László Lampé

Effective contraception with the levonorgestrel-releasing intrauterine device: 12-month report of a European multicenter study

The use-effectiveness of an intrauterine contraceptive device releasing 20 mcg of levonorgestrel daily (Lng-IUD), and of a Nova T copper-releasing IUD, were studied in a randomized, comparative multicenter trial. The Lng-IUD was inserted in 1821, and the Nova T in 937 women. The 12-month net pregnancy rate with the Lng-IUD (0.1 per hundred women) was significantly lower than that with the Nova T (0.9 per hundred). Removal rates for menstrual problems and/or pain were similar for the two methods (net rates 7.5 and 8.7, respectively). The 12-month continuation rates were 82.2 for the Nova T and 79.7 for the Lng-IUD. The reduction of the bleeding led to oligomenorrhea and amenorrhea in users of the Lng-IUD; the removal rate for these reasons was 1.4. The removal rate for hormonal side effects with the Lng-IUD was 2.4. Blood hemoglobin concentrations increased among users of the Lng-IUD and decreased among users of the Nova T. The results show that the Lng-IUD was a highly effective contraceptive method which reduced menstrual bleeding. It is a promising alternative for women desiring a highly effective method for long-term use.

Randomised trial comparing combinations of cyclophosphamide and cisplatin without or with doxorubicin or 4′-epi-doxorubicin in the treatment of advanced ovarian cancer

Forty‐eight patients with FIGO stage III and IV epithelial carcinomas of the ovary were entered in this randomised trial. Radical surgery was performed and no residual tumor with a diameter greater than 2 cm was left behind. Of these patients 62.5% (10/16) had a complete or partial response on cyclophosphamide + cisplatin (CP) 87.5% (14/16) on cyclophosphamide + doxorubicin + cisplatin (CAP) and cyclophosphamide + 4′‐epi‐doxorubicin + cisplatin (CEP). The median time to progression was 3.5 months on CP, 12.5 months on CAP and 11.0 months on CEP. Patients treated with CAP combination chemotherapy had generally longer progression‐free survival (log rank χ2 = 5.4; P = 0.04). No significant difference was found, however, between patients on CAP and CEP. The median survival times were 12.5 months on CP, 26.5 months on CAP and 14.0 months on CEP. Patients treated with CAP combination chemotherapy had generally longer survival (logrank χ2 = 9.08; P = 0.0099). No significant difference was found, however, between patients on CAP and CEP in terms of survival. Asymptomatic mild‐to‐moderate laboratory test toxicity occurred in 6–12% of patients on CP, 6–12% on CAP and no toxicity of this type and grade on CEP. Nausea and vomiting were also less severe and less frequent in the CEP group. Cardiotoxicity was seen in 12.5% (2/16) only in the CAP group.

Placental macrophage contact potentiates the complete replicative cycle of human cytomegalovirus in syncytiotrophoblast cells: Role of interleukin-8 and transforming growth factor-β1

Although syncytiotrophoblast (ST) cells can be infected by human cytomegalovirus (HCMV), in vitro studies have indicated that ST cells do not support the complete viral reproductive cycle, or HCMV replication may occur in less than 3% of ST cells. The present study tested the possibility that placental macrophages might enhance activation of HCMV carried in ST cells and, further, that infected ST cells would be capable of transmitting virus to neighboring macrophages. For this purpose, we studied HCMV replication in ST cells grown alone or cocultured with uninfected placental macrophages. Our results demonstrated that HCMV gene expression in ST cells was markedly upregulated by coculture with macrophages, resulting in release of substantial amounts of infectious virus from HCMV-infected ST cells. After having become permissive for viral replication, ST cells delivered HCMV to the cocultured macrophages, as evidenced by detection of virus-specific antigens in these cells. The stimulatory effect of coculture on HCMV gene expression in ST cells was mediated by marked interleukin-8 (IL-8) and transforming growth factor-beta1 (TGF-beta1) release from macrophages, an effect caused by contact between the different placental cells. Our findings indicate an interactive role for the ST layer and placental macrophages in the dissemination of HCMV among placental tissue. Eventually, these interactions may contribute to the transmission of HCMV from mother to the fetus.

Ovarian function after the menarche and hormonal contraception

The aim of the study was to determine the date of regular ovulation after the menarche to better understand the physiology of female adolescence, especially as it pertains to the use of hormonal contraception. Early morning urine samples were collected from 51 girls in the perimenarche for 9 weeks semi‐annually during 2 years. Estrone‐ and pregnanediol‐3‐glucuronide values were determined. Cycles lasting 35–40 days at the onset of menses shortened to 28 days after the 23rd–25th cycle. Menses reached a 5.0–5.5 day average length at about the same time. After the 20th cycle, ovulation could be demonstrated in more than 50% of the study patients. Using a scoring system, regular ovulation could be expected on the basis of somatic data with scores of > 16. Hormonal contraception may be prescribed 2 years after the menarche, based on scores of > 16 and ovulation proven by hormonal cytology and basal body temperature.

Female child sexual abuse within the family in a Hungarian county.

Background: The aim of the study was to analyze the characteristics of intrafamiliar female child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention. We also described the medical and legal approaches to handling child neglect. Methods: This was a descriptive, cross-sectional study on 52 sexually abused girls under the age of 18 at the Department of Obstetrics and Gynecology, Medical and Health Science Center of Debrecen. We prospectively recorded the data of all cases. Intrafamiliar events were defined if the victim and perpetrator belonged to the same family. Legal outcomes were also recorded. Results: During the 16-year period, 209 cases of sexual abuse were seen in our clinic, 52 of them had been involved in child sexual abuse within the family. This accounts for 25% of adolescent cases. Eighty-six percent of the victims were pupils, 50% of them were between 11 and 14 years of age. The perpetrator was the victim’s father in 44%, and the stepfather in 40%. There was a slight difference between the type of abuse among the pre- and postpubertal group of victims, but statistically it was not significant. The abuse occurred on multiple occasions in 52%. The occurrence rate of assault was the highest in the summer season (58%), mostly in the afternoon (42%) and it took place almost exclusively at home (98%). The mother accompanied the victim in 38% of the cases and the police in 40%. Vaginal penetration was the type of abuse in 75%, and sexual perversion in 25%. Six victims were physically injured, the presence of sperm could be confirmed on vulvovaginal smears in 2 cases. One pregnancy conceived. Nine cases were reported to the police and as a result of legal proceedings, 5 perpetrators have been sentenced. Conclusion: The majority of crimes take place within the family and are disclosed after multiple episodes. The small proportion of reported sexual assaults is the consequence of the lack of harmony between the Hungarian conditions of emergency care and the criminal law. Prevention calls for attention at all levels of child education, observation at off-school times, early involvement of health professionals, applying standardized medical guidelines and the modification of jurisdiction.

A comparison between Nova T and Copper T 200 Ag in Hungary

In a comparative use‐effectiveness study, 855 Nova T and 883 TCu 200 Ag devices were inserted in a randomised sequence. By the end of the first year the gross rate of unplanned pregnancy was 1.1 per 100 users of Nova T and 2.1 per 100 users of TCu. After 2 years the pregnancy rates for Nova T and TCu were 3.1 and 4.8 per 100 users, respectively. Although there was no statistically significant difference between the rates for the two devices, they suggest a higher contraceptive efficacy for Nova T.

Clinical experiences with intrauterine devices inserted with and without tail

Nova T and TCu 200 Ag IUDs were inserted with or without a tail in order to study the possible role of the thread on the occurrence of PID. The five‐year gross cumulative termination rate for infection was 3.7 in the group with a tail and 1.3 in the group without a tail. The results indicate a lower risk of genital infection if the device is inserted without the tailstrings.

Ovarian function immediately after the menarche.

Estrone and pregnanediol‐glucuronide values of early morning urine samples collected from young girls in the perimenarche were determined by radioimmunological technique. A total of 58 teenage girls started collecting urine samples after their menarche at various times. Of these, 9 completed collection within 100 days of the onset of the first menstrual period. In 3 cases, insignificant changes in estrone and pregnanediol levels were noted. Normal estrone values were found in 3 cases together with pregnanediol levels suggestive of ovulation. In 2 further cases the possibility of ovulation without follicular release was suggested. The results indicate that ovarian activity is unpredictable immediately following the menarche. Between very low levels of sexual steroid hormone production and those normally observed in adult females, all transitional values could be found.

Ovarian malignancies in childhood and adolescence

We retrospectively reviewed all cases of ovarian malignancies during a 10-year period at the Department of Obstetrics and Gynecology, University Medical School of Debrecen, Hungary. The experience with 16 cases: three epithelial tumors, one granulosa cell tumor, 11 germ cell tumors (six dysgerminoma, four teratoma, one endodermal sinus tumor), and one metastatic ovarian cancer is discussed. Malignant ovarian tumors can best be treated with conservative surgery, followed by adjuvant chemotherapy. Survival mainly depends on tumor type and stage at the time of diagnosis.

Comparison of four antiemetic regimens for the treatment of cisplatin-induced vomiting

OBJECTIVE: To improve the treatment of cisplatin‐induced acute emesis and vomiting, the adjuvant effect of two different doses of metoclopramide and metoclopramide plus droperidol was compared to a defined standard antiemetic regiment. METHOD: One‐hundred and twenty‐one consecutive cisplatin‐based chemotherapy treatments for ovarian carcinoma were randomly assigned to receive standard plus no adjuvant (control, n = 24), high‐dose metoclopramide (HDM, n = 33), very high dose metoclopramide (VHDM, n = 50) and very high dose metoclopramide plus droperidol (VHDM + DP, n = 14) antiemetic treatment. The number of vomiting episodes up to 4 h after the treatment were recorded and compared in the four different antiemetic groups. The effect of the number of previous chemotherapy cycles, the strength of previous antiemetic treatments, age and stage of disease on the number of vomiting episodes was also assessed. RESULT: The mean number of vomiting episodes during the first 4 h after the chemotherapy was 9, 6.4, 6.2 and 2.7 among patients receiving the standard HDM, VHDM and VHDM + DP antiemetic regimens, respectively. Analysis of variance of vomiting episodes confirmed significant differences between the groups (P < 0.001, F = 406.5, df = 120). The number of previous chemotherapy cycles and, to a lesser extent, the stage of disease, the strength of previous antiemetic regimens and the age showed significant correlation with the number of vomiting episodes (r = 0.443, −0.159, −0.14 and −0.009 respectively). CONCLUSION: Substantial improvement in the control of cisplating‐induced vomiting can be achieved by adding high‐dose metoclopramide and droperidol to a basic antiemetic regimen consisting prochlorperazine, dexamethasone and thiethylperazine.