Biomedical subjects
Publications and source records attributed to G S Berger.
This report provides specific information on the prevalence rates of the most common side effects during the first 3 cycles of use of 3 combination oral contraceptives (OCs) containing 50 mcg estrogen. The probabilities of a symptom occurring for the first time, or persisting once present, during the initial cycles of OC use are given for each of the 3 combined OCs.
A study was undertaken to assess the effects of the study design (frequency and method of inquiry about the side effects) on the reporting of oral contraceptive (OC)-associated side effects. The study found that the one-contact-per-cycle schedule yielded consistently lower rates of side effects than the two-contact-per-cycle schedule. Also, asking subjects about the occurrence of specific symptoms led to the reporting of higher rates of side effects than those obtained by general inquiry. The study suggests that differences in the reported rates of side effects may be due in part to the manner in which the data were collected.
The results of a multihospital study involving a total of 588 twin pairs born in Chicago in 1970-1975 are reported, with special respect to differences in mortality between first and second twins by time as well as by cause of death. Mortality was higher in second than in first twins and most commonly occurred after delivery and was the result of immaturity and of respiratory distress syndrome.
Forty women with normal menstrual cycles who had been sterilized by tubal ligation or electrocoagulation requested tubal reconstruction. As part of their preoperative evaluation, progesterone measurements were obtained in the midluteal phase (5-10 days before the next menstrual period). This group of women had a significantly lower (P less than 0.005) mean midluteal progesterone level (9.4 +/- 4.7 ng/ml) than a control group of 24 women with infertile male partners attending the same clinic (17.4 +/- 7.1 ng/ml). In 25 (62%) of the sterilized women, progesterone levels were less than 10 ng/ml, whereas in the control group such low values were found in only 4 (17%) of the women. Thus, reduced midluteal serum progesterone concentration appears more common among women with prior tubal ligation or electrocoagulation than among a control population of apparently normal women.
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A set of empirical results is used to test a model that assigns rankings to oral contraceptives in terms of relative hormonal potencies. The association between the observed incidence of side effects attributed to excess of estrogen and progestin and their incidence as predicted by the model is analyzed. Results of the study show the model to have incorrectly predicted the observed ranking order of symptoms associated with excess estrogen. Further, while the model correctly predicted the oral contraceptive with the highest progestogenic potency (Ovral), the observed ranking order of the other two preparations is shown to be the reverse of that predicted by the model.
A review of data from various large-scale studies reveals as much variation between studies as between devices. Many factors clearly unrelated to the IUD design undoubtedly influence their efficacy and continued use. Thus, the conclusions of the 1968 FDA report on effectiveness and utility still appear valid at this time. They are: A. "The Committee finds adequate scientific data attesting to the effectiveness and utility of the intrauterine devices." B. "The intrauterine devices are highly effective in preventing pregnancy, although they are not quite as reliable as the hormonal contraceptives if the latter are taken according to instructions." C. "The rate of continuation of use is similar to that of the oral contraceptives and is far higher than that of traditional methods, at least among the socially and economically deprived."
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Medical directors of clinics must monitor three aspects of service to ensure high-quality care in abortion clinics: (1) physician training and selection, (2) patient selection, and (3) abortion outcome monitoring as a means of providing an ongoing audit of clinic performance standards. Methods and criteria for monitoring and evaluating these parameters are discussed, and the importance of such monitoring is emphasized.
A system of classification of adnexal disease is proposed. Hysterosalpingography is important to determine tubal patency (stage I) and to distinguish between the presence of rugae in early fillage of the ampullae (stage II) and their absence (stage III or IV). Diagnostic laparoscopy under general anesthesia with the double-puncture technique is recommended to inspect the ovaries thoroughly and to put adhesions on a stretch for evaluation of thin, avascular adhesions (A) and thick, vascularized adhesions (B). The extent of adnexal disease can be classified as stage I minimal if most or all of the ovarian surface is visible; stage II, over 50% of the ovary is visible; stage III, less than 50% of the ovary is visible; Stage IV, no ovarian surface is visible. Each adnexum should be described separately. The worst aspect of each adnexum should be described. The best adnexal classification should be used in describing the patient for purposes of comparing surgical treatments. Using this approach, the authors describe a gradient from stage I (best prognosis) to stage IV (poorest) in a personal series of 99 tuboplasties over a 10-year period.
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This is an analysis of changes in menstrual cycle length and regularity occurring for a group of 211 women who had discontinued use of oral contraceptives. The analysis is based on prospectively recorded histories from the Menstruation and Reproduction History Program. Post-pill menstrual cycle length and regularity are compared with pre-pill averages. In the first post-pill cycle, there was an average increase of 6 days in cycle length. In subsequent cycles, however, cycle length and regularity were comparable to pre-pill norms in most cases.