A multicenter study for analgesia involving fenoprofen, propoxyphene [alone or in combination] with placebo and aspirin controls in postpartum pain.

One investigator at each of 4 institutions followed the requirements of a core protocol designed to evaluate propoxyphene napsylate (50, 100 and 150 mg), fenoprofen calcium (200, 400 and 600 mg) and their combination (50/200, 100/400 and 150/600 mg) in patients reporting postpartum pain. Placebo and aspirin (650 mg) were included as control medications. Analyses were based on subgrouping which isolated individually the interactions between medications and the following factors: dose-observation criteria, the investigator-observer-institution differences, the intensity of pain at the time the medication was given, and postepisiotomy-wound compared to uterine-cramp pain. Each of these factors influenced the absolute scores for analgesia significantly, but had no significant influence on the relative rankings of the medications. The analgesia scores for individual patients in each subgroup were transformed to ridits and then pooled. A linear increase in effectiveness occurred in response to increasing doses of propoxyphene, fenoprofen, and their combination in this dose range. The dose responses were essentially parallel. The combination was more effective than either drug alone.

Pregnancy and sarcoma.

Six cases of pregnancy associated with sarcoma are presented. Among these six cases is one patient with vulvar sarcoma which was diagnosed during the 34th week of pregnancy. The literature was reviewed with reference to the effect which pregnancy may have on the growth of malignant tumors. Most authors believe that pregnancy has no deleterious effect on the course of cancer, however, this is not well supported through adequate data. Several reports to the contrary contain evidence that pregnancy may have a deleterious effect on the course of cancer. These discrepancies could be explained on the basis of differences in the natural history and biological behavior of different malignant tumors in relation to the pregnancy.

A multicenter analgesic study using single doses of placebo, propoxyphene and acetaminophen.

Six studies were conducted using identical protocols. The design involved single oral doses of placebo, propoxyphene, acetaminophen and a combination of the two drugs. Postpartum patients with either postepisiotomy or uterine cramp pain participated. Both efficacy and adverse reports were evaluated. The differences among medications were consistently less than one standard deviation from the mean for the studies indicating a lack of sensitivity to drug effects. In order of increasing effectiveness based on the pooled data, the medications were placebo, propoxyphene, acetaminophen, and the combination.

Acute leukemia in advanced ovarian carcinoma after treatment with alkylating agents.

Two cases of advanced ovarian carcinoma treated with chlorambucil and terminating in acute leukemia are presented and the literature reviewed. The first patient was diagnosed by laparotomy as having Stage III ovarian carcinoma, and total abdominal hysterectomy and bilateral salpingo-ophorectomy were performed. After 7 years and 2 months of chemotherapy, acute myeloblastic leukemia was diagnosed, and the patient expired 4 months later. At autopsy no residual ovarian tumor was found. The second patient had a right oophorectomy after the diagnosis of Stage III ovarian carcinoma had been made. After 5 years and 9 months of chemotherapy she developed acute myelomonocytic leukemia and expired 2 months later, with residual ovarian tumor present on autopsy. The benefits of surgical reexploration in occasional cases of good clinical remission after chemotherapy are discussed in view of potential carcinogenicity of cytostatic agents.

Postpartum laparoscopy for sterilization.

The necessity of performing sterilization in the immediate postpartum period is evident in many areas of the world. Tubal ligation via laparotomy may extend the postpartum stay and entail a certain morbidity. We have applied the technique of tubal coagulation and or resection via laparoscope to a large series of patients shortly after parturition. The technique is readily acquired, complications have been minimal, and in most instances, postpatum stay is not extended. A portion of these patients were followed by hysterosalpingogram approximately 3 months postpartum at which time tubal occlusion was demonstrated. We conclude that this procedure is not contraindicated in the postpartum period.