Higher densities of distributed pheromone sources provide disruption of codling moth (Lepidoptera: Tortricidae) superior to that of lower densities of clumped sources.

Field experiments quantified the effect of synthetic pheromone release-site density and distribution on 1) orientational disruption of male codling moths, Cydia pomonella (L.) (Lepidoptera: Tortricidae), to pheromone-baited traps; and 2) fruit injury. A clustering test varied pheromone release-site density from 0 to 1,000 Isomate-C Plus dispensers per ha while maintaining the total number of dispensers at 1,000. Percentage of orientational disruption of pheromone-baited traps increased significantly as a function of increasing density of release sites. Fruit injury decreased as the density of release sites increased and was lowest in plots treated with Isomate-C Plus dispensers distributed as 1,000 point sources per ha. We also manipulated point source density of 0.1-ml paraffin-wax drops containing 5% codlemone [(E,E)-8,10-dodecadien-1-ol], and thus the total amount of pheromone deployed per hectare. The percentage of disruption of traps baited with either 1.0- or 0.1-mg codlemone lures increased with increasing density of wax drops deployed. Both trapping and field observations confirmed that wax drops were attractive to male codling moths, suggesting that disruption was mediated by competitive attraction. Development of dispensers that can be mechanically applied at high densities has potential to improve the efficacy and economics of codling moth disruption at high population densities.

Small plot trials documenting effective mating disruption of oriental fruit moth by using high densities of wax-drop pheromone dispensers.

In 2004 field experiments, we compared the effectiveness of various deployment densities of 0.1-ml paraffin wax drops containing 5% pheromone versus Isomate M-Rosso "rope" dispensers for disruption of Grapholita molesta (Busck). Treatments were evaluated in 0.05-ha (12-tree) plots of 'Delicious' apples receiving regular maintenance according to growers' standards, but not sprayed with insecticides. The application densities of 0.1-ml wax drops were 3 per tree (820/ha), 10 per tree (2,700/ha), 30 per tree (8,200/ha), and 100 per tree (27,300/ha). Wax drops were compared with 3-ml dispensers of pheromone-containing paraffin wax or Isomate M-Rosso ropes at 1.8 per tree (500/ha) and untreated control plots. Treatments were applied before the start of each of three moth generations. Orientational disruption, as measured by inhibition of moth captures in pheromone-baited delta traps, was greatest in plots that received 100 drops per tree (99.2%) and 30 drops per tree (99.4%). More than 55% of tethered, virgin females were mated in control plots after one night of deployment. However, no mating was recorded at the two highest application densities of wax drops where orientational disruption of traps exceeded 99%. Mating ranged from 7 to 20% among the other treatments, including Isomate rope dispensers. G. molesta males were observed closely approaching pheromone dispensers in plots containing ropes and wax drops, documenting competitive attraction between synthetic pheromone sources and feral females. The majority of observed G. molesta males approached within 60 cm of wax drops or pheromone ropes and departed within 20 s by flying upwind. Thirty wax drops per tree yielded higher mating disruption of G. molesta than did Isomate M-Rosso dispensers deployed at the recommended rate of 500/ha (1.8 per tree). Measurement of release rates confirmed behavioral data indicating that paraffin wax dispensers would need to be applied once per G. molesta generation in Michigan. Paraffin wax drops are a promising technology for moth mating disruption. They are cheaper and easier to produce, require less total pheromone per annual application, and produce better mating disruption at appropriate deployment densities compared with Isomate M-Rosso dispensers under high G. molesta population densities. The cost-effectiveness of this approach will require an appropriate mechanized applicator for wax drops.

AGUS in cervical endometriosis.

OBJECTIVE: To evaluate cervical endometriosis as a source of abnormal glandular cells in cervicovaginal smears. STUDY DESIGN: Histologically documented cases of cervical endometriosis with concurrent cervicovaginal smears were reviewed. The cytologic specimens were evaluated for the presence of glandular abnormalities. RESULTS: There were eight cases of superficial endometriosis (five of which had concurrent tuboendometrioid glandular metaplasia) and two cases of deep endometriosis in this series. Five of the eight cases of superficial endometriosis had abnormal glandular cells in the smears; neither of two cases of deep endometriosis had glandular abnormalities. Four of the eight cases of superficial endometriosis had previously undergone conization for cervical intraepithelial neoplasia (CIN) (squamous intraepithelial lesion [SIL]) and were being monitored for recurrence. Of the five cases of atypical glandular cells of unknown significance (AGUS), one case had concurrent high grade CIN (SIL). Another case was originally misinterpreted as recurrent glandular dysplasia. CONCLUSION: Physicians monitoring patients after treatment for CIN need to be aware that endometriosis and tuboendometrioid metaplasia may be the source of atypical glandular cells and on occasion may be subject to misinterpretation.

Comparison of standard and loupe colposcopy (part I).

BACKGROUND: Our objective was to determine whether colposcopy can be performed with surgical-type loupes. METHODS: Sixty-one patients with abnormal Papanicolaou (Pap) smear test reports were examined with 6× loupes supplied by Designs For Vision, Inc. (Ronkonkoma, NY) and with a standard Zeiss Colposcope (Model OM-1). Comparisons between the two instruments were made for colposcopic impression and final histological analysis. Statistical analysis was performed by using the Kappa test. RESULTS: Comparison of the two methods of examination demonstrated excellent agreement (κ = .86) with Pap smear and biopsy results. CONCLUSIONS: We decided that surgical loupes are adequate for colposcopic examination.

Comparison of Standard and Loupe Colposcopy (Part II): Initial Experience with a New 6×-10× Surgical Loupe.

BACKGROUND: Our objective was to describe our experience in using a newly designed surgical loupe as a substitute device for colposcopy. METHODS: Eighty-two patients were examined with a prototype surgical loupe. The instrument has a self-contained halogen light source, allows for 6× and 10× magnification, and has a green filter. Colposcopic impression within one degree of the histological diagnosis was considered in agreement. The colposcopic impression using the new instrument was compared to biopsy diagnoses. RESULTS: Colposcopic impressions with this new instrument agreed with final histological diagnoses in 93% of cases. The instrument was easy to use. CONCLUSION: The 6× to 10× surgical loupe is comfortable to use. Correlation with final pathological evaluation is comparable to standard colposcopic instruments. A trial of this instrument against a standard colposcope is ongoing.

Microcolposcopy. When and how to do it.

Microcolposcopy is a valuable accessory technique for the busy colposcopist and is particularly helpful in locating the new squamocolumnar junction. Microcolposcopy is an evaluation of cytology, and colposcopy is a study of vascular and growth patterns. The two methods are complementary.

LA-1 oncogene. A possible new prognostic index for evaluating cervical squamous intraepithelial lesions.

Cervical biopsies from 96 patients referred to the Union Memorial Hospital Colposcopy Clinic were analyzed for the expression of the LA-1 oncogene by using an antibody directed against a 13 amino acid epitope of the oncogene product. The expression of the oncogene was found to correlate with the grade of the cervical intraepithelial lesion. A trend was suggested even though chi 2 analysis was not significant (P = .08). Further studies are warranted to determine whether the LA-1 test predicts persistence or progression of the disease.

Microcolpohysteroscopy compared with colposcopy in the evaluation of abnormal cervical cytology.

Microcolpohysteroscopy allows one to observe the cervix and endocervix at magnifications of 1:1-1:150. More important, it permits examination of the squamocolumnar junction when it is obscured within the endocervix. This preliminary report compares standard colposcopy with a microcolpohysteroscopy technique in 65 patients with abnormal Papanicolaou smears. Using contact microcolpohysteroscopy, the clinician can map out geographically entire cervical intraepithelial neoplastic lesions; locate correctly the epicenter of most lesions; and in cases of inadequate colposcopy, visualize the squamocolumnar junction within the cervix. Microcolpohysteroscopy was equivalent to traditional colposcopy in detecting abnormal histology. This technique predicted lesions with viral cytopathic effects, which correlated with histology in 83% of cases. The results of this study suggest that microcolpohysteroscopy is a diagnostic tool that can precisely qualify and localize a cervical lesion.

Ovabloc. Five years of experience.

Female sterilization with the Ovabloc was performed on 438 women in five years. The complications, failure rate and pregnancy rate are discussed.

Silicone devices for tubal occlusion: radiographic description and evaluation.

Hysteroscopically placed silicone devices for occlusion of fallopian tubes have been evaluated in over 1,300 patients as a means of contraception during the past five years. Radiologic evaluation of the device is vital to the gynecologist both at initial implantation and for follow-up. Normal appearance of plugs and typical examples of complications including separation, extravasation, and abnormal configurations, are presented.

PIP: The silicone fallopian tube implant is being evaluated as a means of contraception. With implants in over 1300 patients, it is important that radiologists be familiar with their typical appearance and proper radiographic evaluation. The occlusion device is placed hysteroscopically after localization of the tubal ostea in the cornual portion of the uterus. The ostea is occluded by a catheter fitted with a detachable tip. Silicone solution is pumped through the tip into the fallopian tube. Curing occurs in situ with the silicone crosslinking to itself and to the detachable tip. Both tubes are occluded during the same procedure. After implantation, pelvic radiographs are obtained for evaluation. Frontal radiographs of the pelvis are obtained after implantation for evaluation. Points to be considered are configuration of the tubal plug, which should be larger in the ampullary portion than at the isthmus or in the cornual portion of the tube; the length of the plug, which should be approximately 6 cm; and the continuity of the plug and the tip. Because of considerable tortuosity of the fallopian tubes, it is often necessary to obtain oblique radiographs to evaluate the entire length of the occlusion device properly. Follow-up radiographs are obtained 3 months later to check the location and to insure continuity of the devices before regular contraceptive measures are stopped. Further follow-up radiographs are obtained 2 years after placement to evaluate late separation. Complications encountered can be grouped into those dealing with device placement, those related to silicone separation, and those dealing with tubal abnormality. Abnormal configuration and placement can be due to injection of silicone solution into the uterine wall with typical extravasated appearance. This configuration is believed to be due to injection into the myometrium or venous sinusoids. Discontinuity of the occlusive device occurs as a result of either incomplete filling of the tube or failure of crosslinkage of the plug to the tip. Abnormal configurations tend not to be retained. Delayed separation is demonstrated on follow-up radiographs with the remainder of the plug being extruded into the peritoneal cavity. Radiographic evaluation of the silicone tubal occlusion device is vital to the gynecologist to insure proprer placement and configuration of the implant. Initial evaluation should insure the integrity of the device. The gynecologist should be alerted when either separation or abnormal configuraton of the silicone is observed.

Hysteroscopic sterilization: silicone elastic plugs.

PIP: Erb, Davis, and Kyriazis developed the application of the silicone rubber plug directly into the cornual openings of the fallopian tubes in rabbits by working through hysterotomies. Subsequently, does were exposed to bucks for periods up to 280 days, and none of the does became pregnant. Tissue sections of some tubes were studied microscopically, and no pathological findings were found. The only finding was the flattening of the cilia. This work continued through the early 1970s at Franklin Research Center and Hahnemann Medical College in Philadelphia. 2 basic concepts were developed: 1) there was direct application of catalyzed silicone rubber into the cornual ostium, and 2) the molded obturator (cornual) tip became part of the plug. The technique's success depends on the fact that silicone rubber cures (becomes a rubbery solid) in about 5 minutes without heat or chemical reaction. The formed-in-place plug is made possible because the silicone rubber in curing will cross-link to itself only with the result that the obturator tip at the cornu cross-links and becomes part of the formed-in-place plug. The procedure, as performed in humans, is outlined in detail and is diagrammed. A single hinged bivalve speculum exposes the cervix so that after the hysteroscope is inserted through the cervix into the uterine cavity, the speculum can be removed. The procedure should be performed early in the proliferative phase of the cycle, for generally visualization is better at this time because the endometrium is thinner and less vascular and succulent. Once the ostia have been identified, the aspirator is removed from the cavity. The guide assembly with its attached obturator tip is introduced through the opening channel of the scope into the uterine cavity. Once bilateral good push tests have been obtained, the assistant adds catalyst (stanous octuate) to the silicone in the nonairentraining mixer and dispenser that has been taken from the freezer. Once curing is complete, the assistant loosens the chuck holding the inner and outer guides together and pulls back on the inner guide. When both sides have been occluded, the patient has a flat plate x-ray of the pelvis done to determine proper plug formation. The method is still under investigation and a Food and Drug Administration protocol. Thus far, 1058 women have applied for the procedure. 93 were refused for various anatomic reasons. Of the remaining 956 patients, 791 or 82% have had successful bilateral plugs formed. These women have been observed for 4505 woman months without contraception, and no pregnancies have occurred. Complications other than pregnancies with improper plugs have been few and minor. About 3% in the author's series of 350 have had minor abnormal bleeding problems. 4 patients have required dilation and curettage. None has required a hysterectomy. In sum, it seems that good antifertility efficacy is obtained when proper plugs are formed.^ieng

Hysteroscopic tubal occlusion with silicone rubber.

A new method of sterilization for women is being investigated in several outpatient centers. The technique involves flowing liquid silicone rubber into the fallopian tubes. The silicone cures in place and forms a rubbery solid plug. The catalyzed liquid silicone is pumped through a special polysulfone guide assembly that fits through the operating channel of a standard hysteroscope. On the end of the guide is a hollow premolded silicone rubber tip that fits into the cornual ostium of the tube. When the silicone cures it also cross-links to this tip so that the tip becomes part of the plug. Results as of April 1, 1982, from 350 women in the Philadelphia center suggest that proper plug formation prevents pregnancy and that the method can be applied to about 85% of properly selected women.

Tubal occlusion with silicone rubber: an update.

PIP: Patients underwent tubal sterilization with silicone rubber plugs and throughout the series, women received a paracervical block with 1% lidocaine in 1:100,000 epinephrine for anesthesia. Patients used contraception for 3 months after the procedure and when contraception was later terminated, they were followed at regular 6-month intervals. A successful bilateral procedure was accomplished on 99 of 135 patients. Problems preventing successful completion included natural occlusion, anatomic problems, and diseased tubes. Review of the cases indicated that 4 types of abnormal plug formation were experienced: extravasation, reflux, diseased, and the slow gel type. However, the authors now know how to prevent the 1st; how to deal with reflux and slow gel plugs (remove and replace); and that this particular method of sterilization is not suitable for those with diseased tubes. The procedure offers very low risk to the patients and it is a safe, simple procedure.^ieng

Hysteroscopic oviductal blocking with formed-in-place silicone rubber plugs. I. Method and apparatus.

This method of nonsurgical female tubal sterilization involves the flowing of catalyzed silicone material into the oviduct through a silicone rubber obturator tip positioned at the tubal ostium. The method, described earlier as a fluoroscopic technique, has now been developed as a hysteroscopic procedure. Components include the obturator tip with retrieval loop, guide assembly, nonair-entraining mixer-dispenser, flow-actuation apparatus and plug-forming materials. Steps in the procedure include placement of the obturator tip in the tubal ostium, flow of the silicone, releasing of the tip (bonded to the cured plug) from the guide and removal of the guide.