Months Of Insertion Research Articles

The Hysteroscopic Approach to Sterilization

Permanent sterilization is the most common form of contraception in the United States today. Previously, this was accomplished via the laparoscopic method. A new less invasive method has been developed, in which the Essure microinsert is inserted through a hysteroscope into the fallopian tubes. A subsequent benign inflammatory process results in tubal occlusion within 3 months of insertion. Approved since 2002, this method offers high efficacy without incisions, general anesthesia, or a prolonged recovery period.

Gross and Pathologic Analysis of Long-Term Silicone Implants Inserted into the Human Body for Augmentation Rhinoplasty: 221 Revision Cases

In augmentation rhinoplasty, delayed morphologic changes are often observed with silicone implants, despite them being known as a safe implant material. The purpose of this study was to identify the cause and time course of delayed shape changes of silicone implants, through the long-term evaluation of inserted implants and their surrounding nasal soft tissues after their removal at revision rhinoplasty operations. Two hundred twenty-one silicone implants removed during revision rhinoplasty were studied. The period of insertion ranged from 1 month to 25 years, with an average of 6 years 7 months. Calcification within the silicone implants and, when available, the capsular soft-tissue attachments were examined with the naked eye and light microscopy. Calcification was first observed grossly with the naked eye after 5 years 8 months of insertion. With light microscopy, calcification debris could be seen after 4 years. After implant insertion for more than 9 years, focal calcification could be seen in 50 percent of implants. When implants had been inserted for more than 15 years, a denatured type of large calcification was clearly observed. Plasma cell, macrophage, and neutrophil proliferation was noted in the soft-tissue capsule surrounding the superficial calcifications in those individuals with an early inflammatory response, and lymphocyte proliferation was noted in those with a late inflammatory response. Silicone implants were noted to induce calcification when inserted for a long time, causing long-term morphologic changes. This should be taken into consideration when choosing silicone implants for augmentation rhinoplasty.

Intrauterine Contraception: Current Evidence-Based Recommendations

A 28‐year‐old nulliparous female presented to our family planning clinic for initiation of a new contraceptive method. Her past medical history was significant for chlamydial infection at age 20, which was successfully treated with antibiotics. Her family history was essentially unknown because she was adopted as an infant. She began menstruation at 12 years old, with regular periods occurring every 28 days, lasting between 4 and 5 days each. She had no history of pelvic inflammatory disease (PID), abnormal Pap smears, or known uterine abnormalities. She had her first sexual experience at age 17, and has had a total of six partners, two within the past year. She was not in a relationship at the time of the clinical encounter. She reported sexual partnership with men only. Her contraceptive history consisted of intermittent condom use from age 17 to age 20, followed by oral contraceptives with consistent condom use recently. She stated a desire for a nonhormonal contraceptive method. Upon questioning, she reported no desire to have children within the next 5 years. After discussing her contraceptive alternatives, she opted for a copper intrauterine device (IUD). She was tested for chlamydia and gonorrhea, and the results of both tests were negative. She returned to the clinic for IUD insertion the following week. At that time, she was advised that expulsion is the most likely cause of IUD failure, and is most common in the first 3 months of insertion, usually during menstruation.1 Instructions on how to check for the IUD and its threads were offered. She was instructed to assume the device had been expelled if she is unable to find the threads after menstruation, and that alternative contraception should be used until she is able to return to the clinic. Finally, she was informed of the signs and symptoms of pelvic infection and told to seek immediate medical care upon experiencing any of them, especially within the first 3 weeks following insertion.1 Upon returning to the clinic 4 weeks after insertion, she reported complete satisfaction with the method. She was reminded that menstrual abnormalities, including spotting or longer menstrual periods, are common in the first 3 to 6 months of use, but that any serious abnormalities in her bleeding pattern after 6 months should be reported.1

Spontaneous upward movement of lowly placed T-shaped IUDs

Objective To assess the possible progression of intrauterine devices (IUDs) to a lower or upper position in women. Material and Methods Thirty-two lowly placed T-shaped IUDs in women with 0–3 children were examined with transvaginal ultrasonography after 2 months of insertion in order to assess the possible progression of the IUDs. Also, the IUDs inserted in women with 0–3, 0–1 and 2–3 children were compared to determine whether this progression was different depending on parity. Results Intrauterine devices (97%, 100% and 93.7%) in the group of women with 0–3, 0–1 and 2–3 children, respectively, moved upward. The mean decrease in IUD–fundus distance was 6.8, 7.4 and 4.9 mm, respectively. Conclusion Lowly inserted T-shaped IUDs tend to move upward after insertion. Therefore, initial concern about low placement of a T-shaped IUD is not justified as most of them spontaneously readjust their position.

Effectiveness and complications of multi load (MLU 375) intrauterine device among females attending family planning clinic

OBJECTIVE: To see the effectiveness and complications of intrauterine device (IUCD); multi load (MLU 375) among females attending a family planning clinic. DESIGN: A prospective study. SETTING: A family planning clinic at Hyderabad, Sindh from June 2003 to May 2004. SUBJECTS AND METHODS: Out of 145 women, a total of 75 (51.72%) were registered after screening for the insertion of IUCD Multi load (MLU 375). Effectiveness and complications of IUCD (MLU 375) were recorded through a proforma. IUCD insertion was done under aseptic technique. Women were advised for follow up after 1, 6 and 12 months of insertion. They were provided a booklet for keeping their menstrual cycle record. RESULTS: Most of the women were educated and belonged to urban area. Mean age of women was 24.4 years. Majority of women 23 (30.66%) had 5 children. After one month follow up, 32 (42.66%) women complained of menorrhagia, 21 (28%) complained of lower abdominal pain, 17 (22.33%) increased vaginal discharge while 5 (6.66%) did not complain of any symptom. After six month follow up, 69 (92%) women were symptom free and satisfied with this method, 5 (6.6%) developed pelvic infection and only 1 (1.34%) had displaced IUCD, which was removed under general anesthesia. After 12 month follow up, 74 (98.66%) women continued this method and only 1 (1.34%) woman was given alternative method of contraception. Pregnancy rate was zero. CONCLUSION: IUCD (MLU 375) is a highly effective, safe and reversible method of contraception with zero pregnancy rate and also has minimal complications which decrease simply by good counseling and regular follow up.

Expulsions following 1000 GyneFix insertions

ContextThe GyneFix intra-uterine device has been used in our family planning service since 1997. One of the perceived advantages is its low expulsion rate, as reported by clinical trials.ObjectiveTo calculate...

Characteristics and outcomes of children with enterostomy feeding tubes: A study of 325 children

To examine the characteristics and outcomes of children with gastrostomy and gastrojejunostomy tubes inserted before age three years, and to identify the factors that predict removal of the enterostomy tubes within 12 months of insertion. Case review of a consecutive sample of 325 medical records. A tertiary care paediatric hospital that is situated in a large metropolitan area. All outpatients and inpatients from birth to 36 months of age who had an enterostomy tube inserted from 1994 to 1996. No direct intervention was provided. In the subgroup of 203 patients with a follow-up period of at least 12 months after tube insertion, children whose tubes were removed within 12 months of insertion were compared with children who continued to receive tube feedings for 12 months or longer. At the time of tube insertion, the median age of patients was six months; 47% of the children for whom data were available were failing to thrive. Although 66 (21%) of 321 patients for whom data were available had their tubes removed, only 25 of the 203 (12%) patients with a follow-up period of 12 months or more had their tubes removed within 12 months of insertion. Children whose tubes were removed less than 12 months after insertion differed from children whose tubes were not removed with respect to medical diagnosis (no children with cerebral palsy had their tubes removed versus 33% of children with cancer who had their tube removed). Most children with failure to thrive at the time of tube insertion were also failing to thrive at the time of tube removal. Children with cerebral palsy are not likely to have enterostomy tubes removed within one year of insertion.

Complications of removing percutaneous endoscopic gastrostomy tubes in children.

Little information has been reported regarding the frequency and type of complications arising from removal of percutaneous endoscopic gastrostomy (PEG) tubes in children. The records of 397 patients who had PEG tubes placed from 1993 through 1998 were reviewed for complications after removal. Data collected included length of time the tube was in place, age of the patient at insertion, type of tube removed, and patient diagnosis. Fifty-four children had the PEG tube removed by traction or endoscopy. The only complication was persistent leaking through a gastrocutaneous fistula in 13 patients (24%). Leaking ceased in 6 children coincident with H2-antagonist therapy and silver nitrate cautery, and surgical closure of the fistula was required in 7 patients. Comparison of these 7 children with those who did not require surgery (n = 47) showed a longer duration of tube placement (mean +/- SE of 20.6+/-3.6 months, range 11-31 months vs. 11.1+/-1.3 months, range 1-35 months; P<0.05). Further analysis showed no child with a PEG tube removed before 11 months (n = 23) after insertion required surgery, whereas 7 (23%) of 31 children with a PEG tube removed after 11 or more months required surgery. Age at insertion, type of feeding device removed, and patient diagnoses were not different between the two groups. These data indicate that persistent leaking necessitating surgical closure of a gastrocutaneous fistula does not occur in children with a PEG tube removed within 11 months of insertion. In contrast, 23% of children with a PEG tube removed 11 or more months after insertion require surgery. In patients identified as candidates for tube removal, this time frame may be important in clinical decision making.

Gastrocutaneous fistula in children after removal of gastrostomy tube: Incidence and predictive factors

Background/Purpose: Removal of a gastrostomy tube may result in a persistent gastrocutaneous fistula. The authors reviewed their experience to determine the incidence of this event in children, and the factors that contribute to its occurrence. Methods: Over a 3-year period, 32 children had a gastros-tomy tube placed that was subsequently removed. Of these, 18 sites closed spontaneously and 14 had a persistent gastrocutaneous fistula (44%). The groups were similar with respect to age, sex, and diagnosis. Mean time from insertion to removal of the tube was 6.5 ± 2 months in the group with spontaneous closure, and 29.8 ± 8 months in the gastrocutaneous fistula group ( P < .05). Results: One of 17 (6%) children who had tubes removed within 8 months of insertion had a fistula, compared with 13 of 15 (87%) of those who had one removed after 9 or more months ( P < .001). Patients with tubes inserted percutaneously (PEG) were less likely to have a fistula than those using the Stamm technique (28% v 55%, not significant), although PEGs also tended to be in place for a shorter time before removal (12.6 v 21.1 months). Steroids did not increase the likelihood of a fistula (50% v 42%, not significant). Conclusions: The incidence of persistent gastrocutaneous fistula is high after gastrostomy tube removal in children. The most important factor predisposing to this problem appears to be the length of time the tube is in place before its removal. Almost all tubes removed within 8 months will close spontaneously.

Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system

Adenomyosis is an important cause of menorrhagia. Besides hysterectomy, the treatment options for adenomyosis have been limited. Presented here is the successful treatment of adenomyosis in a woman presenting with menorrhagia, dysmenorrhea, and an enlarging uterus, for whom conservative therapy initiated with mefenamic acid was unsatisfactory. The patient had insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS). A marked decrease in uterine size occurred within 12 months of insertion accompanied by resolution of the menorrhagia and dysmenorrhea. Thus, the LNG-IUS is a viable option and represents a real advance in the treatment of adenomyosis.

Prophylactic antibiotics for intrauterine device insertion: a metaanalysis of the randomized controlled trials

We evaluated the effectiveness of prophylactic antibiotic administration before IUD insertion in reducing the incidence of pelvic inflammatory disease, unscheduled visits back to the clinician, and IUD discontinuations within 3 months of insertion. We performed a metaanalysis of all known randomized controlled trials comparing an antibiotic (either oral doxycycline or azithromycin) versus a placebo or no treatment. Use of prophylaxis significantly reduced the frequency of unscheduled return visits (odds ratio 0.82; 95% CI 0.70, 0.98). The protection against pelvic inflammatory disease was smaller and not statistically significant 0.89 (95% CI 0.53, 1.51). No significant effect on premature IUD discontinuation was evident. Use of either doxycycline or azithromycin before IUD insertion offered little observable benefit in the US. Prophylaxis reduced unscheduled visits and possibly PID in developing countries, which have higher rates of sexually transmitted diseases than in the US. A more important finding in these trials is the low incidence of pelvic inflammatory disease with or without prophylactic antibiotics.

Antibiotic prophylaxis for intrauterine contraceptive device insertion.

Concern about the risk of upper genital tract infection (pelvic inflammatory disease) often limits use of the IUD, a highly effective contraceptive. Prophylactic antibiotic administration around the time of induced abortion significantly reduces the risk of postoperative endometritis.(Sawaya, 1996) Since the risk of IUD-related infection is limited to the first few weeks to months after insertion,(Lee, 1983; Farley, 1992) contamination of the endometrial cavity at the time of insertion(Mishell, 1966) appears to be the mechanism, rather than the IUD or string itself. Thus, antibiotic administration before IUD insertion might reduce the risk of upper genital tract infection from passive introduction of bacteria at insertion. To assess the effectiveness of prophylactic antibiotic administration before IUD insertion in reducing IUD-related complications and discontinuations within three months of insertion. The primary outcome was pelvic inflammatory disease (four reports) or early removals of the device (two reports). We searched both MEDLINE and EMBASE, handsearches of journals through CENTRAL, and lists of references. We also wrote to international experts in the field to identify unpublished studies. We included randomized controlled trials using any antibiotic compared with a placebo. We found four such trials; two had pilot study data available. We used searches of MEDLINE, EMBASE, and handsearches of journals available through CENTRAL. We also reviewed lists of references in original research and in review articles. We wrote to experts to identify unpublished trials and made telephone calls to authors to supply missing information. Two independent reviewers abstracted data. We assessed the validity of each study using methods suggested in the Cochrane Handbook. We generated 2x2 tables for the principal outcome measures. We used the Peto modified Mantel-Haenszel technique to calculate odds ratios and assessed statistical heterogeneity between studies. The odds ratios for pelvic inflammatory disease associated with use of prophylactic doxycycline or azithromycin compared with placebo or no treatment was 0.89 (95%CI 0.53-1.51). Use of prophylaxis was associated with a small reduction in unscheduled vists to the provider (OR 0.82; 95% CI 0.70-0.98). Use of doxycycline or azithromycin had little effect on the likelihood of removal of the IUD within 90 days of insertion (OR 1.05; 95% CI 0.68-1.63). Significant heterogeneity did not exist between studies. Use of either doxycycline 200 mg or azithromycin 500 mg by mouth before IUD insertion confers little benefit. While the reduction in unscheduled visits to the provider was marginally significant, the cost-effectiveness of routine prophylaxis remains questionable. A uniform finding in these trials was the low risk of IUD-associated infection, with or without use of antibiotic prophylaxis.

Correlates and consequences of early removal of levonorgestrel implants among teenaged mothers.

To determine if adolescent mothers who request early removal of levonorgestrel implants differ from those who do not in ways that might predispose them to repeated conceptions and in their concerns about adverse effects. We hypothesized that adolescent mothers who request removal of levonorgestrel implants within 2 years of insertion have more risk factors for repeated pregnancy than those who do not. We studied the prevalence of 21 characteristics associated with repeated adolescent pregnancy and 16 adverse effects of levonorgestrel implants in 181 postpartum, adolescent levonorgestrel implant recipients, 66 (36%) of whom had the levonorgestrel implants removed within 20 months of insertion (hereafter, removers). Removers (n = 66) had significantly more risk factors for repeated pregnancy and reported significantly more adverse effects than did those who continued to use levonorgestrel implants (hereafter, users) (n = 115). Concerns about adverse effects rose in tandem with risk factors for repeated pregnancy (r = 0.26; P = .001) and were the most important determinant of levonorgestrel implant removal (relative risk, 9.72; 95% confidence interval, 4.62-19.49). However, the number of risk factors for repeated pregnancy was also a significant, independent predictor of levonorgestrel implant removal (relative risk, 2.34; 95% confidence interval, 1.10-4.66). Following removal, contraceptive use was poor and conception occurred rapidly; 24 (37%) of the removers conceived again within 2 years of the index delivery. The study hypothesis was supported. Our findings that concerns about the adverse effects of levonorgestrel implants rise in tandem with risk factors for repeated pregnancy suggest that the efficacy of counseling before and after levonorgestrel implant insertion could be improved by addressing those aspects of the user's life that undermine the motivation to use contraception.

Percutaneous Epiphysiodesis Using Transphyseal Screws (PETS)

We describe a new technique of percutaneous epiphysiodesis using transphyseal screws (PETS) and our experience with it in 32 cases of limb-length inequality and nine angular knee deformities. A subgroup of 18 patients with postfracture limb overgrowth formed a clinical model for study of the real efficacy of PETS. It proved a reliable method with few complications and many advantages such as simplicity of technique, short operating time, rapid postoperative rehabilitation, and reversibility. Bone-length inequality decreased from a preepiphysiodesis average of 2.47 cm (range, 1.5-4.6) to 0.51 cm at skeletal maturity. The tibiofemoral angle reduced from a preoperative average of 7.66 degrees to 0.86 degrees at maturity. The screws began to exert significant growth inhibition within 6 months of insertion, slowing down the distal femoral and upper tibial physes by 68 and 56%, respectively. They achieved maximum growth retardation over the ensuing 12 months, slowing down the distal femoral physis by 89% and the proximal tibial physis by 95%. At skeletal maturity, total femoral growth was 45% and total tibial growth was 52% that of the normal side. Key

Perforations with intrauterine devices: Report from a Swedish survey

This survey comprised 50 consecutive perforations occurring with intrauterine devices (IUD) reported to the National Patient Insurance Scheme Register during 1990 to 1993. All 50 women were parous and >20 years of age at the time of IUD insertion. Forty-two (84%) of the IUD were inserted by a midwife and eight by a gynecologist. A total of 45 women (90%) had their IUD inserted <1 year after a full-term pregnancy and 31 women (62%) had their IUD inserted ≤12 weeks after delivery. Of the 50 women, 27 (54%) reported that they were breastfeeding at the time of IUD insertion. No particular IUD was overrepresented in relation to its share on the market. In 31 cases (62%), severe pain at insertion and during the first 24 h was recorded. In 14 women (28%), the perforation was diagnosed early (ie, within 1 month of insertion) and in 36 women (72%), the perforation was diagnosed >1 month after insertion. Lower abdominal pain was the most frequent symptom at early diagnosis but in two cases, the main symptom was heavy bleeding. Among the 36 women in whom the perforation was discovered more than 1 month after insertion, the diagnosis was made when an unexpected pregnancy occurred in 20 women (56%). In 15 cases, the IUD strings were not visible during pelvic examination at a routine check-up, which led to efforts to locate the IUD. Thirty-two women (64%) underwent laparotomy for removal. We conclude that lactating women seem to be a risk group for perforation and that a national register of IUD perforations could provide a better means of quality control.

"Determinants of Early Implant Discontinuation among Low-income Women."

The determinants of contraceptive implant discontinuation within six months of insertion were examined among 786 low-income women attending family planning clinics in three U.S. cities. The six-month cumulative life-table discontinuation rate was 7.6%. Menstrual side effects were the most common reasons given for early implant removal, although women who discontinued use were no more likely than those who continued with the method to report menstrual irregularities. Women who opted for early removal were more likely than those who continued with the method to experience headaches, hair loss, weight gain and arm infection. Logistic regression analysis indicates that dissatisfaction with prior contraceptive methods, a partner who wants a child within the next two years, perceived pressure from health care providers to choose the implant, exposure to negative media coverage and the number of implant side effects significantly predict early implant discontinuation. Women's social and demographic characteristics, Medicaid status and motivation to avoid an unplanned pregnancy were not significantly related to early removal.

Determinants of Early Implant Discontinuation Among Low-Income Women

The determinants of contraceptive implant discontinuation within six months of insertion were examined among 786 low-income women attending family planning clinics in three U.S. cities. The six-month cumulative life-table discontinuation rate was 7.6%. Menstrual side effects were the most common reasons given for early implant removal, although women who discontinued use were no more likely than those who continued with the method to report menstrual irregularities. Women who opted for early removal were more likely than those who continued with the method to experience headaches, hair loss, weight gain and arm infection. Logistic regression analysis indicates that dissatisfaction with prior contraceptive methods, a partner who wants a child within the next two years, perceived pressure from health care providers to choose the implant, exposure to negative media coverage and the number of implant side effects significantly predict early implant discontinuation. Women's social and demographic characteristics, Medicaid status and motivation to avoid an unplanned pregnancy were not significantly related to early removal.

Quinacrine Sterilization Method Found Effective Among Women in Vietnam

The authors of the study posit that quinacrine sterilization has many advantages over surgical sterilization. The study researchers find that quinacrine appears to be safe effective and easy to deliver and is useful to women desiring an end to pregnancy in developing countries. In Vietnam quinacrine use is estimated to have reduced maternal mortality at the rate of 242 deaths prevented as a result of 31781 sterilizations at the low cost of about $1 for two quinacrine insertions. Quinacrine was inserted in 31781 Vietnamese women who were evaluated during 1989-92. 3% of the sample (818 women) subsequently became pregnant. Pregnancy outcomes included 684 induced abortions 19 ectopic pregnancies 6 spontaneous abortions and 79 live births. There was 1 stillbirth and 29 were still pregnant at the end of the study period. There were no deaths or uterine perforations. 8 had a variety of serious complications that were potentially related to the process. All conceptions that occurred within one month of insertion were aborted by menstrual regulation. One infant who was conceived 2.5 months after quinacrine insertion was anencephalic which may have been due to maternal exposure to agricultural chemicals. All other infants were normal. 508 women were studied for menstrual changes and side effects. Side effects after the first insertion includes vaginal itching headache and lower abdominal pain. After the second insertion 77% had no change in menstrual flow 19% had decreased flows and 4% had increased flows. 50 patients were followed up after a year. Those who received only one dose had twice the failure rate of those who received two doses. Pregnancy rates a year after insertion were 2.6% among 9461 women with two insertions compared to 5.2% among women with one insertion. Among 4010 women in one province each of 88 workers had at least one failure (165 pregnancies). Clinicians who performed over 100 insertions had the lowest failure rates of 5% compared to 17% among those who performed 10 or fewer insertions. It was concluded that research was needed on the effectiveness of insertion as it related to placement in the uterus.

Longitudinal study on torque around the sagittal axis in lower distal‐extension removable partial dentures

The purpose of this study was to examine the longitudinal changes of torque around the sagittal axis in lower distal-extension removable partial dentures. The torque transmitted from the denture base to retainers was measured on several separate occasions from the insertion of new dentures to about 2 months after it. The maximal mean value of torque (Max.MT) was calculated from the magnitude of all chewing strokes of the minimum of the interocclusal distance. The integration values of torque (I) and time (T) from initiation of chewing to swallowing were obtained and then the average value of torque (Ave.T) was calculated (Ave.T = I/T). Subjects could be divided into two groups. Max.MT and Ave.T were almost constant in one group while they were remarkably decreased in another. After 1 month of insertion of new dentures the value of both groups was within the range of less than 3 x 10(-3) kgm (1 kgm = 9.8 Nm) of Max.MT and less than 1 x 10(-3) kgm ss-1 of Ave.T.

Qualitative interfacial study between bone and tantalum, niobium or commercially pure titanium

Tantalum (Ta), niobium (Nb) and commercially pure titanium (c.p. Ti) were sputtered on to the surfaces of polycarbonate plastic implants. After 3 month of insertion, in the tibial metaphysis of rabbits, the implants were removed with a surrounding bone collar and processed for light (LM) and electron microscopy (EM). By EM a zone of ground substance tens of nanometers wide without collagen filaments was noticed surrounding the Ta implants. Multinucleated macrophages could occasionally be recognized in the interface zone. Foreign body reactions were more striking at the Nb interface while no multinucleated macrophages were observed in the c.p. Ti interface. The ground substance layer had a thickness in the range of 40–60 nm for the Nb implants, whereas in c.p. Ti sections the collagen filaments were noticed 20–40 nm from the metal surface. There are more subtle differences between tantalum and c.p. titanium than between c.p. titanium and niobium which seems to be less well tolerated when implanted in bone.