Extensive epidural spread of cerebrospinal fluid displacing the spinal cord after an inadvertent dural puncture in an obstetric patient.

We report a rare complication of an inadvertent dural puncture in an obstetric patient. A 24-year-old healthy primipara had a difficult neuraxial labor analgesia insertion. Subsequently she developed severe back pain and started having 'electric shock'-like sensations radiating from the spine to the lower extremities, raising a suspicion of a vertebral canal hematoma. Topping up the epidural for emergency cesarean section was unsuccessful and the surgery was done under general anesthesia. Subsequent emergency magnetic resonance imaging (MRI) of the spine showed no signs of bleeding but her symptoms persisted, and a repeat MRI of the spine ultimately revealed substantial epidural fluid collection extending from the cervical level to the lower thoracic spine, with signs of intracranial hypotension in the MRI of the brain. The dorsal dura and the spinal cord were displaced anteriorly and there was a slight compression of the spinal cord. Repeated neuro-imaging led to the diagnosis of a previously unrecognized inadvertent dural puncture and extensive cerebrospinal fluid spread within the epidural space, causing a sensory phenomenon in the spine and lower extremities known as Lhermitte's sign. An epidural blood patch relieved the symptoms and restored cerebrospinal fluid surrounding the spinal cord, demonstrated at follow-up MRI. In conclusion, a repeated MRI of the spine and brain should be performed if the patient has persistent symptoms in the back or extremities, in order to detect a possible undiagnosed dural puncture complicated by the potentially serious consequences of extradural fluid leakage.

Clinical performance of Fincoid-350 standard and short models: a comparative study.

Comparison of the clinical performance of the standard and short models of the Fincoid-350 showed that the overall performance of the short Fincoid-350 was superior to that of the standard Fincoid-350. There were significantly fewer (p < 0.01) removals for bleeding/pain among Fincoid-350 Short users (2.6%) than among Fincoid-350 standard users (7.6%). The short model gave better contraceptive efficacy (0.6%) than did the standard one (1.1%), although no statistical significance could be established. In other respects the two devices performed equally. From the comparison, a conclusion can be drawn that the short model causes fewer side-effects and is therefore preferable to the standard.

Tailoring of Fincoid-350 insertions--experience with Hasson's Wing Sound 1 Cavimeter.

The total uterine and endometrial cavity lengths of 212 nulliparous and 331 parous women were measured with Hasson's Wing Sound 1 Cavimeter prior to insertion of IUDs. A rather poor correlation between these two measurements was established, indicating that the total uterine sound measurement does not give reliable information about the endometrial cavity length. Furthermore, the cavimetric measurements showed that a majority of both nulliparous and parous uterine cavities were less than 35 mm in length. Consequently, the devices of standard size on the market are too long for most uterine cavities. The results of 543 tailor-made insertions showed that the tailoring of IUD length according to the endometrical cavity length produces better clinical performance. In particular, the continuation rates improved whereas the pregnancy rates remained practically unchanged.

Influence of age on the clinical performance of IUD in nulliparous and parous women: an analysis of 1144 insertions.

The influence of age on clinical performance of a new IUD, the Fincoid, was evaluated in 1144 nulliparous and parous women separately, with a follow-up of 12 months and with 11,859 woman-months of use. Of the individual terminations, the rates for pregnancies, expulsions, and removals for pain decreased with age, whereas removals for bleeding increased with age. This applies to both parous and nulliparous women. The IUD is not a 1st choice method of contraception for young nulliparous and parous women (under age 24). Patient materials should be analogous for age and parity to obtain comparable performances for different IUDs.

[A new copper IUD (Fincoid) in adolescent and young nulliparous women]. / Nouveau D.I.U. au cuivre (Fincoid) chez les adolescentes et les jeunes femmes nullipares.

PIP: The contraceptive performance of a new copper IUD, the Fincoid, in nulliparous adolescent and young women was tested in a clinical trial of 241 1st insertions and 2268 woman-months of use, with an individual 12-month follow-up. The participating women were age 21 or younger with a mean age of 19.7 years. The 1st segment net cumulative rates were: pregnancy 4.2, expulsion 10.4, removals for bleeding 0.9 and for pain 5.5, and removal for infection 2.1. The continuation rate was 73.1 and the lost-to-follow-up percentage 6.8. (author's modified)^ieng

Corrosion and weight loss from copper wire in the Fincoid IUD in utero.

A total of 190 Fincoid IUDs were removed after varying periods of use in utero. Of 84 wires removed after 4 years of use, the 1st 12 wires were SEM photographed. In 1 of these wires, which was fragmented, a SEM photograph revealed deep corrosion pits. In the 11 unbroken wires, SEM photographs disclosed no clear pitting corrosion. Among 84 copper wires removed after 4 years of use, there were 4 fragmented ones. The risk of fragmentation after 4 years was thus 4.8%. Among the 106 copper wires removed for different reasons before the lapse of 4 years, there was not a single fragmented one. Annually, the mean daily release of copper ranged from 40.2 mcg to 43.3 mcg without any markedly higher initial release, 80% of the original weight still existing in the copper wires after 4 years in utero. The low incidence of pitting corrosion and fragmentation is most probably attributable to the higher positioning of the copper wire on the IUD. It is concluded that the effective life of the Fincoid IUD is more than 4 years.

A new copper IUD (Fincoid) in adolescent and young nulliparous women.

PIP: The contraceptive performance of a new copper IUD of Finnish design and manufacture, the Fincoid, was tested at an outpatient clinic in 241 nulliparous adolescent and young women in whom oral contraceptives (OCs) had caused side effects or were contraindicated. Each patient was followed up for 12 months, and 2268 woman-months of use were analyzed. The patients ranged in age from 15-21, with a mean age of 19.7 years. The principal finding was a fairly high pregnancy rate of 4.2. 8 pregnancies, 1 of them ectopic, occurred uniformly across age groups. Other 1st segment cumulative rates were expulsion 10.4; removals for bleeding 0.9, for pain 5.5, and for infection 2.1. The continuation rate was 73.1, and 6.8% were lost to follow-up. The relatively low removal rates for bleeding and pain may have been due to the high elasticity of the Fincoid side arms, which adapt well to smaller uterine cavities. The Fincoid IUD may be an alternative method of contraception for subjects who are negligent about contraception or for whom OCs are contraindicated.^ieng

Hangover headache and prostaglandins: prophylactic treatment with tolfenamic acid.

Tolfenamic acid (TA), a potent inhibitor of prostaglandin (PG) biosynthesis and action, was tested prophylactically against hangover symptoms in 30 healthy volunteers in a double-blind cross-over study. One capsule of TA (200 mg) or placebo was taken before starting to drink alcohol and another before going to bed. The hangover symptoms were evaluated in the morning. TA was found significantly better than placebo in the subjective evaluation of drug efficacy (p less than 0.001) and in reducing the reported hangover symptoms in general (p less than 0.01). In the TA group, significantly lower symptom scores were obtained for headache (p less than 0.01), and for nausea, vomiting, irritation, tremor, thirst and dryness of mouth (all p less than 0.05). In a separate study with eight participants, plasma levels of PGs were followed during ingestion of alcohol with or without TA. The plasma concentrations of PGE2 and TXB2 (a metabolite of thromboxane A2) were lower in the TA group during alcohol ingestion, while PGF2 alpha and 6-keto-PGF1 alpha (a metabolite of prostacyclin) were unaffected. TXB2 correlated with blood alcohol levels in a U-shaped manner.

Fincoid--a new copper IUD: a preliminary report.

Fincoid, a new copper IUD, was tested on a single clinic basis in a preliminary series of 956 1st insertions and 10,015 woman-months of use with an individual follow-up of 12 months. 458 (48%) of the women were nulliparous and 498 (52%) were parous. About 1/3 of the women had previously discontinued the use of other types of IUDs (mostly copper) because of side effects. The 1st segment of net cumulative rates for the whole series were: pregnancy 1.1, expulsion 4.7, removal for bleeding and/or pain 7.6 and removal for infection 0.8. The continuation rate was 78.9 and the percentage lost to follow-up was 2.8%. The parous group had a higher continuation rate (81) than the nulliparous group (76). Rates for pregnancy, expulsion, and infection in the nulliparous group were about 2-fold the corresponding rates of the parous group. There was no difference in the removal rate for bleeding and/or pain between the 2 parity groups. The results of the study show that the Fincoid is a valid method of intrauterine contraception.

The use of conjugated oestrogen in oral contraception.

PIP: To find a suitable contraceptive combination 11 dosage combinations of estrogen and megestrol acetate were studied clinically. An additional combination for treatment of menopausal symptoms was used in 603 treatments, each with 21 pills. A dose of 3.75 mg and even 4.0 mg of conjugated estrogen was not sufficient to inhibit ovulation. Pregnancies occurred also when 21 daily doses of 3 mg conjugated estrogen were combined with 2 or 3 mg megestrol acetate daily. Consequently, not even 3 mg megestrol acetate can be considered a sufficient dose to prevent the pentration of spermatozoa through the cervical mucus when used in combination with estrogens. Clinically best results were obtained with following 2 combinations (2 and 7): conjugated estrogen 3.75 mg/day for 21 days + 5 mg megestrol acetate for the last 5 days and conjugated estrogen 4 mg/day for 21 days + 5 mg megestrol acetate for the last 7 days. The tolerance to conjugated estrogen was good in the whole series. No embolism was observed, nor were any changes in the ASAT; GOT or ALAT; GPT values recorded.^ieng