The oral contraceptives and infertility.

PIP: This paper emphasized the syndrome of anovulation and infertility following oral contraceptive therapy in patients with previously regular menses. Case histories of 2 successfully treated patients are given. The first was 22-years-old, gravida 0, and had taken Enovid for almost a year following marriage. Physical and histological findings were normal. Withdrawal flow but not ovulation followed oral administration of 10 mg of 6-alpha methyl 17-acetoxyprogesterone daily for 5 days. Ovulation began after prednisone, 5 mg twice daily, was given for 1 month. Several months later she conceived and has had a normal delivery. The other patient, a 23-year-old gravida 0, used Enovid for 2 years. After cessation her previously regular menstrual periods became very irregular and complete amenorrhea had lasted 4 months. Prednisone, 5 mg twice a day, restored ovulation in 1 month. She conceived the following month. Relative frequency of anovulation following oral contraception is believed greater than suspected. Patients who have not yet completed their families should be warned of the risk and contraceptives should not be used to treat infertility to produce a "rebound" effect.^ieng

Is Candida stellatoidea disappearing from the vaginal mucosa?

A total of 681 vaginal isolates of germ tube-positive or germ tube-untested white, yeastlike fungi obtained from patients in various cities of the United States were tested for the presence of Candida stellatoidea (type I). Only 1 of the 681 isolates was identified as C. stellatoidea.

Endometrial cancer: stage at diagnosis and associated factors in black and white patients.

OBJECTIVE: This study examined the relationship of clinicopathologic, health status, medical system, and socioeconomic factors to differences in stage at diagnosis of endometrial cancer in black and white patients. STUDY DESIGN: A population-based study of 130 black and 329 white patients with invasive endometrial cancer was conducted as part of the National Cancer Institute's Black/White Cancer Survival Study. Logistic regression was used to determine the relative importance of factors thought to be related to stage at diagnosis after age and geographic location were adjusted for. RESULTS: High-grade (poorly differentiated) lesions increased the risk for stage III or IV disease (odds ratio 8.3, 95% confidence interval 3.4 to 20.3), as did serous histologic subtype (odds ratio 3.5, 95% confidence interval 1.4 to 8.8) and no usual source of care (odds ratio 5.5, 95% confidence interval 1.4 to 20.9). In the final statistical model these three factors also accounted for the majority of the excess risk of advanced stage for blacks. CONCLUSIONS: Black-white racial disparities in stage at diagnosis appear to be related to higher-grade lesions and more aggressive histologic subtypes occurring more frequently in black patients with endometrial cancer.

Racial differences in tumor grade among women with endometrial cancer.

Black women with endometrial cancer have more advanced disease and less favorable tumor grade than do white women. This study evaluated whether racial differences in tumor grade could be explained by hormone-related factors and other putative determinants of grade. Subjects included 207 white and 81 black postmenopausal women diagnosed with primary cancer of the uterine corpus between 1985 and 1987. Blacks had poorer tumor grade than whites (odds ratio for FIGO grade 2 versus grade 1 is 1.8; odds ratio for grade 3 versus grade 1 is 2.8). Over 75% of the excess of poorly differentiated tumors versus well-differentiated tumors among blacks could be explained by racial differences in use of replacement estrogens, age at first pregnancy, history of oophorectomy, poverty, stage of disease, use of screening, and access to health care. The most prominent factor was estrogen therapy, which was associated with favorable tumor grade and was used much less frequently by blacks. Although not statistically significant, a moderate racial difference in tumor grade remained after control of the potential explanatory explanatory variables. This may reflect true biologic variation between blacks and whites and may explain, in part, the observation that blacks with endometrial cancer have a worse prognosis.