Theodore M. King

Efficacy of 17α-Hydroxyprogesterone Caproate in the Prevention of Premature Labor

Abstract We conducted a double-blind study to determine the efficacy of 17α-hydroxyprogesterone caproate in preventing premature delivery in 43 high-risk patients. Premature delivery did not occur in 18 patients receiving the progestational agent, whereas 41 per cent of the 22 receiving the placebo had premature delivery (P < 0.01). The mean duration of pregnancy and the mean birth weight in the former group (38.6 weeks ± 1.6 S.D., and 2836 g ± 412 S.D.) were both significantly greater (P <0.025) than that in the latter (35.2 weeks ± 6.7 S.D.; 2361 g ± 1085 S.D.). The perinatal mortality rate in the group given the progestational agent (0 per cent) was significantly less than that observed in the placebo group (27 per cent) (P < 0.05). Although there were no complications attributable to the progestational drug, the study population was too small for assessment of immediate or long-term safety. However, the results indicate a possible obstetric use for this drug. (N Engl J Med 293:675–680, 1975)

Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization *

The present study reviews pregnancy outcome following tubal anastomosis in 80 previously sterilized women. Thirty of 58 women (52%) sterilized by monopolar cautery techniques delivered a living child as compared to 19 of 22 women (86%) sterilized using the Falope ring method. Cumulative pregnancy curves were calculated for the Falope ring and cautery groups using life-table methods. Following reversal of Falope ring sterilization, the estimated cumulative probability of pregnancy 6, 12, 24, and 36 months after surgery was 28.4%, 48.8%, 69.3%, and 87.2% respectively. The corresponding estimates following reversal of cautery sterilization were lower at 6, 12, 24, and 36 months following surgery: 22.7%, 37.8%, 52.4%, and 57.9%, respectively. The ectopic tubal pregnancy and spontaneous abortion rate were higher among women sterilized with monopolar cautery. A decreased pregnancy rate was associated with ampullary-isthmic anastomosis in the cautery group; however, pregnancy was least likely to occur in women with shortened oviducts of less than 4 cm.

A preliminary report on a new laparoscopic sterilization approach: The silicone rubber band technique

Abstract A preliminary report is given of a new laparoscopic sterilization approach with the use of silicone rubber bands. A description of the laparoscope silicone rubber band applicator, as well as its operative utilization, is provided. One hundred cases have been completed without any major problems. No statement can be made at this time as to the incidence of failure. The described technique eliminates the need for the thermoenergy which is used in tubal occlusion and thus removes the cause of intestinal burns. The potential for successful future tubal reopening procedures should be greater with this procedure.

13, 14-Dihydro-15-keto-prostaglandin F2α concentrations in human plasma and amniotic fluid

An antiserum to 13,14-dihydro-15-keto-prostaglandin F2alpha (PGF2alphaM) was prepared and a radioimmunoassay evaluated in various reproductive states. PGF2alphaM plasma concentration was 63.6 +/- 10.3 pg/ml (mean +/- SEM) in cycling women. The concentration fluctuated throughout the menstrual cycle and pregnancy, but no discernible patterns were noted. PGF2alphaM concentrations were elevated at the time of urea + oxytocin induced abortion (238 +/- 54 pg/ml) and during late stages of normal labor (352 +/- 107 pg/ml) but were not elevated during labor prior to 7 cm dilatation. Following intra-amniotic instillation of 5 mg of PGF2alpha tromethamine into the amniotic sac, PGF2alphaM concentration increased in the amniotic fluid. In the plasma of these patients there was an eighteenfold rise in plasma PGF2alphaM concentration compared to a 3.5-fold rise in PGF2alpha at 1 hour, suggesting changes in PGF2alphaM may be more easily detected than the parent compound. While PGF2alphaM may be a useful index of PGF2alpha production, it appears that PGF2alphaM is of little value in predicting the occurrence of uterine contraction.

Endometriosis and The Development of Tuboperitoneal Fistulas After Tubal Ligation

The present study details gross and histologic findings of 79 previously ligated fallopian tubes from 3 groups of patients. Of 20 oviducts removed after documented sterilization failure (group I), 6 revealed a process compatible with endometriosis. Four of nine previously ligated fallopian tubes removed at the Johns Hopkins Hospital (group II) were successfully injected with India ink. In two patients histologic examination demonstrated the India ink in epithelium-lined spaces that lay beyond the muscle of the tubal wall extending from the tubal lumen to the serosal surface. Fifty oviducts were studied in twenty-five patients requesting reversal of their sterilizations (group III). A higher percentage of fistulas was demonstrated in patients with less than 4 cm of remaining proximal tubal segment. Furthermore, most of these fistulas were demonstrated in patients for whom 3 years had elapsed since the original sterilization procedure. Patients sterilzed by laparoscopic cautery methods were observed to have a higher percentage of fistula formation and histologic documentation of endometriosis at the sterilization site as compared with patients sterilized by other methods. Our observations suggest that ligation of the oviduct within 4 cm of the uterine cornu may predispose to the development of endometriosis and subsequent fistula formation in the tip of the ligated oviduct.

Pharmacokinetic studies on quinacrine following intrauterine administration to cynomolgus monkeys

Recent efforts have been made to develop a chemical oviductal occluding agent. Intrauterine quinacrine has been used in certain areas of the world with moderate success in effected tubal closure. This report presents the pharmacokinetics of a quinacrine solution (30 mg) as administered to cynomolgus monkeys via the intrauterine route, compared with intravascular injection. The data show rapid transfer of the drug from the uterine to the vascular compartment and uptake by almost all tissues examined. Although plasma concentrations disappear within 24 hours, levels can be detected in most tissues for at least 1 week following intrauterine injection. After 28 days, however, tissue levels of the drug are absent or near the limit of detection.

Cytologic detection and clinical significance of Actinomyces israelii in women using intrauterine contraceptive devices

Pancervicovaginal (Papanicolaou) smears exhibiting pseudomycilial-like clumps of organisms obtained from 35 women employing IUDs were studied by direct immunofluorescent technique for identification of A. israelii and A. naeslundi. In every case the specific fluorescence was achieved with species-specific antiserum against A. israelii. The clinical profile of these 35 women was retrospectively analyzed.

A two-year experience with the Falope ring sterilization procedure

The use of cautery laparoscopic sterilization procedures has two major disadvantages: (1) occasional inadvertent thermal injury to organ structures other than the Fallopian tube and (2) the inability to limit the injury to the Fallopian tube in a manner that might allow subsequent reconstructive surgery. In an effort to avoid the use of thermal energy to effect female sterilization, the Falope ring laparoscope was developed. From October, 1973, through September, 1975, 4,390 sterilization procedures were completed employing this approach; 902 cases have been completed at the Womans Clinic of the Johns Hopkins Hospital, 1,741 cases were completed by gynecologists in various cities in the United States, and 1,747 procedures were completed by physicians in various locations throughout the world sponsored by the International Fertility Research Program.

Progestational activity of Danazol in the human female subject

A progestational action of Danazol has not been reported in the human subject. Danazol administration for 1 month suppressed serum FSH and estradiol values, and the midcycle LH surge; ovulation promptly resumed after treatment. Administration to patients with polycystic ovarian disease resulted in increased LH values, elevated basal temperature, secretory findings in the endometrial biopsy, and menses. Ovarian biopsy did not document corpus luteum formation, and plasma progesterone did not rise. Administration of Danazol to an ovariectomized patients pretreated with estrogen resulted in an atypical endometrial secretory change. Clinical responses to Danazol may in part be explained by a progestational-like effect of the drug.

Posterior cervical rupture following prostaglandin-induced mid-trimester abortion.

Abstract Two cases of transverse posterior cervical rupture in association with mid-trimester abortion induced by prostaglandin F 2α (PGF 2α ) are reported. The mechanism of rupture is described. It is suggested that the effects of PGF 2α upon cervical dilatation must be further explored.