Consumption of fatty fish from the Baltic Sea and PCB in whole venous blood, plasma and cord blood from delivering women in the Aland/Turku archipelago.

The present study aimed to assess the role of fish consumption for the body burden of polychlorinated biphenyls (PCBs) in mothers living in the Aland and Turku archipelago in Finland. The overall objective was to investigate whether there exists an appropriate population for a full-scale prospective study on PCB-related developmental effects in infants. Concentrations of the four major PCBs were determined in whole venous blood and cord blood from 30 delivering mothers, of which 20 subjects consumed fatty fish from the Baltic Sea (2.5-12.5 meals per month) and the remaining 10 mothers did not. The concentrations of CB-118, CB-138, CB-153, and CB-180 in cord blood were generally two- to threefold lower than in whole blood from the mothers, but strong correlations were observed between PCBs in the two matrices (r = .67-.80). Neither the venous blood nor cord blood concentrations of PCBs, however, were correlated with stated fish intake. Moreover, the concentration of CB-153 in plasma was only weakly associated with fish intake, and the level of organic mercury in erythrocytes was not correlated with fish intake at all. The present results of CB-153 concentrations in women's blood are lower than those reported in other recent investigations. A reasonable contributing explanation is the rapid decline during the last decades of PCB in Baltic Sea fish, which has resulted in less impact of fish intake on the body burdens of PCB in relatively young women (median 30 yr in the present study) as compared with older females. The relatively low PCB levels in blood taken together with the low number of yearly deliveries in the archipelago population makes it an inappropriate study base for a prospective study of PCB-related health effects in infants.

Prognostic factors in invasive squamous cell carcinoma of the vulva.

Histological malignancy grading and its correlation to prognosis were retrospectively investigated in 303 cases of squamous cell carcinoma of the vulva. A scoring system based on several variables is suggested. The scores and the individual histological variables were tested along with clinical factors with a view to predicting survival. Various histological variables including mode of invasion, depth of invasion and nuclear polymorphism, as well as the sum of the scores were good predictors of survival. The study revealed a significantly better survival rate in stage III if no metastases were suspected. An age factor was also found showing that cancer of the vulva has a worse prognosis in older women.

State III squamous cell carcinoma of the vulva. Results of a Swedish study.

One hundred fifty-three cases of stage III vulvar squamous cell carcinoma were studied. The survival rate was significantly higher in the 99 patients given standard treatment than in the 54 given other treatments. The principal prognostic factor was the presence of groin metastases. In cases without metastases at the time of primary treatment, the five-year survival rate was 89%; in cases with metastases it was 36% When nodal metastases were not suspected (International Federation of Obstetricians and Gynecologists stage N0N1), the survival rate was also higher than when nodal involvement was suspected (N2). Stage III should be subdivided according to either postoperative stages or new clinical stages by separating N0N1 cases from N2 cases.

[Background factors of defective contraception in abortion-seeking patients]. / Bakgrundsfaktorer till bristande antikonception hos abortpatienter.

PIP: 459 women seeking abortion answered a questionnaire about their motives, contraceptive methods and use, and their reasons for failing to use them. An additional 50 in-depth interviews were conducted to obtain a more detailed view of their relationship to partners, decision to seek abortion, and experience with contraceptives. Results indicated that 254 women (56%) admitted to not having used any contraception before getting pregnant, and 44% had used condoms. Socioeconomic factors were less important than geographical location for those seeking abortion. Those under 20 were most likely not to use contraceptives (67%), while only the 30-34 age group's usage pattern exceeded 50%. 174 women (38%) had had 1 or more previous abortions, while 11% had 3 or more. The rate of contraceptive use increased from 40% to 45% after abortion. Repeat abortions were typical for very fertile, sexually active women. Women who had harmonious relationships with their partners used contraceptives more extensively. 11 of 14 women who had problematic relationships had not used any contraception at the time the unwanted pregnancy occurred. Women with several partners tended to use contraceptives less -- a paradoxical finding. Women who made the decision about abortion alone were less likely to use contraception than those whose partners were also involved in the decision making. Only 37% of the women who were ambivalent about having a child in the future used contraception, evincing an unconscious desire to have children. Counseling after the abortion procedure combined with advice about contraception may help prevent repeat abortions.^ieng

Malignancy grading and prognosis from a biopsy only in cases of electrocoagulated squamous cell carcinoma of the vulva, stages I and II.

Histologic malignancy grading and prognosis from a biopsy only was retrospectively investigated in 92 cases of stages I and II of cancer of the vulva treated with electrocoagulation. A scoring was made of several histologic variables. The score proved to be a better predictor of survival than any other single factor analysed, including clinical staging. Depth of invasion did not significantly influence survival, thus indicating improper use of "microinvasion", if defined only by depth of invasion.

Pre-abortion treatment with a single vaginal suppository containing 9-deoxo-16,16-dimethyl-9-methylene PGE2 in late first and early second trimester pregnancies.

In the present study the efficacy of a new stable prostaglandin E analogue, 9-deoxo-16,16-dimethyl-9-methylene-PGE2 (9-methylene-PGE2), administered as a single vaginal suppository for preoperative dilatation of the cervical canal was evaluated in 382 mainly nulliparous patients. Late first trimester patients received either 20 mg 3 hours prior to or 30 mg 12 hours prior to vacuum aspiration. Early second-trimester patients received 40 mg of the analogue and vacuum aspiration was performed 12 hours later. The degree of cervical dilatation was related to the pretreatment time and the dose of 9-methylene-PGE2. However, even with 20 mg of the analogue and 3 hours pretreatment time, cervical dilatation was adequate in almost 40% of the patients and in the remaining women further mechanical dilatation was regularly performed with ease. The frequency of gastro-intestinal side effects was significantly lower than that found for comparable doses of 15-methyl-PGF2 alpha methyl ester administered by the same route. With 20 mg 9-methylene PGE2, side effects were very rare; only 9% of the patients experienced occasional episodes of vomiting. Three hours' pretreatment with 20 mg of the analogue seems suitable for late first trimester pregnant women in whom the abortion is performed on an outpatient basis. For early second trimester patients pretreatment with 40 mg 9-methylene-PGE2 for 12 hours followed by vacuum aspiration seems to be a better alternative than the two-stage procedures in current use.

[Experiment with foaming intravaginal suppository shows on good contraceptive effect and tolerance]. / Försök med skumbildande vagitorium visar på god skyddseffekt och tolerans.

PIP: The foaming intravaginal suppository Patentex Oval was used for 726 months by 136 women at a contraceptive clinic at Stockholm. 3 unplanned pregnancies occurred, 2 of them during improper use of the suppository. While no side effects were reported, there were instances of discomfort. After a high dropout rate during the first 4 months of the trial, the remainder (77% or 46 women) continued until the end of the year. (author's modified)^ieng

Concentrations of copper in human secretions and weight of the copper wire during the 4 to 7 years after insertion of a Cu-IUD (intrauterine device).

The useful life span of the two most commonly used copper intrauterine devices (Cu-IUDs) (Gravigard and Cu-T) was investigated in a long-term study up to 90 months after insertion. Minor differences between the two types of devices were found that, however, probably do not contribute to a diverging contraceptive efficacy with time. To be able to ensure maximal contraceptive effect, the authors suggest on the basis of the present data that the time of use not exceed 5 to 6 years.

PIP: This Swedish study assesses the useful life span of copper intrauterine devices (Cu-IUDs) beyond the recommended 3 years to between 4-9 years. The subjects consisted of 109 regularly menstruating women (para, 0-4; ages, 18-46) who had voluntarily used a Cu-IUD for 43-90 months. Uterine secretions were collected with a urethral catheter before the Cu-IUD was removed or replaced. Secretions varied in amount from 0.7-10.3 gm and were collected on days 8-23 of the cycle. Copper content was measured by atomic absorption spectroscopy and the copper wire weighed. Results indicate no significant differences in: 1) copper concentrations after 4 years of use, 2) the copper concentrations in uterine secretions of women using Gravigards and Cu-Ts, 3) secretions obtained during cycle days 8-14 in comparison with cycle days 15-23, and 4) weights over time between the two devices. The study also found a decreasing concentration of copper during the period of 43-87 months after insertion of Cu-IUDs. With reference to copper ion concentrations, the contraceptive efficacy of a Cu-IUD used for 43-90 months would be just as high for a Cu-IUD used for 4 years. The life span of a Cu-IUD is limited by corrosion. The study recommends that use of a Cu-IUD with a wire surface area corresponding to 200 sq mm should not exceed 5-6 years.

Dilatation of the cervix prior to vacuum aspiration by single vaginal administration of 15-methyl-PGF2 alpha methyl ester.

PIP: The efficacy and safety of treatment with 1 vaginal suppository containing 15-methyl prostaglandin (PG) F2 alpha-methyl ester for cervical dilatation before vacuum aspiration in the 9th-14th week of pregnancy were tested in 489 patients: Group 1, patients 9-12 weeks pregnant, received a 1-mg suppository; Group 2, patients 13-14 weeks pregnant, were given a 1.5-mg dose. The vacuum aspiration procedure was performed 12 hours after insertion of the suppository. Mean cervical dilatation at the operation was 9.4 mm in Group 1 and 10.9 mm in Group 2. In about 50% of the patients, the cervix was further dilatated at operation. Mean additional dilatation was 2.8 and 1.5 mm, respectively, accomplished with minimum resistance. Mean bleeding at operation, including the conceptus, for the 9-12 week pregnant patients was 60 ml, and for Group 2, 135 ml. Gastrointestinal side effects, i.e., vomiting and diarrhea, were common but were rare only in cases frequent enough to be regarded as disturbing to the patient. No other treatment-requiring side effects were observed. In 22% of the patients in both treatment groups, the conceptus was expelled into the vagina prior to the operation. No cervical laceration was observed, and no uterine perforation occurred at the operation.^ieng

Effects of ethinylestradiol/D-norgestrel combinations on serum lipoproteins.

Serum lipoproteins were analyzed in 33 young women (mean age 22 years) before and after two cycles of treatment with one of the following ethinylestradiol/d-noirgestrel combinations (microgram/microgram): 30/150, 50/150 and 50/250. A slight but significant weight increase of 1.2 akg was found only in the 509/150 group. All three hormone combinations had similar effects on the lipoproteins. Before treatment all subjects had normal lipoprotein concentrations. Whole serum triglyceride (TG) and cholesterol concentrations were not significantly affected. In the whole group the LDL-TG concentration increased from 0.24 to 0.33 mmol/l (p < 0.001) and HDL-cholesterol fell from 1.54 to 1.35 mmol/l (p < 0.001). Smokers tended to have lower HDL-cholesterol than non-smokers. It is possible that HDL reductions for longer periods of time may be one of the factors that promote the development of atherosclerotic manifestations in young women on oral contraceptives.

[Oral contraceptives and HDL cholesterol]. / P-piller och HDL-kolesterol.

PIP: Serum lipid and cholesterol levels were measured in 33 women before and after 2 cycles' use of 3 low dosage combination preparations. Cholesterol levels in the HDL fraction showed a 12% decrease (P .001). Serum-TG and cholesterol levels in other fractions did not change significantly in any of the 3 groups.^ieng

Histologic malignancy grading in invasive squamous cell carcinoma of the vulva.

A preliminary report on a histologic malignancy grading of vulvar carcinoma is presented. A retrospective histologic study of 40 vulvar carcinoma cases stage I and II (TNM-system) with a minimum five-year follow-up was carried out and correlated to the course of the disease. Morphologic criteria characterizing the tumor cell population, as well as the tumor-host relationship, were examined and scored. The scores obtained could be divided into three groups that correlated well with the clinical outcome. The low-score group had no metastases or recurrence, whereas 82% of the high-score group had both metastases and fatalities. Depth of invasion was found to have a strong correlation to clinical outcome. A more accurate morphologic malignancy grading of such carcinomas could lead to a more individual and often less radical treatment plan.

Clinical evaluation of C-Film, a vaginal contraceptive.

PIP: C-film, a 5 X 5 cm piece of water-soluble polyvinyl alcohol film, containing the spermicide nonylphenoxypolyethoxyethanol, was used as the sole contraceptive method by 237 women for 1866 months. 14 pregnancies occurred for a pregnancy rate of 9/100 woman-years. However, 11 of the women failed to use the method as instructed for a theoretical method failure rate of about 2/100 woman years. 156 women observed for 12 months or longer were analyzed by the life-table method. They showed an overall pregnancy rate of 6.5% and a continuation rate of 68.6%. Among the reasons for stopping were difficulty in applying the film properly, complaints about the sharp edges (especially if a package had been opened for a few weeks and air had come in contact with individual films,) and problems with inserting the interleaved silver foil as well as the film. Male insertion was tried but discontinued after reports of higher failure rates. C-film should not be offered as an alternative to oral contraception or IUDs but will increase the reliability of an IUD or condom and may be used alone to postpone pregnancy, for women approaching menopause, and where absolute protection against pregnancy is not required.^ieng

[An intrauterine device with inert principle]. / Ett IUP med inert princip

PIP: A report on 2 types of inert IUDs is presented. The characteristics and method of implantation of the Dalkon Shield and the Dalkon Shield Small are described. The Dalkon Shield was implanted in 198 patients, with a 1.6% frequency of expulsion, 1.1 frequency of gravidity, and an 82.4% continuation rate. The Dalkon Shield Small was implanted in 97 patients with a 0% frequency of expulsion, a 3.7% frequency of gravidity, and a 65.8% continuation rate.^ieng