Herbert W. Horne

THE PREVENTION OF POSTOPERATIVE PELVIC ADHESIONS FOLLOWING CONSERVATIVE OPERATIVE TREATMENT FOR HUMAN INFERTILITY

A combination of Decadreon (dexamethasone) and Phenergan (promethazine) was tested in this collaborative study of 240 infertility patients as a means of preventing postoperative adhesion formation after simple pelvic surgery. 24 patients were lost to follow-up. The overall pregnancy rate among the 240 patients was 51.7% (124): 49% with primary infertility and 58% with secondary infertility conceived after surgery. 90 full-term deliveries were recorded, 27 spontaneous abortions occurred, and 7 ectopic gestations were conceived. In all, 31 cases were reinspected for various reasons after the drug treatment postsurgery; 42% showed no adhesions, 23% showed minimal adhesions, and 35% had significant adhesions. Complications coincident with use of the combined medication were seen in 2.2% (11 of 240) patients. Though this study lacked controls, the authors feel thta the use of corticosteroids postoperatively after pelvic intervention may control the numbers of adhesions which form postoperatively.

Tetracycline-Resistant T-Mycoplasmas (Ureaplasma urealyticum) from Patients with a History of Reproductive Failure

The susceptibilities of T-mycoplasmas (Ureaplasma urealyticum) to minocycline, demeclocycline, doxycycline, tetracycline, and erythromycin were determined by a direct tube dilution test. T-mycoplasma-positive urine sediments of 105 patients with a history of reproductive failure were used as inocula. Minocycline was found to be the most active of the group of antibiotics commonly used to eradicate T-mycoplasma infection. Based on the median initial minimum inhibitory concentration, minocycline was the lowest with 0.03 μg/ml, followed by demeclocycline and doxycycline with 0.125 μg/ml, tetracycline with 0.25 μg/ml, and erythromycin with 2.0 μg/ml. Six T-mycoplasma isolates which had been cloned three times were also tested for susceptibility to the same five antibiotics. The same susceptibility pattern was found. Strains resistant to high concentrations of all antibiotics occurred. Strong positive correlation was seen in 21 patients between in vitro highly resistant strains and positive posttreatment cultures. These results indicate that empirical treatment of genital mycoplasma infections is not justified. Cultures should be taken pretreatment, susceptibility testing performed prior to treatment, and follow-up cultures done posttreatment.

Adrenosem Therapy for Bleeding Coincident with the Use of Intrauterine Contraceptive Devices: A Double Blind Study

A double blind study of the use of Adrenosem in IUD wearers who were having trouble with bleeding was conducted. 26 women with IUDs in situ for more than 3 months were studied during 2 precontrol 6 treatment and 2 posttreatment control menstrual cycles. Each kept a daily calendar of the number of pads or tampons used. Each patient received a randomized double blind kit containing Adrenosem 10 mg oral tablets and matching placebos in 6 numbered bottles. Each bottle was used only during a single menstrual cycle. Each patient took 1 pill 3 times daily throughout the 6 treatment cycles. There was no statistically significant reduction in the number of pads of tampons used during the actual 5 days of menstruation each cycle. There was however a significant decrease both in the number of days of bleeding and the number of pads of tampons used in the treated cycles compared to the placebo cycles as well as in the number of days of intermenstrual staining or spotting that occurred when no pads or tampons were used. Although the intermenstrual bleeding that is fairly common in wearers of IUDs was not completely eliminated by the treatment with Adrenosem there is no question that the amounts of nuisance bleeding that these patients experienced was greatly diminished in most instance to the real satisfaction of the patient and her husband.

Intrauterine Contraceptive Devices in Women with Proven Fertility: A 5-Year Follow-up Study

Between December 1962 and January 1968, 301 private patients (ages 17-34) were inserted with either the Lippes loop or the Margulies spiral; the latter being abandoned after 1 year due to frequency of bleeding and irritation to husband during intercourse. While the study was limited (1st 3 years) to women with 2 or more children who were living with their husbands, it has since been expanded to include 3 nulliparous women and 14 with a parity of 1. All women attended preinsertion lectures since patient orientation is considered necessary to reduce the number of IUD removals. Follow-up in the 1st 4 years consisted of examination 1 month after insertion followed by regular 6-month checkups; follow-up was later done by telephone conversation. Results based on 642 woman-years of use show 30 removals for bleeding and pain, 6 due to lack of confidence, 2 because of infection, 7 for hysterectomies, 13 for desired pregnancies, 1 because of endometriosis, 8 no longer needed the device, and 10 were lost to follow-up. From a study group of 269, 192 (71%) devices remained in place. The pregnancy rate was 3.2/100 woman-years of use.

Sexually Transmitted Diseases

Major social and behavioral changes have occurred in the pediatric population since the Academy published its first statement more than 20 years ago concerning the pediatrician’s role in the diagnosis and treatment of sexually transmitted diseases (STDs).’ As we approach the year 2000, adaptation to these changes requires greater vigilance and expertise by the practitioners who care for children and adolescents. Of the 20 000 000 cases of STDs reported annually, one third occur in adolescents.2 Although a few sexually transmitted diseases have been known since biblical times, the current recognized spectrum has expanded to more than 20 potential pathogens (Table).3 In the last 10 years the recognition of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has added even greater urgency to the need for pediatricians to address the management and prevention of STDs. Asymptomatic STDs contribute to a reservoir of potential infection that allows unknowing transmission to a succession of partners, challenging the physician to be alert in history taking, to use appropriate diagnostic techniques, and to treat patients promptly and appropriately. Sexually transmitted diseases can be transmitted horizontally, ie, to sexual partners, or vertically, ie, from mother to infant.

The effect of propylthiouracil on the hormone levels of early human gestation

Abstract Five patients who had arranged for termination of unwanted pregnancies were studied between the 6th and 10th week of gestation to determine the effect of propylthiouracil on thyroid function and its effect on the hormone levels of early pregnancy. In all 5 patients, the various parameters studied did not rise as is normally expected in early pregnancy. Two patients had spontaneous abortions after the end of the period of medication. The other 3 patients sought surgical termination at 12 weeks menstrual dates in another state. Whether the medication routine here outlined causes its effect by direct action on the thyroid output or on the trophoblast and/or the corpus luteum will require further investigation.