A randomised study of ornidazole as a radiosensitiser in carcinoma of the cervix: long term results.

This paper presents long-term results of a randomised study of ornidazole as a radiosensitiser in locally advanced carcinoma of the cervix. A total of 76 patients were randomised and followed-up with a median of 85 months. All patients were treated with external and intracavitary irradiation. The 10 year actuarial local control rate was 61% in patients receiving ornidazole, compared with 50% for placebo group. This difference was not statistically significant. Ten year actuarial overall and disease-free survival rates were also similar in the two treatment groups. Although, when analysed by stage, there was a significant advantage in the local control (54% vs 15%; P = 0.044) and disease-free survival rates (37% vs 8%; P = 0.047) in ornidazole group for stage IIIB cases, its implication is obscure because of the small number of patients. In this study moderate and severe complication rates were found to be 30%. These results suggest that ornidazole seems to have relatively weak sensitisation and it may show a possibility of a marginal benefit with unconventional irradiation using relatively large radiation doses. However, the results are insufficient for a real gain in the probability of local tumour control and survival.

Postoperative radiotherapy in carcinoma of the cervix: treatment results and prognostic factors.

In order to assess the role of postoperative radiotherapy and prognostic factors, 126 patients who were treated with radiotherapy after surgery for clinical early-stage carcinoma of the cervix were reviewed. All patients received external pelvic radiotherapy and 37 patients were treated with additional vaginal cuff irradiation. The 5-year overall survival, disease-free survival and locoregional control rates were 71.1, 69.9 and 78.1%, respectively. The 5-year disease-free survival rates were 40% for grade 3 vs. 75.4% for grade 1 tumours (p = 0.05), 76.5% for pathological stage IB versus 54.1% for pathological stage IIA (p = 0.04), 36.6% for node-positive patients versus 82.5% for node-negative patients (p = 0.0017), 54% for full thickness cervical invasion versus 100% superficial cervical invasion (p = 0.01), 34.8% for positive margins versus 78.1 for negative margins (p < 0.0001). After a multivariate analysis, tumour grade (p = 0.026) and presence of positive margins (p = 0.006) were found to independently influence the outcome. Grade II and III complication rate was 5.5% in all patients. In conclusion, postoperative radiotherapy should be used in patients treated with simple hysterectomy as well as those treated with radical hysterectomy with unfavorable pathological findings.

Private fee no barrier to family planning in the Czech Republic.

PIP: Until 1990, contraception was free of charge for women in Czechoslovakia. Condoms were the only contraceptive which had to be paid for. Abortion was also free and was permitted for health and social reasons under certain circumstances. In 1987, Abortion Committees were abolished, and women were given the decision whether or not to have an abortion with only a time limit remaining (12 weeks of gestation). At this time, it was decided to charge fees for abortions performed after eight weeks of gestation. During this period, the use of modern contraceptive methods remained relatively low. When the Czech Republic was established as an independent state, fees were introduced for some health services including abortion and contraception. Abortions for health reasons remain free of charge. Health insurance schemes are being developed which cover the costs of some contraceptive supplies. Despite the initiation of fees, the number of induced abortions has slowly decreased since 1989, the number of births has decreased, and the use of modern contraceptives has increased. The priorities of the Czech Family Planning Association, therefore, are to identify target groups of women who do not use contraception and to increase the effectiveness of sex education.^ieng

Practice, attitudes and knowledge of Czech and Slovak gynaecologists concerning contraception.

PIP: 155 Czech and Slovak gynecologists completed questionnaires during the National Gynecological Congress held during November 4-6, 1992. Information was solicited on experience in family planning and practice, knowledge, and attitudes concerning contraception. The average age was 42.8 years, 33% were women, and 52% had practiced as gynecologists for 6-20 years. 93% rejected abortion as a method of birth control, while 10% stated that abstinence is more detrimental to health than abortion. The combined pill and the IUD were prescribed always (80%) or very often (60%). Over 90% perceived OCs, the IUD, and male or female sterilization as very reliable. Also, 75-90% perceived vaginal douche, rhythm, withdrawal, and the cervical mucus methods as rather reliable. Fewer gynecologists working in outpatient clinics perceived the OC as completely reliable (31%) as compared to hospital staff gynecologists (61%). Younger gynecologists also tended to be more positive about OCs than older ones. Regarding safety, only 8% mentioned the IUD, and 10% mentioned injectables and implants. 85% of gynecologists living in Prague perceived condoms as very safe compared to 50% of their colleagues elsewhere. Gynecologists working in hospitals, those with postgraduate training, over 40 years of age, and with more than 10 years of experience were less positive about the safety of the IUD. The perceived safety of OCs and of the IUD influences prescription rates. IUDs, OCs, injectables and implants, female and male sterilization, condoms, diaphragms, and rhythm method were perceived as most convenient. Convenience was significantly correlated with the prescription rate of IUDs. The attitude concerning the suitability of contraceptives for women under 35 years of age was correlated with the prescription rate of OCs, IUDs, and condoms. 51% of the physicians were familiar with the action of hormonal contraception. Only 45% knew that OCs were also safe for smokers below 35 years. The perceived side effects and benefits of OCs and IUDs were also evaluated.^ieng

Attitudes of Czech and Slovak gynecologists toward family planning.

A survey was held among 155 gynecologists of the former Czech and Slovak Federal Republic (CSFR) who visited a national gynecological congress. The sample was fairly comparable to the total group of Czech and Slovak gynecologists concerning sex, age and county. Questions were asked on personal and professional characteristics, experience with the provision of contraception, attitudes toward family planning and knowledge about contraception. Almost all gynecologists rejected abortion as a birth control method and mentioned the lack of sex education, non-use of contraception and the widespread use of traditional contraceptive methods as main reasons for the high prevalence of abortion. About 60% of the physicians thought that at least some women would rather have an abortion than use contraception. According to the physicians, special family planning services should be developed and delivered by gynecologists. Opinions on proper services for teenagers varied. Only a few physicians felt that patients should pay the full price of contraceptives. Physicians' knowledge about the pill was found to be insufficient. The physicians overestimated the knowledge of their female patients about the pill. Apart from books and journals, colleagues and pharmaceutical firms were reported as important information sources. Overall, the present survey showed that introduction of well structured pre- and postgraduate courses in family planning should be encouraged.

Oral contraception in the former Czech and Slovak Federal Republic: attitudes and use.

This paper presents and discusses data on oral contraception from a national representative survey (n = 1072) on knowledge, attitudes and practice with regard to contraceptive use in the Czech and Slovak Federal Republic (CSFR). Only 7% of the women at risk of unplanned pregnancy used the pill. The low rate of use seems to be due to the general negative image of oral contraception, reinforced by the experiences of past users and opinions expressed by relative, friends, doctors, and the media. In particular, perceived psychological disadvantages have an important bearing on the decision not to use the method, whereas perceived advantages have hardly any impact. It is likely that this negative image is closely linked with the types of oral contraceptives that have been available in the country and also with the limited choice. Second- and third-generation oral contraceptives have only very recently become available. It is recommended that balanced information on the advantages and disadvantages of oral contraception be made available to doctors and to the general public on a large scale and through a variety of channels.

[Favorable effects of oral steroidal contraceptives]. / Priznivé úcinky orálnich steroidnich kontraceptiv.

In addition to preventing pregnancy which in the wider sense of the word implies prevention of all complications of gestation, incl. extrauterine pregnancy, the use of steroid contraceptives has a favourable effect on some other diseases which are not directly associated with gestation. The authors give an account of all diseases where the use of steroid contraceptives may act as a preventive factor as regards the incidence of these disease and/or their intensity. This action is frequently omitted in the professional and lay press. The authors also draw attention to the advantages of modern steroid contraceptives with a minimal dose of oestrogens and on gestagens of the third generation.

[FSH, LH, prolactin, estradiol and progesterone after burn injuries in premenopausal and postmenopausal women]. / FSH, LH, prolaktin, estradiol a progesteron po popáleninovém traumatu u premenopauzálních a postmenopauzálních zen.

The authors examined 49 women who suffered severe burns and had to be hospitalized. Thirteen of these women were postmenopausal, 35 premenopausal and in one women, incipient pregnancy was revealed. In 14 women repeatedly FSH, LH oestradiol, progesterone and prolactin were assessed in serum by RIA. The group of premenopausal and postmenopausal women did not differ as to the levels of oestradiol, progesterone and prolactin. The gonadotropin levels in postmenopausal women were somewhat higher but the difference was significant only in FSH. The mean levels of the investigated hormones in premenopausal and postmenopausal women were: FSH 7.98 and 21.56 mIU/ml resp. oestradiol 151.88 and 183 micrograms/ml) resp. These differences cannot be explained by possible differences in the extent of burns or the time when the serum sample was taken. The authors interpret the results to the effect that the adrenals and steroid hormones produced by them resp. have a central position in the dysfunction of the pituitary-ovarian axis. These hormones influence by a backfeed mechanism the secretion of pituitary gonadotropins. This is consistent with data in the literature dealing with burns in men.