Characteristics of a group of adolescents undergoing loop electrical excision procedure (LEEP).

STUDY OBJECTIVE: To describe the sociodemographic characteristics of a cohort of adolescents undergoing loop electrosurgical excision procedure (LEEP) of the cervix, and to determine if LEEP is a safe and effective procedure for evaluation and treatment of high-grade squamous intraepithelial lesions (HSIL) of the cervix in adolescents. SETTING: Case series of all adolescents who underwent LEEP between 1995 and 1997 at Children's Hospital, Boston, MA. DESIGN: Medical and laboratory records were reviewed to assess baseline characteristics and the following outcomes: (1) LEEP pathology results, (2) postoperative complications, (3) pregnancy outcomes, (4) compliance with follow-up appointments, and (5) recurrence of disease over a 12- to 37-month period. PARTICIPANTS: Thirty-five adolescents underwent LEEP. The mean age of the adolescents at the time of LEEP was 17.9 +/- 1.5 yrs. RESULTS: The mean interval between coitarche and LEEP was 3.69 +/- 2.09 yrs. On preoperative colposcopy, 28 (80%) had HSIL on biopsy, 3 (8.6%) had HSIL on Pap smear with a discordant biopsy demonstrating low-grade squamous intraepithelial lesion (LSIL), 1 (2.9%) had a persistent LSIL, 2 (5.6%) had diffuse LSIL with an unsatisfactory colposcopy, and 1 (2.9%) had a HSIL Pap smear with a normal biopsy. LEEP specimen histopathology results were: HSIL in 19 (54%), LSIL in 10 (29%), SIL difficult to grade in 3 (9%), and no residual disease in 3 (9.0%). Postoperative complications were bleeding in 2 (5.7%), pain in 1 (2.9%), vaginal discharge in 1 (2.9%), cervicitis in 3 (8.6%), and endometritis in 2 (5.7%). Fourteen pregnancies were diagnosed after LEEP; no spontaneous abortions occurred. Mean follow-up period was 21.1 +/- 9.4 months. Compliance with follow-up appointments was 51% in the first 12 months post-LEEP and 26% in the second 12 months post-LEEP. Of the 28 patients followed for 12 months or more, there was one recurrence of HSIL confirmed by colposcopy and biopsy. CONCLUSIONS: Outcome and complications of LEEP in adolescent females are similar to those reported in larger series of adult women. LEEP appears to be a safe and effective procedure for the evaluation and treatment of HSIL of the cervix in adolescents, but additional long-term data are needed.

Impact of etonogestrel-releasing implant and copper intrauterine device on carbohydrate metabolism: a comparative study.

BACKGROUND: We investigated the influence of an etonogestrel-releasing (ETG) implant and copper intrauterine device (IUD) on carbohydrate metabolism. STUDY DESIGN: In this nonrandomized, open-label, prospective controlled trial, 40 healthy women received an implant or IUD (20 per group). Outcome measures were fasting glucose, fasting insulin, oral glucose tolerance test (OGTT) and glycosylated hemoglobin A(1)C (HbA(1)C) levels at baseline and after 6 and 12 months. RESULTS: The groups were similar in age, body mass index and laboratory parameters at baseline. Carbohydrate metabolism was not modified by the ETG implant at baseline and at 6 and 12 months (mean ± SD) (fasting glucose: 85.9 ± 5.13, 87.05 ± 5.36, 88.19 ± 5.05; insulin: 7.77 ± 2.42, 10.64 ± 9.4, 8.82 ± 3.73; OGTT: 94.8 ± 25.28, 96.5 ± 19.67, 99.47 ± 24.6; HbA(1)C: 5.27 ± .34, 5.55 ± .39, 5.7 ± 0.37). The same was true for the IUD (fasting glucose: 88.87 ± 7.2, 89.65 ± 5.86, 88.75 ± 4.79; insulin: 7.94 ± 3.6, 8.3 ± 4.1, 7.34 ± 3.02; OGTT: 96.85 ± 15.16, 97.48 ± 13.42, 91.3 ± 22.16; HbA(1)C: 5.41 ± .49, 5.75 ± .41, 5.9 ± 0.73). CONCLUSIONS: The ETG-releasing implant did not affect carbohydrate metabolism in normal women after 12 months.

Avaliaçäo do pH de sangue de cordäo umbilical e sua relaçäo com o escore de Apgar em recém-nascidos a termo / Evaluation of umbilical cord pH and its relationship with Apgar score in term newborn infants

O valor do escore de Apgar como índice para avaliaçäo de asfixia perinatal tem sido questionado. O presente estudo pretende relacionar o pH da artéria e da veia umbilicais com o escore de Apgar em recém-nascidos a termo. Foi realizado um estudo transversal, envolvendo 76 recém-nascidos a termo, no Centro Obstétrico do Hospital de Clínicas de Porto Alegre, no período de março a setembro de 1995. As amostras sanguíneas foram obtidas de sangue de artéria e veia umbilicais no momento do parto. Separou-se a populaçäo estudada em 3 grupos, de acordo com o escore de Apgar: Grupo A(n=60):ò 7 no 1§ e 5§ minutos; Grupo B(n=13):< 7 no 1§ e ò 7 no 5§ minuto; Grupo C (n=3)< 7 no 1§ e 5§ minutos. A frequência de acidemia nos recém-nascidos do Grupo A foi de 18,3 por cento (11 recém-nascidos), para pH arterial < 7,20 e 5 por cento (3 recém-nascidos) para pH arterial ó 7,10. Três recém-nascidos (23 por cento) do Grupo B apresentaram pH arterial ò 7,20 e nove (56,2 por cento), pH arterial > 7,10. A sensibilidade e a especificidade para Apgar menor que 7 no 1§ minuto, na detecçäo de acidemia fetal foram, respectivamente, 54,1 e 94,1 por cento. Este trabalho confirma que há baixa correlaçäo de escore de Apgar com o pH do sangue de cordäo, mesmo em recém-nascidos a termo, e ressalta a importância de se obter essa medida ao se definir asfixia perinatal.