A. Marsh Poulson

Metabolic parameter, bleeding, and weight changes in U.S. women using progestin only contraceptives

Our objective was to determine the effect of progestin-only contraceptives on metabolic parameters, bleeding patterns, and weight changes during the first year of use. Seventy-one women (> 95% Caucasian), who were advised regarding contraception alternatives, self-selected levonorgestrel implants (n = 44), depo-medroxyprogesterone acetate (n = 22), or oral norethindrone (n = 5). One year later, 11 levonorgestrel implant and five depomedroxyprogesterone acetate patients were randomly selected to compare (pre- and post-progestin use) levels of cholesterol, triglycerides, low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), apolipoproteins A-1 and B-100, bilirubin, and sex hormone binding globulin. Monthly bleeding and spotting records were kept in each group. Body weights were also monitored in each group. No statistically significant differences in metabolic parameters were found between pre- and post-progestin use in the levonorgestrel implant and depo-medroxyprogesterone acetate groups. Continued bleeding patterns were more prominent in the levonorgestrel implant and oral norethindrone groups than in patients receiving depo-medroxyprogesterone acetate. No significant weight gain was detected in any group. No changes in metabolic parameters or weight were noted over the one year of use of levonorgestrel implants or depo-medroxyprogesterone acetate. Depo-medroxyprogesterone acetate had the highest incidence of amenorrhea.

Argon laser therapy of endometriosis: a review of 92 consecutive patients

The conception rate, relief of pain, and safety of argon laser photocoagulation of endometriosis were evaluated in 92 patients. All patients were treated at the time of diagnosis with the argon laser delivered through a flexible quartz fiber passed through the operating channel of a standard and unmodified laparoscope. The uncorrected pregnancy rate was 34% (19 of 56), with 64% of the pregnancies occurring within 6 months of therapy. The conception rate was slightly greater in women with infertility of 24 months or less and in women without other fertility factors. Ninety-two percent of 50 women with pelvic pain reported a reduction of their pain after treatment. The argon laser is an effective, simple, and safe alternative for the treatment of mild or moderate endometriosis.

Microsurgical ovarian transplantation in the primate

We have developed a technique for orthotopic transplantation of ovaries by microsurgical reanastomosis of the ovarian blood vessels in rhesus monkeys. Four monkeys receiving autografts resumed cyclic menses and had postoperative circulating luteinizing hormone (LH) and progesterone concentrations consistent with developing follicles and corpus luteum function. Postoperative luteal phase ovarian biopsies were indicative of ovulation in three of the four animals. However, in a fifth recipient an ovarian allograft from an unrelated donor was rejected despite the use of a standard immunosuppressive regimen. This study suggests that ovarian transplantation by direct vascular anastomosis is a technically feasible surgical procedure in the human, where the vascular anatomy is similar and the caliber of the ovarian vessels if greater than in the rhesus monkey.

Comparison of the ClearView uterine manipulator with the Cohen cannula in laparoscopy.

The ClearView Uterine Manipulator was compared with the Cohen acorn-tipped cannula for efficacy and safety in patients undergoing laparoscopy at the University of Utah Medical Center. Fifty consecutive patients were randomized by computer to have either the ClearView instrument or the Cohen cannula used as a uterine manipulator (25 patients each). The ClearView manipulator was statistically superior to the Cohen cannula for range of motion in the anterior and posterior sagittal plane (p <0.0001). The Cohen cannula was consistently inserted in less time (p <0.02). There was no statistically significant difference between the instruments in ease of uterine manipulation, ease of dye instillation, percentage of dye leakage from the cervix, overall ease of use, ease of device insertion, and ease of device removal. Two cervical perforations occurred during cervical dilatation in the ClearView manipulator group in patients with cervical stenosis requiring dilatation with metal dilators (os <2 mm). No patients in the Cohen cannula group had cervical stenosis. In that group two cervical lacerations occurred requiring suture ligation. The ClearView instrument provides a greater range of motion, does not require an assistant to maintain uterine position, and allows manipulation without a cervical tenaculum. Its insertion occasionally (36%) required tenaculum placement, uterine sounding, and cervical dilatation, increasing the time of insertion compared with placement of the Cohen cannula. In patients with cervical stenosis, use of a uterine sound and cervical dilatation increase the risk of perforation.

Photodynamic therapy of human ovarian epithelial carcinoma, OVCAR-3, heterotransplanted in the nude mouse

OBJECTIVE Our objective was to develop an animal model for the study of photodynamic therapy in the treatment of human ovarian epithelial carcinoma. STUDY DESIGN The human ovarian carcinoma OVCAR-3 was heterotransplanted into nude, athymic mice and treated with photodynamic therapy consisting of the hematoporphyrin derivative Photofrin II 10 ng/kg and argon-pumped dye laser light at 630 nm (200 J/cm2). Growth of tumors on one side of seven mice (treated tumors, n = 7) was compared with contralateral tumors (control tumors, n = 8) not exposed to laser. Hematoporphyrin derivative uptake was determined in tumor and other tissues. RESULTS Photodynamically treated tumors were completely ablated, and all remained absent. Hematoporphyrin derivative uptake was nonselective for tumor compared with other tissues. CONCLUSION This model provides reproducible parameters for the study of photodynamic therapy in the treatment of gynecologic malignancies and demonstrates the need for methods to increase selective uptake of hematoporphyrin derivatives.

Tumor necrosis factor-alpha inhibits ovulation and steroidogenesis, but not prostaglandin production in the perfused rat ovary.

OBJECTIVE: We tested the null hypothesis that tumor necrosis factor-alpha (TNF-alpha) does not decrease ovulation, estradiol and progesterone production, or prostaglandin (PG) E2, PGF2alpha, or 6 keto-PGF1alpha production in the open bursa rat ovarian perfusion model. METHODS: Experimental animals were controlled for age, weight, litter, and pregnant mares serum gonadotropin (PMSG) aliquot. Female Sprague-Dawley rats, 26-27 days old, were injected with 25 IU PMSG. Forty-eight hours later, the right ovary was dissected, the bursa removed, and the specimen placed in the perfusion chamber with defined media. Luteinizing hormone and isobutylmethylxanthine were given as an ovulatory trigger. Test perfusions also received TNF-alpha in 0.8-nmol/L, -pmol/L, and -fmol/L doses. Samples were collected at 0, 1, 3, 5, 7, 10, and 20 hours. Ovulations were counted at 20 hours. Steroids and PGs were measured. RESULTS: The addition of TNF-alpha to the rat ovarian perfusion model resulted in a dose- dependent decrease in ovulations (mean ± standard deviation): 16.14 ± 6.2 in controls (n = 7) versus 2.38 ± 3.4 with TNF-alpha 0.8 nmol/L (n = 7), and 4.3 ± 1.5 with TNF-alpha 0.8 pmol/L (n = 3), both P < .001. Tumor necrosis factor-alpha also inhibited estradiol (P < .005) and progesterone production (P < .05) throughout, but produced no significant changes in PG production. CONCLUSION: Tumor necrosis factor-alpha inhibits ovulation in a dose-dependent fashion, and inhibits estradiol and progesterone production without altering PG production in the open bursa rat ovarian perfusion model. (J Soc Gynecol Invest 1994;1:59-64)

Detection of ovulation by a method of change in finger-finger electropotential readings

The purpose of this study was to determine whether ovulation can be detected by using a device (OvultronR) that measures electropotential differences in finger-to-finger contact. Daily basal body temperatures and five consecutive readings on the OvultronR were obtained each morning in 34 women for a three-month period. During one cycle an endometrial biopsy was taken and dated to document the time of ovulation. Our results showed that in only five out of 104 cycles did the device show an isolated change at the time of ovulation. This device is not a reliable method either for prediction of or the detection of ovulation. Therefore, one cannot effectively use this device alone as a basis for a rhythm method of contraception.

Summary of the University of Utah in Vitro Fertilization Program.

Serious efforts to establish an in vitro fertilization program at the University of Utah began late in 1981 when we contacted Professor Carl Woods in Melbourne, Australia. At his suggestion, three members of our team traveled to Melbourne and attended the International Symposium on in Vitro Fertilization in July 1982. In addition, we spent the following week with Drs. Ian Johnson and Alex Lapata at the Womens Hospital in Melbourne. In February of 1983 three members of our team spent 2 days with Dr. Richard Marrs in Los Angeles. Finally, in March of 1983 the first patient entered our program and completed ovulation induction, oocyte recovery, and embryo transfer.

Student evaluation of learning activities

Abstract A question which has plagued medical educators for quite some time has been concerned with the use of student ratings of instruction. Are such ratings valid? Do high-performing students rate differently than low-performing students? How can such data be used to improve instructional programs for students? Does the use of such data dishearten the faculty from teaching, or does it bring the faculty information which stimulates them to strive for excellence in teaching programs? An approach with the use of correlation techniques over an 18 month period was tested. Student evaluation of learning activities correlated with three measures of student performance were computed, analyzed, and used as criteria for updating teaching programs. Changes are reported and conclusions are reached about the technique.