatric care. The authors present the findings of three surveys that assessed the impact of threatened or actual cuts in third-party payments on the treatment provided by private practitioners. One survey indicated that, contrary to popular opinion, more than half of the psychiatrists in Northern California see severely disturbed Medicaid patients and that they provide outpatient psychiatric services to them for less cost than would public clinics. Two surveys conducted in the Washington, D.C., area indicated that both patients and psychiatrists have suffered from insurance cutbacks, with fewer patients being able to afford intensive private treatment and psychiatrists using reduced fees and less optimal treatment modalities. The fiscal and ethical dilemma posed by the cutbacks and further research needs are also explored.

Brown amiotic fluid in congenital erythropoietic porphyria.

Brown amniotic fluid due to congenital erythropoietic porphyria has been observed at the 15th week of pregnancy in a fetus proved after abortion to have the disease. The color is produced by abnormal porphyrins resulting from a deficiency of uroporphyrin cosynthetase. The mother, a carrier of the autosomal recessive gene, has since delivered a normal infant whose amniotic fluid was unremarkable.

Reappraisals of J. Marion Sims.

Sims' development of repair for vesicovaginal fistula introduced the present epoch of gynecology. He remained professionally active for 30 years thereafter and achieved national and international reputation. He continued to contribute medically until his death. Sims was extravagantly eulogized. Now, 90 years later, he is being roundly denounced for using slaves as experimental subjects and for doing multiple procedures on hapless women. One must however be skeptical of judging 1850 decisions by 1975 norms. Sims undoubtedly exploited the misery of his patients but their abject state must be remembered. Sims was insensitive to the status and needs of women, but in that he was a product of his era. His medical achievements have borne up well in the test of time.

Obstetrics in Cuba, 1974.

In the past 17 years, Cuba has established a system of governmental medical care, and undergraduate and graduate medical education have also been revised and expanded. Special attention has been directed to maternal and pediatric care, but no description of this has been published outside Cuba. Standards of care have been formulated by national committees, with emphasis placed on the training of specialists in obstetrics and neonatology. Prenatal care and identification of high-risk patients has produced an institutional delivery rate of over 97% with much antenatal hospitalization and referral of high-risk gravidas to tertiary care facilities. New laws providing benefits for working women encourage prenatal care, rest, and breastfeeding. In 1974 the maternal mortality rate was 55.6 per 100,000 live births, and perinatal mortality was 28.5 per 1000 live births.

Acquired hypertrichosis lanuginosa associated with endometrial malignancy.

A 46-year-old nulligravida complained of the recent development of an erythematous skin eruption and fine blond hair over her face. These complaints appeared to be symptoms of acquired hypertrichosis lanuginosa, which may be associated with malignancy. The patient was found to have an endometrial adenocarcinoma with nodal metastases and was treated with hysterectomy and irradiation. Eighteen months later there was no evidence of the cancer, and the lanugo hairs had vanished. This is the first known instance of hypertrichosis lanuginosa associated with a gynecologic cancer and the first ever observed in which the lanugo hairs disappeared after cancer therapy.

Chronobiologic and inbred strain differences in blood hemoglobin of the mouse.

Hemoglobin concentration in mouse blood exhibits differences as a function of inbred strain, age and circadian rhythm. The detection of an age-effect can depend upon the circadian stage chosen for sampling.

Vaginal evisceration.

Although vaginal laceration following sexual trauma is a well-reported entity, vaginal evisceration appears to be a rare occurrence. This paper presents 2 cases of vaginal evisceration recently managed at the Bronx Municipal Hospital Center and a review of the literature. Etiologic factors and management are discussed.