Ambulatory care of aging women: a gynecologist's point of view.

The purpose of this presentation has been to describe, in a very general way, the gynecologic problems of elderly women and of the system available to provide gynecologic services to them on an ambulatory basis. Several suggestions to improve care are made. Some can be implemented readily, but others will require new and additional personnel. I firmly believe that the care of aging women will soon require the creation of new facilities and development of new equipment and of new approaches much like the care of other special groups has required.

Normal pregnancy and delivery after cerebral metastases of choriocarcinoma: Case report.

Normal pregnancy and delivery after chemotherapy and radiation of cerebral metastases in a case of choriocarcinoma is presented. The need of surgical approach to these lesions as proposed by Stilp and his group is questioned.

Complications of dermoid tumors of the ovary.

There were 253 dermoid tumors of the ovary studied. Torsion of the pedicle with hemorrhagic infarction proved to be the most frequent complication; malignant change was the most lethal. Nine patients with malignant dermoid tumors, most of them with locally advanced disease, were treated with conservative surgery, radiation, and/or chemotherapy. The longest known survivor lived 3 years; most patients died within a year. It was concluded that a more aggressive surgical approach might salvage some patients with locally advanced malignant disease.

Changing patterns in cervical cytology among oral and non-oral contraceptive users.

PIP: 9634 patients (21-39 years, with at least 1 normal pregnancy) with no previous experience with oral contraceptives or IUDs, seen at clinics in Rio Piedras, Caguas, and Ponce, Puerto Rico from July 1961 to October 1969 to study their changing patterns in cervical cytology were divided randomly into 2 groups, of which 4846 were given oral contraceptive, Enovid, and 4788 provided with a vaginal contraceptive excluding IUDs, and followed for a period of 6 months-8 years. Separate Pap smears were obtained at admittance to the study by an endocervical aspiration with the pipette and cervical sample with Ayre spatula scraped over the cervico-columnar junction. The cervix was diagrammed showing any erosion. Schiller tests were done. Possible presence of Trichomonas vaginalis was treated. Repeat smears were done at 3-month intervals. 2129 oral patients and 2249 nonoral patients experienced either regression or progression in cytological patterns throughout the 8 years of observation. The analysis is divided into 3 groups, irrespective of the time at which they were observed. Of the 2129 oral patients showing a first change, 55.5% progressed to a higher Pap class, 44.5% regressed to a lower Pap class. In the nonoral group, 55.2% progressed and 44.4% regressed. 1255 patients had a second change: in the oral group, 37.5% progressed, 62.5% regressed. In the nonoral group, 36.7% progressed, 63.3% regressed out of 1258 patients. 690 oral patients showed a third change: 46.1% progressed and 53.9% regressed. Of the 718 nonoral patients 47.1% progressed and 52.9% regressed. There was no significant difference in the pattern of progression and regression between oral and nonoral groups. Oral contraceptives do not aggravate the conditions which lead to development of premalignant lesions in the uterine cervix.^ieng

Thyroid status in long-term, high-dose oral contraceptive users.

PIP: The effect of high-dose, long-term oral contraceptive use on thyroid function and thyroid disease was investigated. Between 1956 and 1962 there were 836 patients treated with Enovid. Initially doses of 10 mg were given, then 5 mg, and finally 2.5 mg. 53 patients used oral contraceptives continuously through a total of 8111 cycles with an average of 156 cycles and an average dose of 3.75 mg/day/cycle. These 53 women were studied for protein bound iodine (PBI), resin triiodothyronine (T3) uptake, total thyroxine (TT), free thyroxine level (FT), radioiodine uptake, and a thyroid scan. Fractional uptakes were done on some. The PBI, T3, TT, and FT tests were done at the Bio-Science Laboratories in California, the others at a local laboratory. Uptake values were abnormally low in 40% of patients. This finding had not been previously reported. Thyroid scannings for 48 patients showed 44 were normal. In 3 patients the thyroid appeared uniformly enlarged but this was not apparent on physical examination. A small cold area was noted in 1 thyroid. No nodule or other variation was found on physical examination. A combination of the PBI test and T3 would be most helpful in evaluating hypo or hyperthyroidism. In the presence of a nontoxic goiter the PBI would be normal or high and the T3 normal or low. Though individual tests showed alterations no definite e vidence of thyroid disease was found in the patients studied.^ieng