Charles C. Tsai

Effect of Thirty-Two Per Cent Dextran 70 on Peritoneal Adhesion formation and Re-Formation after Lysis *

Thirty-two per cent dextran 70 in dextrose (Hyskon) has been reported effective in limiting adhesion formation following a peritoneal injury when employed in doses larger than that known to be safe for intraperitoneal use in humans. The effectiveness of a lower dosage believed to be safe for human use was investigated. Female rabbits received a standardized injury to their uterine horns and proximal fallopian tubes. Following the injury, Hyskon (2.5 ml/kg of body weight) was dripped over the sites of injury in the treatment group. Animals were reoperated upon 2 weeks later, and adhesions were scored. Hyskon significantly reduced adhesion formation. In a second experiment the effect of Hyskon on adhesion re-formation was evaluated. Adhesions were induced in the same manner. Two weeks later, the animals were reoperated upon, and adhesions were scored and lysed. Hyskon was instilled in the treatment group as in the first experiment. No significant difference was noted between adhesion scores in control and treatment groups after adhesion induction or when re-evaluated 2 weeks after lysis.

Hirsutism and menstrual patterns in women exposed to diethylstilbestrol in utero

Hirsutism and menstrual patterns were evaluated in 32 female patients with documented diethylstilbestrol (DES) exposure in utero. Nine nonhirsute regularly menstruating and nine consecutive hirsute oligomenorrheic women with no known DES exposure served as controls. Hormone measurements included follicle-stimulating hormone, luteinizing hormone, prolactin, cortisol, testosterone, androstenedione, dehydroepiandrosterone, sex hormone-binding globulin, and estradiol. Hirsutism was present in 72% and irregular menses occurred in 50% of DES-exposed patients. The mean age of the DES-exposed group was 26.8 +/- 0.7 years (mean +/- SEM). The mean age of mildly hirsute DES-exposed patients (24.7 +/- 1.4 years) was significantly lower (p less than 0.05) than that of severely hirsute DES-exposed patients (28.8 +/- 1.1 years). Mean testosterone, androstenedione, sex hormone-binding globulin, testosterone/sex hormone-binding severely hirsute DES-exposed group but higher than in nonhirsute control subjects. Mean testosterone, androstenedione, sex hormone-binding globulin, testosterone/sex hormone-binding globulin, and luteinizing hormone levels in hirsute DES-exposed patients were similar to those in hirsute control subjects but significantly higher than those in nonhirsute control subjects. Mean DHA levels as well as the clitoral indices were comparable in all groups. Our data suggest that DES exposure in utero may result in hypothalamic-pituitary-ovarian dysfunction.

Ultrasound and the Prenatal Diagnosis of Congenital Anomalies: A medicolegal perspective

A survey was conducted to determine the frequency of obstetric ultrasonography use, its value in detecting fetal anomalies, and the frequency with which ultrasound errors lead to malpractice allegations. Questionnaires were sent to one-fifth of The American College of Obstetricians and Gynecologists Fellows in District IV and were returned by 68%. Ultrasound equipment is housed in the offices of nearly 64% of the responding obstetricians, and ultrasound scanning is used in 69% of pregnancies in the district. Over 67% of obstetricians have detected one or more fetal anomalies by ultrasonography, and over 51% have overlooked anomalies. Ultrasound-related lawsuits were reported by 4.7% of the respondents.

Low-dose oral contraception and blood pressure in women with a past history of elevated blood pressure

Sixty-one women with a past history of elevated blood pressure (high-risk group) associated with oral contraceptive use (27 patients), unknown etiology (17 patients), or preeclampsia (17 patients) used a low-dose oral contraceptive containing 0.4 mg of norethindrone and 35 micrograms of ethinyl estradiol for 3 to 24 months. The highest blood pressures recorded in the past were 141.0 +/- 14.9 (mean +/- SD) mm Hg systolic and 98.3 +/- 8.0 diastolic. Sixty-one women without a past history of elevated blood pressure (low-risk group), selected from a pool of 616 low-risk patients, were matched with the high-risk group for race, initial age, initial body weight, duration of use, history of smoking, and family history of hypertension. The blood pressures in the high-risk group before and after oral contraceptive therapy were significantly higher than those in the low-risk group. Despite these differences, the mean systolic and diastolic blood pressures in these two groups of women using the low-dose oral contraceptive did not rise when compared with their own baseline blood pressures. Five high-risk patients (8.2%) discontinued therapy because of the redevelopment of hypertension; however, blood pressures at discontinuance were comparable to the previous highest blood pressures.

Cytotoxic sperm antibodies and in vitro fertilization of mature oocytes: A preliminary report

The fertilization rates of mature oocytes during in vitro fertilization and embryo transfer (IVF-ET) using fetal cord serum-supplemented insemination media were ⩾57% for five infertile couples without sperm antibodies (group 1). But they were ⩽50% for four of nine infertile couples (group 2) with cytotoxic sperm antibodies in both partners (n=6) or the husband alone (n=3). Two women in group 1 were successful in achieving normal, full-term pregnancies with the delivery of normal infants (χ2=4.2, P < 0.05, by chi-square analysis). One of them consistently tested negative for sperm antibodies, while her husband was previously treated with antibiotics for infection and transient sperm antibodies in the seminal plasma. Subsequently, antibody liters in the husband were in the normal range when the successful IVF-ET was performed. One woman in group 2, with antibodies to her autoimmune husbands sperm but not control sperm and with a long-standing poor postcoital test sperm motility, conceived through artificial insemination with donor sperm (AID) after failing to conceive with her husband through IVF-ET. These data suggest that the presence of cytotoxic sperm antibodies in the serum and/ or secretions of both partners reduces the rates of fertilization of mature oocytes in spite of using fetal cord serum in the IVF media. Pregnancy achievement is impaired in this group.

Subdermal Contraceptive Implant (Norplant) Continuation Rates Among Adolescents and Adults in a Family Planning Clinic

STUDY OBJECTIVE The purpose of this study was to prospectively evaluate the continuation rate of subdermal contraceptive implants (Norplant) among adolescent (< 20 years) and adult (> or = 20 years) women in the clinic population of a tertiary care medical center. DESIGN Adolescents and adults desiring contraception for greater than a 6-month period were eligible for Norplant insertion. Prior to insertion, personal counseling and extensive education were provided. Following insertion, rapid access, personal counseling, and prompt treatment were provided for complications that occurred. Device removal was available to all individuals at any time upon patient request or if side effects could not be ameliorated. Patient demographic, historical, physical, and follow-up data were entered into a computer data base. RESULTS Since February 1991, 1800 subdermal contraceptive implants were inserted. Of these 1688 patients were prospectively followed, providing 45,576 women-months of data for analysis. Adolescents comprised 40% of the study population. Over a 50-month period, the cumulative continuation rate for adolescents was 93.6%, and for adults it was 91.1%. The mean duration of use among adolescents was 26.5 months and for adults was 27.6 months. CONCLUSIONS There was no significant difference between adolescent and adult subdermal contraceptive implant continuation rates for up to 50 months of use. In this patient population, high continuation rates may result from a combination of extensive patient education and intensive surveillance by a well-trained and dedicated multidisciplinary staff. When all patients are enrolled in a program that provides aggressive education and supportive follow-up, age is not a significant factor in continuation rates.

Human follicular fluid and mouse cumulus cells act synergistically to enhance preimplantation mouse Balb/cJ embryo development

ProblemThe development of preimplantation mammalian embryos in vitro is less than optimal. Follicular fluid and cumulus cells have both been used, independently, to improve preimplantation embryo quality in culture.MethodTo determine the ability of mouse cumulus cell coculture in the presence of human follicular fluid to support preimplantation mouse Balb/cJ embryo development in vitro.ResultsCulture of preimplantation mouse Balb/cJ embryos independently in human follicular fluid or on mouse cumulus cells had no significant affect on blastocyst development or total cell number per blastocyst. The coculture of mouse Balb/cJ preimplantation-stage embryos on mouse cumulus cells in the presence of human follicular fluid significantly (P<0.07) improved blastocyst development and the total number of cells per blastocyst.ConclusionsCumulus cells and follicular fluid have a positive synergistic affect on preimplantation mouse Balb/cJ embryo development and formation in vitro.

Unplanned Pregnancy Following Norplant Removal in Adolescents and Adults

Background Norplant is a user-independent subdennal contraceptive composed of six silastic, levonorgestrel containing capsules. Previously reported data demonstrated that the majority of women in our population chose Norplant within one year of a pregnancy (89% of adolescents and 69% of adults); 65% of these women initially became pregnant while using oral contraceptives. The purpose of this study is to prospectively compare the length of time between Norplant removal and unplanned pregnancy in adolescent ( Methods Women using Norplant are prospectively followed from device insertion through removal and subsequent annual examinations as part of an ongoing study. Patient data is collected by personal interview and chart review and entered into a computer database. Data is evaluated for significance by chi-square analysis where p Results Post-removal follow-up data for between 11 and 62 months is currently available for 367 Norplant removals (125 adolescents, 212 adults, and 30 individuals with incomplete data). The average length of follow-up is 24.8 months with a standard deviation of 9.9 months. There have been 41 pregnaneies to date following Norplant removal (18 adolescents and 23 adults). Thirty six (88%) of these pregnancies were unplanned (15 adolescents and 21 adults). The average length of time from device removal to unplanned pregnancy was 4.7 months in adolescents and 5.3 months in adults. Eighty seven percent of adolescent and 57% of adult unplanned pregnancies occurred following device removal despite placement on oral contraceptives. Conclusions Adolescent women discontinuing Norplant use are no more likely to experience unplanned pregnancy than adults. Women experiencing oral contraceptive failure are likely to experience repeat oral contraceptive failure. In this population, user dependent contraceptive methods are less reliable than user independent contraceptive methods.