Hormonal intrauterine devices

Ligase chain reaction (LCR) is a ligation-mediated amplification technique of a target DNA sequence using oligonucleotides and thermostable ligase. LCR is useful for the detection of known DNA sequences and point mutations in a limited amount of DNA. We introduce the principle, development, and protocol of this simple and convenient technique for DNA analysis.     

Expulsion proof intrauterine devices

The author of this paper presents own new generation of IUDs, named "Antigrav", patented, and used for 14 years. Proper construction of these IUDs prevents expulsion by the uterus, and protects the uterus against injuries. This report comprise 7 year od study performed in two periods. Four size of the antigravs were used during the study. In the first period od study when applied only two sizes of antigravs-size 2, and 3 in parous women, very great different of Pearl index was obtained. In the case of the bigger size 3 of the antigravs-0.5, and for smaller size 2 of the antigravs-2.5. On the base of such differences results, the author of this paper came to the conclusion that efficacy of an IUD depend on paper selection od IUD to the dimension of the uterine cavity. For fulfill such condition the author performed measurements of the uteri cavities in vivo with a uterometer, and revealed great differences in their dimensions. Consequently the uteri were divided into four groups depending on inner length (depth), and four sizes of antigravs were used. Owing to such action in the second period of study was applied 4 size of antigravs selected to the dimension of the uterine cavity, what decreased Pearl index to 0.8. During 7 years of study none of the antigravs fell out of the uterus. Excluding pregnancies, 4 personal, and two clinical reasons requiring removal of antigravs, no others complications were record.     

Comparison of continuation rates of intrauterine devices

The optimal heart rate in the immediate period following acute coronary occlusion has been controversial from the standpoint of arrhythmias and the extent of ischaemic injury. In the present study we have examined the effect of heart rate on both local myocardial contractile ability and ischaemia in 10 open chested dogs using strain gauge arches and epicardial electrograms. After sinus node destruction, atrial pacing was instituted for rate control at 100/min and increased randomly to 150, 175, and 200/min. Before coronary occlusion, total tension and rate of tension rise progressively increased at higher rates while ST segments demonstrated no significant changes. After coronary artery occlusion, total tension and rate of tension rise in the ischaemic zone decreased markedly and showed no significant change with increments in pacing rate. In the border zone, after the initial decrease in tension, pacing at 150 beats/min improved tension without a change in ST segments. However, when the rate was increased to 175 and 200 beats/min, although border zone tension increased further, ST segments rose significantly. Thus, a heart rate between 100-150/min provides the optimal range for increasing contractile ability in the nonischaemic and border zones without adversely affecting the degree of ischaemic injury.     

Safety of intrauterine contraceptive devices during MR imaging

OBJECTIVE: We report a case of candidiasis of the upper urinary tract that presented as acute renal failure associated with septic syndrome. The patient initially required hemodialysis. Right hydronephrosis and perirenal collection were observed on ultrasound examination. METHODS: A percutaneous nephrostomy was performed. Nephrostomy urine cytology and cultures were positive for Candida tropicalis. An anterograde pyelography showed a 'fungus ball' in the urinary tract. RESULTS: Therapy with oral fluconazole and percutaneous amphotericin B achieved excellent results. CONCLUSIONS: Candidiasic urinary infection of the upper urinary tract often produces obstructive uropathy requiring percutaneous nephrostomy, which can also be used to instill amphotericin B. Combination therapy with amphotericin B and fluconazole can achieve excellent results.     

Ectopic pregnancy in women who use intrauterine contraceptive devices]

This study analyzes occurrence of ectopic pregnancies in women using intrauterine contraceptive devices. During a 5-year period, 1990-1994, 524 women with ectopic pregnancies underwent surgery at our Clinic, while 22 (4.2%) had intrauterine devices. At admission most patients had signs of heavy intraabdominal bleeding, so in 77.27% cases the diagnosis was made by punction of the Douglas area, and only in 9.09% by laparoscopy, that is other methods for early detection of diseases. Rupture of the fallopian tube occurred in 50% of patients, tubal abortions in 36.36% and ovarian pregnancies in 13.64%, whereas 18 salpingectomies and 4 adnexectomies were performed. Late diagnosis and impossibility of performing conservative operations on fallopian tubes are the consequence of disregarding the possibility of getting pregnant by the users of intrauterine devices themselves, as well as by physicians whose help is asked for after symptoms appear.     

Diagnostic ultrasound in the management of patients using intrauterine contraceptive devices

A group of 80 patients was scanned by ultrasound within 24 hours of insertion of an intrauterine contraceptive device (IUCD) and re-examined clinically and/or by ultrasound after the next menstrual period. An attempt was made to identify factors such as uterine size, uterine flexion and the position of the IUCD which might be related to its expulsion or removal when, on initial scanning, the device was not located in the fundal area; removal was necessary in 5 out of 6 patients. In patients with an endometrial cavity of less than 40 mm length and/or acute uterine flexion, the overall figure for expulsion and removal was 54 per cent (13 out of 24). It is hoped that a consideration of these factors will lead to a reduction of the failure rate of the IUCD.     

A review of bacteriological culture of removed intrauterine contraceptive devices

The management of pain in patients with burn wounds is complex and problematic. Burn-wound pain is severe, inconsistent and underestimated. Patients experience severe pain, especially during procedures, until wound healing has occurred. A multi-modality approach is needed for effective management of pain, which requires an understanding of the mechanisms of pain. Altered pharmacokinetics and pharmacodynamics in burn-wound patients makes drug actions unpredictable. Opioids alone are seldom sufficient for pain control. The multi-modality approach includes the use of opioids and non-steroidal anti-inflammatory, anxiolytic and alternative drugs. Ketamine has been found to be a useful agent for analgesia in burn-wound patients; a dose of 10 mg/kg qid per os was found to be an effective adjunct to pain therapy.     

Complications of use of intrauterine devices among HIV-1-infected women

BACKGROUND: A WHO expert group and the International Planned Parenthood Federation recommend against use of intrauterine devices (IUDs) in HIV-1-infected women based on theoretical concerns about pelvic infection and increased blood loss. We investigated whether the risk of complications after IUD insertion is higher in HIV-1-infected women than in non-infected women. METHODS: 649 (156 HIV-1 infected 493 non-infected) women in Nairobi, Kenya, who requested and met local eligibility criteria for insertion of an IUD were enrolled. We gathered information on IUD-related complications, including pelvic inflammatory disease, removals due to infection, pain, or bleeding, expulsions, and pregnancies at 1 and 4 months after insertion. Patients' HIV-1 status was masked from physicians. FINDINGS: Complications were identified in 48 of 615 women (11 [7.6%] HIV-1-infected women, 37 [7.9%] non-infected). Incident pelvic inflammatory disease (two [1.4%] HIV-1 infected, one [0.2%] non-infected) and infection-related complications (any tenderness, removal of IUD for infection or pain; ten [6.9%] HIV-1 infected, 27 [5.7%] non-infected) were also rare and similar in the two groups. Complication rates were similar by CD4 (immune) status. Multivariate analyses suggested no association between HIV-1 infection and increased risks for overall complications (odds ratio 0.8 [95% CI 0.4-1.7]) or infection-related complications (1.0 [0.5-2.3]), adjusted for marital status, study site, previous IUD use, ethnic origin, and frequency of sexual intercourse, but a slight increase cannot be ruled out. INTERPRETATION: Our data suggest that IUDs may be a safe contraceptive method for appropriately selected HIV-1-infected women with continuing access to medical services.     

Fetal Candida infection associated with an intrauterine contraceptive device

Fetal Candida infection is rarely described but is often associated with a retained intrauterine contraceptive device (IUCD). A case of abortion due to Candida infection in a patient wearing an IUCD is reported.     

A case of early intrauterine parvovirus B19 infection

Cutaneous and subcutaneous gangrene are serious sequelae of secondary or tertiary hyperparathyroidism which may accompany chronic renal failure. Based on analysis of the present typical case and a retrospective survey of similar cases in the literature, we propose the term 'uraemic gangrene syndrome' for this association. These skin lesions in chronic renal failure patients represent the most serious clinical manifestation of calciphylaxis, a condition originally described by Selye. The appearance of early skin lesions should be regarded as an indication for subtotal parathyroidectomy. The association of cutaneous gangrene with vascular calcification was first described by Bryandt and White in 1989, and was termed by these authors as 'gangrenous calcification'. A total of 80 cases of this rare complication of chronic renal disease had been reported up to early 1994. A retrospective review of these reports has strongly suggested a close interrelationship between renal failure, secondary hyperparathyroidism, vascular calcification and cutaneous gangrene. The present report concerns a characteristic case to draw attention to this syndrome which is accompanied by serious, predominantly cutaneous, changes.     

Effect of copper and platinum intrauterine devices on endometrial morphology and implantation in the rabbit

The response of the rabbit endometrium to the copper IUD was investigated. A plastic IUD bearing copper foil (42 mm2) was inserted into one horn of the rabbit uterus and a physically similar platinum-bearing IUD in the contralateral horn served as a control. The Pt-IUD caused no tissue damage and little if any inflammatory reaction in ovariectomized, oestrous or pregnant animals, whereas the Cu-IUD produced endometrial ulcers in 14 out of 15 does in all hormonal states. The associated inflammation was particularly intense in the pregnant animals in which a unilateral pyometra was usually present. Despite the endometrial trauma produced, the Cu-IUD was only partly effective as a contraceptive agent, 36% of the ova shed from the ovary ipsilateral to the Cu-IUD implanting, compared with 63% of the ova ipsilateral to the Pt-IUD. However, almost half of the implantation swellings in the copper-bearing horns were abnormally small or distorted in shape at 9 days post coitum. The tissue destruction observed in the rabbit endometrium emphasizes the need for careful histological studies of the effect of the copper IUD on the human uterus.     

Fetal and maternal endocrine responses to experimental intrauterine infection in rhesus monkeys

OBJECTIVE: Our purpose was to describe the temporal and quantitative relationships among intrauterine infection, fetal-placental steroid biosynthesis, and preterm labor in a nonhuman primate model. STUDY DESIGN: On approximately day 130 of gestation (term 167 days) chronically instrumented rhesus monkeys (Macaca mulatta) were infected with 10(6) colony-forming units of group B streptococci either by intraamniotic (n = 4) or choriodecidual (n = 2) inoculation. As controls, four additionally chronically instrumented noninfected monkeys were followed up to spontaneous parturition. Amniotic fluid and maternal and fetal arterial blood were serially sampled in all monkeys (both before and after infection) for progesterone, estrone, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, and cortisol by specific radioimmunoassays, and uterine activity was continuously recorded. RESULTS: Spontaneous parturition was preceded by gradual and significant increases in the plasma concentrations of fetal dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione and fetal and maternal levels of estrone, estradiol, and progesterone but not by changes in cortisol. In contrast, infection-associated parturition (either intraamniotic or choriodecidual) was characterized by abrupt increases in fetal dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, progesterone, and cortisol but not by increases in maternal or fetal estrone or estradiol. Infection-associated steroid changes occurred concurrently with or after increases in uterine activity. CONCLUSION: Infection-associated preterm parturition is associated with dramatic increases in fetal adrenal steroid biosynthesis but not by corresponding increases in placental estrogen biosynthesis. This suggests that fetal stress in accompanied by placental dysfunction and that infection-associated parturition is not dependent on the increased estrogen biosynthesis observed in spontaneous parturition.     

The diagnosis of brain lesions in newborns with an intrauterine herpetic infection

Enzyme immunoassay and DNA hybridization technique were used to diagnose herpetic infection. Blood and liquor antiherpetic antibodies were detected, with anticytomegalovirus antibodies used as reference ones. Intrauterine herpetic infection was detected in 61.5% of 91 risk group newborns. We should like to emphasize that two laboratory tests should be used to diagnose an intrauterine herpetic infection in newborns. Detection of antiviral antibodies in the CSF is a valuable method for the diagnosis and differentiation of brain involvement in intrauterine herpetic infection.     

Detection of human chorionic gonadotropin in blood of regularly bleeding women using copper intrauterine contraceptive devices

Highly sensitive and specific radioreceptorassay and radioimmunoassay of human chorionic gonadtropin (hCG) have been used in the detection of hCG in random serum samples during the luteal phase of the menstrual cycles of 200 women and in daily serum samples obtained a few days prior to expected ovulation through the luteal phase in 3 women with regular bleeding patterns and using a copper intrauterine device (IUD). Twelve to nineteen per cent of IUD users showed hCG in serum during the luteal phase, indicating that the presence of the IUD, while permitting fertilization, probably causes interference through degeneration of the blastocyst and consequent lack of implantation.     

Morphological diagnosis of intrauterine chlamydia infection and its clinico-anatomical characteristics

Clinicomorphological characteristics of intrauterine chlamydiasis (IUC) are given. The authors describe a cottonwool-like meningochorioiditis the observation of which at necropsy allows IUC suspection. Chlamydial etiology of this condition is confirmed by means of electron microscopy and immunofluorescence. Fibroblast proliferation of the pia mater followed by intensive fibrillogenesis plays a most important role in morphogenesis of cottonwool-like nodules. The occurrence of IUC at the necropsies varies depending on the age of foetuses and newborns from 6.2 to 38.7%.