Pelvic ultrasonography was systematically performed on 33 girls with idiopathic central precocious puberty to investigate the impact of treatment with gonadotropin-releasing hormone analogues on female internal genitalia. All girls were treated with a long-acting gonadotropin-releasing hormone analogue (Decapeptyl Depot; Ferring Co., Copenhagen, Denmark) 75 micrograms/kg every 4 weeks. Before, during, and after treatment, pelvic ultrasonography was performed and ovarian and uterine volumes were calculated. The size of follicles > 5 mm were accurately measured. The results were related to a normative study of healthy Danish schoolgirls. Our data demonstrated that ovaries and uterus are enlarged in a significant number of girls (50%) with the diagnosis of central precocious puberty at the time of diagnosis. Median ovarian volume at time of diagnosis was 1.1 standard deviation scores (range -0.6 to 3.2 SD), median uterine volume was 1.8 standard deviation scores (range 0.0 to 3.5 SD). Within 3 months of treatment, both ovarian and uterine volumes decreased significantly (p
Broad-scale chlamydia testing of family planning clinic populations has been advocated by public health organizations such as the Centers for Disease Control, but the criteria for such screening remain controversial. The Family Planning Council of Central Pennsylvania found the following criteria to be predictive for chlamydial infection: age under 25 years, abnormal discharge, mucopurulent exudate, and cervical ectropion. The commonly accepted risk factors of number of sexual partners, oral contraceptive use, and gonococcal infection were not significant predictors of chlamydia. A large chlamydia screening project underway in Family Planning Region X (Alaska, Oregon, Idaho, and Washington) plans to screen any patient who exhibits 2 or more of the following criteria: age under 24 years, sexually active, has multiple sex partners, has a new sex partner, has a sex partner with multiple sex partners, or uses a nonbarrier method of birth control. California researchers have devised a cost analysis to determine whether the expense of testing all patients in state-supported family planning programs for chlamydia would be offset by the cost savings involved in avoiding hospitalization and treatment of infected women suffering sequelae such as pelvic inflammatory disease. Preliminary calculations indicate that, in populations with an infection prevalence of 2% or more (most family planning clinics have a chlamydia prevalence rate of 7-10%), such screening will pay for itself. The researchers believe that a state-wide screening program in California would eliminate 33,516 chlamydia infections/year, preventing 8379 cases of pelvic inflammatory disease, 1005 surgical procedures related to that disease, 335 ectopic pregnancies, and 1760 cases of tubal infertility, for a net savings of over US$13 million.
To estimate the prevalence of urinary tract injury and the relative risk of litigation from an injury for benign gynecologic surgery in Canada and to analyze a subset of cases of litigation, determining independent risk factors that predicted medical and legal outcomes.
The prevalence of urinary tract injury and the relative risks of litigation from an injury were determined from the national hospital discharge abstract and the national physician malpractice databases. Multiple logistic regression was performed on a subset of litigation cases.
The prevalence of urinary tract injury at benign gynecologic surgery was low (0.33%). If a patient sustained a urinary tract injury, there was a high relative risk of litigation (relative risk 91, 95% confidence interval [CI] 55-158). Patients had a higher chance of major disability after urinary tract injury from hysterectomy for abnormal uterine bleeding (odds ratio [OR] 6.16, 95% CI 1.13-39.01, P = .04), but a lower chance of this being a permanent disability (OR 0.23, 95% CI 0.05-0.96, P = .05). Permanent disability was more likely after an obstructed ureter compared with other types of urinary tract injuries (OR 4.54, 95% CI 1.55-14.88, P = .008). Only 18% of the injuries were recognized intraoperatively. An acute bladder injury was more likely to be recognized intraoperatively than other types of injury (OR 14.98, 95% CI 3.89-57.74, P
Canadian patterns of incidence and mortality from malignancies of the ovary, fallopian tube, and broad ligament during the periods 1970-1980 and 1950-1984, respectively, were examined. Incidence rates during 1970-1980 remained stable at about ten new cases per 100,000 population per year. Analysis of age-specific rates demonstrated no significant changes in incidence for the eight age groups studied (P greater than .10). Although age-standardized mortality rates have not changed significantly during 1950-1984 (P = .61), four of the eight age groups studied (0-24, 25-34, 35-44, and 45-54) showed significant declines, whereas three other age groups (65-74, 75-84, and 85 and above) experienced significant rates of increase (P less than .025). Rates of increase for women aged 85 and over--0.94 additional new deaths per 100,000 population per year--were the most dramatic of any of the eight age groups studied.
Use of IUDs is limited in developed countries because of perceived threats to future fertility, especially among nulliparas. These fears, shared by most practitioners, led to termination of most IUD sales in the US after July 1986. This review summarizes recent epidemiologic studies that confirm the increased risk of salpingitis and infertility in IUD users. The incidence of salpingitis has increased significantly and continuously over the past 20 years as a result of the development of sexually transmitted diseases. These infections may pass through the cervix and ascend to the tubes, where their sequelae include alteration of tubal function. The IUD is a risk factor for tubal infection because it favors ascending propagation of cervical infections. Studies in the US and Sweden indicate that IUD users have a 3 to 9 times higher risk of salpingitis than do nonusers. Studies in Lund, Sweden, and Seattle, USA, have demonstrated a significantly higher risk of salpingitis and infertility among nulliparas. Studies indicating increased risk of salpingitis among nulliparas are often criticized on methodological grounds for poor control of age factors, but it is known that young women (who are often nulliparas) are more exposed to the risk of salpingitis. The 1st studies suggesting a link between salpingitis and IUDs were criticized on 2 grounds: 1) that the risk of salpingitis varies according to the type of IUD and 2) that the risk of salpingitis in IUD users should be measured in terms of women not using any contraception, since hormonal methods are now known to protect against salpingitis. But studies have shown an increased risk of salpingitis even in Sweden, where the Dalkon Shield, associated with particularly high rates of salpingitis, was never marketed. Estimates of the relative risk of salpingitis among IUD users compared to women not using any contraception have already been made and range from 1.5 to 3. The evidence indicated that IUDs are a risk factor for salpingitis and consequently a threat to future fertility. An even higher risk among nulliparas appears reasonable but is controversial on methodological grounds. IUD use may sometimes be appropriate for older married women with stable sex lives for whom the vascular risks of hormonal methods are increasing. IUD use is contraindicated among young nulliparas because of the possibility of infertility.
Contraception has been a factor in lowering the age at 1st sexual intercourse, which is now about 15 years in France. At that age, changes of partners are frequent, placing sexually active adolescents at high risk of sexually transmitted diseases. 2 risks predominate, those of condyloma following infection with the papilloma virus which exposes patients to risk of dysplasia and cervical cancer, and that of salpingitis with its risk of sterility. Condyloma has become more frequent in adolescents in France in the past 5 years. A comparative study showed that the average age at diagnosis of intraepithelial epithelioma related to condyloma declined by 5 years between 1960-80. The average age of condyloma diagnosis is about 18 years. Condyloma in adolescents should be treated prudently. If resected too soon after the primary infection before formation of antibodies, there is a risk of propagating the virus. Adolescent condyloma represents the major indication for laser treatment after colposcopy and microhysteroscopy have been used to determine the exact limits of the lesion. Patients should be warned of the possibility of return and the need for regular monitoring. Partners should also be treated. Apart from barrier methods, no contraceptive methods are known to affect development of condyloma. Chronic and acute salpingitis are 2 different entities, but both can cause sterility. Of the 100,000 French women diagnosed with salpingitis each year, 1/2 are under 25 and 1/5 are under 20. Salpingitis multiplies the risk of extrauterine pregnancy by 6 and carries a 15% risk of sterility, which doubles with each new episode. 75% of cases of salpingitis are caused by sexually transmitted diseases, with chlamydia trachomatis responsible for about 1/2. The risk of salpingitis in oral contraceptive (OC) users is .2-.9 in relation to women not using contraception. The seriousness of salpingitis is significantly less for OC than for IUD users. On the other hand , various studies have shown pill use to be associated with an increased rate of cervical chlamydia infection in adolescents and adults. The risk of salpingitis is multiplied by 2.7-7.3 in IUD users in relation to women not using contraception and by 1.8-9.3 in relation to users of other methods. IUDs should therefore be avoided in adolescents. No significant study has been done on the protection against salpingitis probably offered by barrier methods. Different studies have shown that 80% of tubal sterility is of infectious origin, but in 1/2 of these cases there was no history of recognized salpingitis. The contraception consultation should be used to screen and treat sexually transmitted diseases among adolescents. An intensive information campaign to combat sexually transmitted diseases among adolescents should be mounted by the government, schools, and the media. Systematic screening and an intensive information campaign have dramatically reduced the rate of salpingitis among adolescents in Sweden.
The survival rate for the most common gynecologic cancer, endometrial cancer, has fallen significantly in the last 25 years. Stage III (International Federation of Gynecology and Obstetrics) disease accounts for most of the deaths. We evaluated prognostic factors, treatment-related survival, and routinely used assessments for identifying stage III disease before the operation.
The data for patients with endometrial cancer stage III (n = 101) who had been treated at the McGill University Health Center between 1989 and 2003 were analyzed.
Stage IIIA, IIIB, and IIIC tumors accounted for 63%, 4%, and 33% of the data, respectively. The cause-specific survival at 2, 3, and 5 years was 82%, 77%, and 67%, respectively. In multivariate analysis with an adjustment for the standard prognostic variables, the final tumor grade, adnexal involvement, and lymph node dissection were significant predictors of cause-specific survival (P = .001, .028, and .017, respectively). Of the preoperative investigations, an elevated CA-125 level was a significant predictor of cause-specific survival in multivariate analysis (P = .029).
An elevated CA-125 level, adnexal involvement, the final tumor grade, and lymph node dissection were independent predictors for cause-specific survival.
The evolution of methods used for the treatment of early cervical cancer in the P. A. Gertsen [correction of Herzen] Research Institute of Oncology, Moscow in 1960-1988 is analysed. Four stages of stepwise transition from traditional to sparing surgery are identified and substantiated. The importance of recent methods used for the treatment of early cervical cancer is discussed.