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PubMed1983

Sterilization at the time of cesarean section: tubal ligation or hysterectomy?

The operative, postoperative and subsequent course of 86 patients who underwent cesarean hysterectomy (C.H.) during the years 1970-1979 are compared to an equal number of cesarean sections with tubal ligation (C.S.L.). Both groups are similar regarding age, gravidity, parity, number of living children and indications for abdominal delivery. Operative and postpartum complications of both groups were all minor, although significantly (p less than 0.05) more frequent in the C.S.L. group. More patients of the C.H. group required blood transfusions than the C.S.L. group (p less than 0.01). The mean period of hospitalization was similar in both groups. Two pregnancies occurred after tubal sterilization, a failure rate of 1:43. During the follow-up period, 49 surgical gynecological procedures were performed in the C.S.L. group compared to 1 in the C.H. group. Ten patients of the C.S.L. group subsequently underwent abdominal hysterectomy. Hysterectomy is the procedure of choice for permanent sterilization and prevention of many subsequent gynecological problems. Consideration must be given to coexisting gynecological conditions while considering sterilization at elective C.S. and C.H. should be offered to those patients.

Adult↗
PubMed1988

Serum estrogens and ovulation return in chronic users of a once-a-month injectable contraceptive.

To determine whether the long-term exposure to a monthly injectable contraceptive, containing dihydroxyprogesterone acetophenide 150 mg and estradiol enanthate 10 mg, induces significant changes on the serum estrogens profile and ovulation return in women, a study in chronic users was undertaken. Ovarian function was assessed for 3 months following a single injection of the contraceptive agent in a group of women (n = 7) who have been on this formulation for an average period of 6.7 years and in a non-user control group (n = 7). The serum concentrations of 17 beta-estradiol, estrone and progesterone were measured in samples drawn at regular intervals throughout the entire study. The endometrial bleeding pattern was recorded in all subjects. The results indicated that the post-injection serum estradiol maximum levels (exogenous peak) occurred significantly earlier (p less than 0.05) in chronic users as compared with the non-user control group. Baseline serum estrone concentrations were slightly higher in chronic users than those observed in the control group, while the values of serum 17 beta-estradiol did not exhibit significant differences among the two groups. Ovulation was documented within 60-90 days after injection in all subjects from both groups. A similar length of the first bleeding-free period was observed in all participants. The overall data provide evidence of a moderate increase of estrone, one of the still active metabolic conversion products of 17 beta-estradiol, in the sera of chronic users of this combined contraceptive without affecting its pharmacodynamics.

Adult↗
PubMed1988

Oral contraceptives and premenopausal breast cancer in nulliparous women.

Characteristics of women with potential for modifying the relationship between use of oral contraceptives (OCs) and the risk of premenopausal breast cancer were investigated using data from the Cancer and Steroid Hormone study, a population-based, case-control study conducted in eight geographic areas of the United States. Cases consisted of 2945 women who were premenopausal and 20-54 years of age when breast cancer was diagnosed between December 1, 1980, and December 31, 1982; controls consisted of 2646 women with no history of breast cancer who were also premenopausal and 20-54 years of age when selected during the same period. Results are presented with the cases and controls divided into eight groups on the basis of age at diagnosis on selection (20-44, 45-54), parity (0, greater than or equal to 1), and age at menarche (less than 13, greater than or equal to 13). Among nulliparous women who experienced menarche before age 13, the relative risk of developing breast cancer in the age interval 20-44 years is estimated to be 1.0 for never-users of OCs (reference), 1.3 for greater than 0-3 years of use (95% confidence intervals 0.7-2.4), 1.3 for 4-7 years (95% CI 0.7-2.6), 2.7 for 8-11 years (95% CI 1.2-6.3), and 11.8 for 12 years or longer (95% CI 1.4-95.7). OC use is not significantly related to the risk of breast cancer among women in any of the other seven groups. These findings suggest that prolonged OC use may accelerate the onset of breast cancer for a small group of susceptible women while having no appreciable impact on overall risk. The findings should be regarded as tentative, however, since they are based upon numerous comparisons and because age of menarche was stratified at 13 years to highlight the concentration of breast cancer risk apparent in our data.

Adult↗
PubMed1988

Follow-up of men in the recovery period immediately after the cessation of gossypol treatment.

Variables in 46 men who had stopped taking gossypol in two centres in China were investigated for their predictive association with the degree and time of recovery of spermatogenesis. Thirty-nine (87%) were azoospermic at cessation of gossypol treatment. In those with sperm present the geometric mean concentration and total sperm count were 8.3 x 10(6)/ml and 30.7 x 10(6), respectively. Twenty-eight (61%) recovered to a defined threshold spermatogenic function (sperm concentration greater than or equal to 20 x 10(6)/ml), with median recovery time 1.1 years. However, 18 men (39%) had not recovered after a median follow-up of 1.9 years and, of these, 10 (22%) remained azoospermic. The failure of recovery was strongly associated with longer treatment, greater total dose of gossypol, smaller testicular volume, elevated FSH concentrations and, to a lesser extent, with greater body weight.

Contraceptive Agents, Male↗
PubMed2001

Sinus node function after mitral valve surgery using the superior septal approach.

UNLABELLED: BACKGROUND; Sinus node function after the superior septal approach (SSA) in mitral valve surgery is controversial. We assessed sinus node function after this approach based on electrophysiological examinations and electrocardiographic change. METHODS: Forty-six patients underwent successful mitral valve surgery via the SSA. Preoperatively, 25 patients were in atrial fibrillation (AF), 20 were in normal sinus rhythm (SR), and 1 patient was paced. Thirteen patients who demonstrated no sinus node dysfunction preoperatively underwent postoperative electrophysiological studies. Peripostoperative cardiac rhythm was monitored using a portable four-lead electrocardiograph, and late cardiac rhythm was examined using standard 12-lead electrocardiography in the outpatient clinic. RESULTS: Twelve of 20 patients with preoperative SR experienced early postoperative supraventricular arrhythmias, but all spontaneously recovered SR. Electrophysiological studies revealed a basic cycle length of 767 +/- 74 ms, sinoatrial conduction time of 72 +/- 34 ms, sinus node recovery time of 1,119 +/- 139 ms, and corrected sinus node recovery time of 349 +/- 114 ms, thus demonstrating a lack of sinus node dysfunction. During the postoperative period (34 +/- 24 months), 2 of the 20 patients with preoperative SR developed persistent AF, and 3 of the 25 patients with preoperative AF achieved normal SR. CONCLUSIONS: The SSA does not appear to cause longterm adverse effects on sinus node function, although temporary effects may occur.

Adult↗
PubMed1998

Pharmacokinetics of medroxyprogesterone acetate after single and multiple injection of Cyclofem in Chinese women.

To provide pharmacokinetic data for safety evaluation on prolonged treatment with Cyclofem, which contains 25 mg medroxyprogesterone acetate (MPA) and 5 mg estradiol cypionate in 0.5 mL microcrystalline aqueous suspension, the pharmacokinetic profiles of MPA after single and multiple administration of this monthly injectable contraceptive were investigated in Chinese women. Nine healthy fertile women received Cyclofem based on a once-a-month regiment for up to 1 year. Blood samples were collected immediately prior to drug administration and on days 1, 3, 5, 7, 14, 21, and 28 after injection. After the 1st, 6th, and 12th injection, the maximum serum concentrations (Cmax) of MPA were observed on days 3.4 +/- 0.9, 4.3 +/- 2.2, and 3.7 +/- 2.6, respectively. Cmax of serum MPA during the 1st, 6th, and 12th treatment cycles were 3.75 +/- 1.27, 5.54 +/- 1.79, and 5.55 +/- 1.80 nmol/L, whereas the areas under the curve (AUC0-28 days) were 55.84 +/- 28.15, 95.45 +/- 26.56, and 98.81 +/- 21.84 nmol/L.day, respectively. There was significant interindividual variation in the pharmacokinetics of MPA after intramuscular injection of Cyclofem. No significant change was demonstrated in mean residence time (MRT) of MPA after single and multiple injection. There was a tendency of increase in Cmax and AUC0-28 days of MPA during the first 6 months of treatment, whereas no further enhancement was found between the 6th and 12th injection (p > 0.05). Peak levels of estradiol (E2) observed in Cyclofem users were within the normal range of the preovulatory phase. Results of this long-term study suggest that no drug accumulation occurred after repeated administration of Cyclofem in the Chinese women.

Adult↗
PubMed1998

Is there any evidence for a post-tubal sterilization syndrome?

OBJECTIVE: To review the literature on menstrual and hormonal changes in women who under go tubal sterilization. DESIGN: A systematic review through MEDLINE and a literature search identified more than 200 articles in the English literature from which the most relevant were selected for this review. RESULT(S): Many authors have investigated the sequelae of female sterilization. Increased premenstrual distress, heavier and more prolonged menstrual bleeding, and increased dysmenorrhea have been reported. However, failure to control for age, parity, obesity, previous contraceptive use, interval since sterilization, or type of sterilization may have affected study results. Most studies that have controlled for these important variables have not reported significant changes, except in women who undergo sterilization between 20 and 29 years of age. CONCLUSION(S): Tubal sterilization is not associated with an increased risk of menstrual dysfunction, dysmenorrhea, or increased premenstrual distress in women who undergo the procedure after age 30 years. There may be some increased risk for younger women, although they do not appear to undergo significant hormonal changes.

Age Factors↗
PubMed1997

Psychosexual adjustment following sterilization: a prospective study on Chinese women.

The present study aimed to identify significant predictors of Chinese women's psychosexual adjustment after sterilization. One hundred fifteen multiparous Chinese women, aged 25-51 years, were interviewed before and after elective laparoscopic or postpartum sterilization. Eight-seven women were also interviewed about their pshychosexual adjustment at 1 year after sterilization. Results showed that the fear of negative evaluation by others, family cohesion and adaptability, and preoperative psychological distress were robust predictors of adverse psychosexual outcome immediately and 1 year after sterilization. There was significant improvement in women's mental health following sterilization, and their sexual adjustment such as coital frequency and sexual satisfaction were not adversely affected at 1 year follow-up. Women with either elective or postpartum sterilization had similar adjustment throughout, except the latter group tended to experience more physical discomfort at 1 year follow-up. About 3.4% of the women experienced regret at 12 months after sterilization.

Adaptation, Psychological↗
PubMed1995

Long-term efficacy and safety of terazosin in patients with benign prostatic hyperplasia. Terazosin Research Group.

OBJECTIVES: To evaluate long-term efficacy and safety of terazosin, a selective alpha 1 blocker, in the treatment of benign prostatic hyperplasia (BPH). METHODS: This was a long-term (42 months), open-label, multicenter study with patients evaluated at 1- to 6-month intervals. Twenty-three outpatient clinics throughout the United States and Canada participated in the study. A total of 494 men with symptomatic BPH, lacking absolute indications for surgery, were enrolled in this study; 298 were transferred into the study from randomized, placebo-controlled studies of terazosin and 196 had no prior terazosin therapy. Terazosin was given starting at 1 mg/d and titrated upward until symptoms were relieved or a maximum dose of 20 mg/d was achieved, whichever came first. RESULTS: Peak urinary flow rates at all visits were significantly higher than baseline values, with mean improvements ranging from 1.0 to 4.0 mL/s. At 3 months, 40% of patients exhibited a 30% or greater improvement in peak flow rate; this improvement was maintained through 42 months. Boyarsky symptom scores improved significantly at all visits; mean total score improved by at least 4.0 points (40%) at all visits beyond 3 months. The most common adverse events resulting in premature termination from the study were dizziness (6.7%), asthenia (3.8%), and somnolence (2.0%). CONCLUSIONS: This study suggests that terazosin is well tolerated and effective in longterm treatment of patients with BPH.

Adrenergic alpha-Antagonists↗
PubMed1991

Acute pelvic inflammatory disease after surgical sterilization.

STUDY OBJECTIVE: Physicians are very cognizant of the possibility of pregnancy after surgical sterilization, but the potential for acute pelvic inflammatory disease (PID) is thought to be rare. This study was undertaken to determine if upper tract PID occurred more frequently than previously reported in patients remote from surgical sterilization. DESIGN: Retrospective review of hospitalized patients with the primary discharge diagnosis of PID. SETTING: Urban, university hospital. PARTICIPANTS: Three hundred sixty-four hospitalized patients with the primary discharge diagnosis of PID over a six-year study period. MEASUREMENTS AND MAIN RESULTS: Patients' age; gynecologic histories and diagnoses; and laboratory, clinical, and surgical findings were noted. Twenty-three cases of acute PID were identified in 21 patients previously sterilized (6%). Nine of the 23 cases had systemic toxicity warranting surgical evaluation; 18 of the 23 cases were admitted from the emergency department. Mean statistical characteristics of the study group were age, 27.3 +/- 0.8 (SE) years; time interval from sterilization, 49.8 +/- 7.4 months; WBC 15,000 +/- 1,200; and temperature, 38.0 +/- 0.2 C. CONCLUSION: We conclude that acute PID may occur more frequently than previously reported in patients with prior surgical sterilization. An increased awareness of this entity is warranted.

Acute Disease↗
PubMed1988

In vitro studies of human pituitary adenomas.

The application of morphologic and tissue culture techniques to the study of human pituitary adenomas allows further investigation of structure-function correlations. Using these methods, we have documented morphometric differences between densely and sparsely granulated somatotroph adenomas but the release of growth hormone in vitro and responses to adenohypophysial hormones/drugs do not correlate with tumor type. The morphologic and functional alterations in somatotroph adenomas exposed to SMS 201-995 appear to be reversible in vitro. Incubation of lactotroph adenomas with bromocriptine for 3 days directly reduces tumor cell size, cytoplasmic volume and cytoplasmic volume densities of endoplasmic reticulum and Golgi regions; these changes are similar to the effects of longterm bromocriptine therapy in vivo. Tissue culture studies of gonadotroph adenomas of men confirm that gonadotropin-releasing hormone (GnRH) stimulates gonadotropin release by tumor cells and yields morphologic evidence of increased hormone synthesis whereas these tumors have variable sensitivity to gonadal steroids; structural changes in tumor cells correlate with hormone release after stimulation, suggesting that morphologic parameters may reflect the hormonal milieu of these adenomas. Null cell adenomas and oncocytomas release small quantities of glycoprotein hormones, predominantly gonadotropins in vitro and there are no functional differences between these 2 tumor types; gonadotropin release responds to GnRH stimulation and, paradoxically, to other adenohypophysiotropic hormones, but such stimulation does not result in secretion of other adenohypophysial hormones by these tumors.

Adenoma↗
PubMed2000

Photoaging of the skin from phenotype to mechanisms.

The skin is increasingly exposed to ambient UV-irradiation thus increasing its risk for photooxidative damage with longterm detrimental effects like photoaging, which is characterized by wrinkles, loss of skin tone, and resilience. Photoaged skin displays prominent alterations in the cellular component and the extracellular matrix of the connective tissue with an accumulation of disorganized elastin and its microfibrillar component fibrillin in the deep dermis and a severe loss of interstitial collagens, the major structural proteins of the dermal connective tissue. The unifying pathogenic agents for these changes are UV-generated reactive oxygen species (ROS) that deplete and damage non-enzymatic and enzymatic antioxidant defense systems of the skin. As well as causing permanent genetic changes, ROS activate cytoplasmic signal transduction pathways in resident fibroblasts that are related to growth, differentiation, senescence, and connective tissue degradation. This review focuses on the role of UV-induced ROS in the photodamage of the skin resulting in biochemical and clinical characteristics of photoaging. In addition, the relationship of photoaging to intrinsic aging of the skin will be discussed. A decrease in the overall ROS load by efficient sunscreens or other protective agents may represent promising strategies to prevent or at least minimize ROS induced photoaging.

Animals↗
PubMed1995

Norplant use by adolescents: viewpoints of three stakeholder groups.

PURPOSE: In the months following FDA approval of Norplant, discussions of the controversies surrounding its introduction took place largely in newspaper and magazine articles detailing interviews with legal and health professionals and scientists who developed the device. This qualitative study brings the viewpoints of selected groups of consumers, reproductive health care workers, and local policy makers to the public discussions of Norplant. This article explores one of several themes raised by study participants--Norplant use by adolescents. METHODS: Eighteen different focused group interviews were conducted in California between November 1991 and November 1992. A total of 146 individuals attended--63 consumers, 44 health care providers, and 39 policy makers. Participants included consumers identified as so-called "targets" of Norplant use, individuals providing reproductive health services, and individuals in policy and decision-making roles. RESULTS: Participants in all the focus groups agreed that Norplant should not be used to accomplish social goals or viewed as the answer to society's pressing social and economic problems. There was no agreement, however, on the issue of Norplant use by adolescents. Study participants argued persuasively on both sides of the question, expressing ambivalence concerning the incidence of teenage pregnancies, the longterm health effects of Norplant use on adolescents, and the threat of increased risk of STDs and HIV/AIDS among adolescents using Norplant. CONCLUSIONS: Study findings highlight a critical need for ongoing dialogue among key stakeholder groups to develop an understanding of the diverse values informing the debate. Participants' responses reinforced that decision-making in public health need not only be the jurisdiction of policy makers, elected officials, and others. Ordinary citizens can be part of the task as well by offering insights for practical and ethical solutions to some of our most pressing social issues.

Adolescent↗
PubMed1999

The psychological impact of reproductive difficulties on women's lives.

Little is known about the long-term impact of reproductive experiences on women's lives. This paper uses questionnaire data collected from 107 White female college graduates, when they were approximately 47 years old. More than half the sample had experienced at least one type of reproductive difficulty (abortion, miscarriage, or infertility). The stress and coping model of life difficulties (Lazarus and Folkman, 1984) was used to examine the relationship between the women's reproductive difficulties and emotional sequelae, politicization, and orientation to motherhood at midlife. As predicted, emotional responses to the reproductive difficulties varied according to the particular nature of each experience. In addition, women who had abortions and no other difficulties were more politicized at midlife than other women. Women whose reproductive experiences were especially likely to arouse feelings of not being in control of their life (those who had miscarriages or infertility) described a more agentic orientation to motherhood when compared with other women.

Americas↗
PubMed1988

Attitudes toward sex, arousal, and the retention of contraceptive information.

Previous research has suggested that women with a negative emotional orientation toward sexuality (i.e., erotophobia) have difficulty learning and retaining sexually relevant material such as contraceptive information. It has been hypothesized that these women become aroused by this material and that this arousal interferes with their ability to learn it. The importance of this issue led us to conduct the current study. Erotophobic and erotophilic women viewed presentations about contraception while their physiological responses were being monitored. In addition, they were tested on the information contained in the presentation before, immediately after, and again 4-6 weeks after the presentation. The results indicated that the erotophobic women knew less contraceptive information before the presentation and were more aroused by the presentation. This arousal, however, did not interfere with retention of the material. These results are discussed in terms of individual differences in reactions to sexual material and the ability to learn, retain, and use contraceptive information.

Arousal↗