Norman G. Courey

Laparoscopic findings in patients with pelvic pain

We have reviewed 1,194 charts of consecutive patients who had a diagnostic laparoscopy for pelvic pain from January 1, 1972, to December 31, 1980, at the Deaconess Division of the Buffalo General Hospital. A total of 749 of these patients had normal pelvic examinations prior to the diagnostic laparoscopy; 479 (63%) had abnormal findings on diagnostic laparoscopy. Of the 445 patients with abnormal pelvic examinations, 78 (17.5%) had normal findings on diagnostic laparoscopy. The laparoscopic findings and ovarian pathology are reviewed. These results are substantiated by other reports in the literature and certainly justify the increasing use of the laparoscope as a diagnostic tool in the gynecologists armamentarium.

Progestational agents and blood coagulation: IV. Changes induced by progestogen alone☆

To evaluate the effects of chlormadinone acetate upon the coagulation of blood and fibrinolysin systems, 35 healthy, young women voluntarily using some form of birth control were studied. 10 women who served as controls used intrauterine devices; 25 women took either a progestin-estrogen (1 mg norethindrone acetate and 1 mg mestranol) combination or a synthetic progestational agent (0.5 mg chlormadinone acetate) on a coded, double-blind basis. Platelet counts, thrombelastograms, and plasma assays were performed prior to and after 3 and 6 months of treatment. After 3 months, those taking progestin-estrogen showed a highly significant increase toward hypercoagulability in Quick time, Factors II, VII, and X, and increased levels in the thromboplastin generation time (TGT), Factors V and IX, and plasminogen. At 6 months all levels remained elevated except for TGT. Those on chlormadinone acetate had only a slightly significant change toward hypercoagulability in Quick time and Factor VIII, an increase in Factor IX, and a decrease in Factor X. In the control group only TGT was elevated. The progestin alone induced only minimal changes in comparison to the marked rises accompanied with progestin-estrogen therapy.

Progestational agents and blood coagulation. V. Changes induced by sequential oral contraceptive therapy.

Blood coagulation changes induced by sequential oral contraceptive (OC) therapy were studied. 112 healthy women volunteers were monitored over a 2-year period while on a regimen of sequential OC therapy (50 mcg ethinyl estradiol daily from Day 5 through 14 and 50 mcg ethinyl estradiol plus 1 mg morethindrone acetate on Day 15 through 25). The treated group showed marked increases toward hypercoagulability in the Hicks and Pitney thromboplastin generation time screening test at 3 and 9 months, Factor 5 at 9 months, Factor 8 at 3 and 9 months, and fibrinogen at 3 months. Decreases from base lines were seen in antiplasmins at 24 months and in alkaline phosphatase at all intervals (3, 9, and 24 months). It was suggested that the decrease in serum antiplasmin indicates a compensatory tesponse in the fibrinolytic system to the hyperactivity of the coagulation system.

Amniotic fluid levels of uric acid and creatinine in toxemic patients—possible relation to diuretic use

Abstract Amniotic fluid uric acid and creatinine were measured in 35 pregnant women as close to term as clinical circumstances warranted, 10 pre-eclamptic patients, 9 control subjects with diuretic therapy, and 16 control subjects without diuretic therapy. Levels of both uric acid and creatinine were significantly higher in women of both groups who had ingested diuretics. The potential harmful effects of these elevated levels on the fetus should be considered. Therapy should be re-evaluated in this light, and the almost routine prescribing of thiazide diuretics should be reconsidered.

Pregnancy following laparoscopic tubal electrocoagulation and division

In a series of 3160 sterilization procedures performed by laparoscopic electrocoagulation and division, 16 pregnancies were reported. 9 of these failures were attributable to surgical error, for a surgical failure rate of .28%. It is suggested that these patients had microscopic tuboperitoneal fistulas in the cut ends of the tubes, and that fertilization occurred on the ovarian surfaces rather than in the oviduct ampullae. 5 of the pregnancies were ectopic, and all were found in the distal ends of the tube. The authors have modified the surgical technique by eliminiating division and using only wide electrocoagulation, with the triple-burn technique of Wheeless, and the Kleppinger bipolar forceps, in hopes of improving the success rate. The modifications also eliminate the risk of burns from unipolar current and of hemorrahage from biopsy.

Progestational agents and blood coagulation: VIII. Effect of low-dose, alternate-day, estrogen-progestin combinations on blood coagulation factors in man, with a special note on the effect of freezing of blood samples

Changes in the blood coagulation system were studied in three groups of 20 patients each. The first group received 0.5 mg. of norethindrone daily, plus 0.06 mg. of ethinyl estradiol on alternate days from cycle Day 5 through 25. The second group, all of whom had been fitted with an intrauterine contraceptive device (IUD), received no hormonal treatment and served as a control group. The third group received 0.5 mg. of norethindrone daily, combined with 0.045 mg. of ethinyl estradiol given on alternate days from cycle Day 5 through 25. Blood samples were drawn prior to the initiation of the study and after three months of treatment. Tests of the following parameters of the blood coagulation system were performed: direct platelet count; platelet adhesiveness; prothrombin time; thrombin time; fibrinogen; factor II assay; activity of factors V, VII, VIII, IX, and X; antithrombin III; and fibrin/fibrinogen degradation products. For a number of these factors, both fresh and frozen blood samples were examined. It was concluded that the two treatment regimens, with the use of alternate-day estrogen administration over a three-month period, had no clinically significant effect on the blood coagulation system.