Negative Pregnancy Test Research Articles

Low-dose aspirin does not improve ovarian responsiveness or pregnancy rate in IVF and ICSI patients: a randomized, placebo-controlled double-blind study

Poor ovarian and endometrial responses to gonadotrophin stimulation in assisted reproduction techniques lead to decreased pregnancy rates. The aim of the present study was to test the hypothesis that low-dose aspirin started prior to controlled ovarian stimulation improves ovarian responsiveness, pregnancy rate (PR) and pregnancy outcome. A total of 374 women who were to undergo IVF/ICSI were randomized to receive 100 mg of aspirin (n=186) or placebo (n=188) daily. Treatment was started on the first day of controlled ovarian stimulation. It was continued until menstruation or a negative pregnancy test. Pregnant women continued the medication until delivery. The main outcome measures were the number of oocytes, number and quality of embryos, the clinical PR and pregnancy outcome. The mean (+/-SD) number of oocytes (12.0+/-7.0 versus 12.7+/-7.2), the total mean number of embryos (5.82+/-4.35 versus 5.99+/-4.66), the mean number of top quality embryos (0.99+/-1.39 versus 1.18+/-1.51) and the number of embryos transferred (1.64+/-0.64 versus 1.63+/-0.71) did not differ in the aspirin and placebo groups. Between the aspirin and placebo group, there was no statistically significant difference in clinical PR per embryo transfer (25.3%, n=44 out of 174 versus 27.4%, n=48 out of 175) or clinical PR per cycle initiated (23.7% versus 25.5%). Birth rate per embryo transfer did not differ significantly between the aspirin (18.4%) and placebo (21.1%) groups. The incidence of poor responders [12 (6.5%) versus 13 (6.9%)] was similar in both groups. The present results indicate that low-dose aspirin treatment does not have any beneficial effect on ovarian responsiveness, PR and pregnancy outcome in unselected women undergoing IVF/ICSI.

Trichuris suis therapy for active ulcerative colitis: A randomized controlled trial

Ulcerative colitis is most common in Western industrialized countries. Inflammatory bowel disease is uncommon in developing countries where helminths are frequent. People with helminths have an altered immunological response to antigens. In animal models, helminths prevent or improve colitis by the induction of regulatory T cells and modulatory cytokines. This study determined the efficacy and safety of the helminth Trichuris suis in therapy of ulcerative colitis. This was a randomized, double blind, placebo-controlled trial conducted at the University of Iowa and select private practices. Trichuris suis ova were obtained from the US Department of Agriculture. The trial included 54 patients with active colitis, defined by an Ulcerative Colitis Disease Activity Index of > or =4. Patients were recruited from physician participants and were randomly assigned to receive placebo or ova treatment. Patients received 2500 Trichuris suis ova or placebo orally at 2-week intervals for 12 weeks. The primary efficacy variable was improvement of the Disease Activity Index to > or =4. After 12 weeks of therapy, improvement according to the intent-to-treat principle occurred in 13 of 30 patients (43.3%) with ova treatment compared with 4 of 24 patients (16.7%) given placebo (P = .04). Improvement was also found with the Simple Index that was significant by week 6. The difference in the proportion of patients who achieved an Ulcerative Colitis Disease Activity Index of 0-1 was not significant. Treatment induced no side effects. Ova therapy seems safe and effective in patients with active colitis.

Pregnancy diagnosis based on the fecal progesterone concentration in beef and dairy heifers and beef cows

The present study was undertaken to examine whether pregnancy diagnosis was possible by measuring fecal progesterone concentrations in beef and dairy heifers and beef cows. Rectal fecal samples collected on days 18–24 after insemination or days 11–17 after embryo transfer were mixed with methanol and shaken for preparation of a fecal solution. After centrifugation, the supernatant was extracted with petroleum ether followed by an enzyme immunoassay for progesterone. All pregnant animals showed fecal progesterone concentrations greater than 50 ng/g of fecal material on days 18–24 after AI or estrus. In non-pregnant animals, however, the fecal progesterone concentrations ranged widely from 5 to 180 ng/g of fecal material. In non-pregnant cattle, the percentage of cattle with <50 ng progesterone/g of fecal material compared with the total number was 37–60% on days 18–20, whereas the percentages increased more than 70% to a maximum of 78.1% on day 23. When 50 ng/g was considered as the cut-off value, the sensitivity and specificity of positive pregnancy tests were less than 70% on days 21–24, and 100% for negative pregnancy tests on days 18–24. There were significant differences in the mean fecal progesterone concentrations between pregnant and non-pregnant cattle on days 19–24. These results suggest that feces can be utilized to substitute for plasma and milk to measure progesterone for the purpose of pregnancy diagnosis in heifers and cows.

Chemotherapy-Induced Ovarian Failure

Thanks to improvements in treatment regimens, more and more patients are now surviving cancer. However, cancer survivors are faced with the serious long-term effects of the different modalities of cancer treatments. One of these adverse effects is chemotherapy-induced irreversible damage to the ovarian tissues, which leads to premature ovarian failure and its resulting consequences such as hot flashes, osteoporosis, sexual dysfunction and the risk of infertility. Chemotherapy-induced ovarian failure (or chemotherapy-induced premature menopause) affects the quality of life of female cancer survivors. Although there is no clear definition of chemotherapy-induced ovarian failure, irreversible amenorrhoea lasting for several months (>12 months) following chemotherapy and a follicle stimulating hormone level of > or = 30 MIU/mL in the presence of a negative pregnancy test seems to be an appropriate characterisation. Different chemotherapy agents, alkylating cytotoxics in particular, have the potential to cause progressive and irreversible damage to the ovaries. The result of this damage is a state of premature ovarian failure, with progressive declining of estrogen levels, decreasing bone mass and an increased risk of fractures. Historically, hormonal replacement therapy (HRT) has been used to treat menopausal problems in the general population, but concerns about the potential of estrogen to increase the risk of breast cancer in women at high-risk or increase the risk of recurrence in cancer survivors, have forced physicians to utilise alternative treatments. This review discusses some of the newer therapies that are now available to provide appropriate symptom control, avoid complications such as fractures and possibly prevent infertility by making the ovarian epithelium less susceptible to cytotoxic agents.

Phase II study of thalidomide and daily cyclophosphamide for adults with malignant glioma

1554 Background: We performed a phase II study to determine the activity and toxicity of thalidomide plus daily cyclophosphamide in patients with recurrent anaplastic astrocytomas (AA) and anaplastic oligodendrogliomas (AO). Methods: Eligibility: adult patients with AA or AO in first relapse with measurable disease; interval of at least 3 weeks between surgical resection or 6 weeks between radiotherapy or chemotherapy; Karnofsky ≥ 60%; negative pregnancy test; and adequate marrow, renal, and hepatic function. Thalidomide was begun at 100 mg at bedtime and increased by 100 mg weekly to a maximum dose of 400 mg. Cyclophosphamide was administered at 100 mg daily. Responses were assessed every eight weeks and patients remained on study for up to one year or until disease progression or unacceptable toxicity. Results: To date, 11 patients with recurrent AA (n = 10) or AO (n=1) have been enrolled (planned accrual=30). Median age is 38 years (range: 27 to 51). All patients received prior radiation therapy and chemotherapy (median: 2, range: 1 to 3). Grade 3 or greater toxicities included neutropenia (grade 3, n=3; grade 4, n=2), and hyponatremia (grade 3, n=1). Responses include one complete and one partial, both of these patients completed one year of treatment and remain off therapy with no evidence of disease progression. One patient achieved stable disease and is in the 21st week of therapy. Five patients progressed after cycle one. Two patients are too early for evaluation and one patient died of intratumoral hemorrhage after six days on protocol. Conclusions: Thalidomide plus daily cyclophosphamide demonstrates encouraging activity and is well tolerated among patients with recurrent AA or AO. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Celgene

Clinicians' views on reproductive needs and services for teens with negative pregnancy tests.

To explore services available to adolescent girls at the time of the negative pregnancy test (NPT) in an urban community. Clinician focus groups were conducted to identify the needs of adolescents at the time of a NPT result. Teens access care in a variety of ways, services provided at the time of a NPT were agency and clinician dependent, and strategies for follow-up care often were unstructured. Few services were available for parents or partners. Barriers included difficulty communicating with agencies, lack of staff trained to work with adolescents, and time/financial constraints. Adolescents need comprehensive, teen-friendly reproductive care at the time of a NPT result.

Topical Self-Treatment with 0.15% Podophyllotoxin (Wartec® Cream) for Female Genital Warts

Objective: Conventional treatments of genital warts with podophyllin lotion or electrosurgery in females are inconvenient, less cost-effective, and time-consuming, both for physicians and patients. There is definitely a need for a refined, simple, safe, fast, and effective first-line treatment modality. The purpose of this clinical study was to evaluate the suitability, tolerability, and effectiveness of 0.15%podophyllotoxin (Wartec® Cream) on female external genital warts in Taiwan. Material(s) and Method(s): Twenty female patients were enrolled in this 8-week clinical study. They were asked to provide their age, marital status, and previous disease history. The inclusion criteria consisted of those who had a clinical diagnosis of exophytic vulvar condylomata acuminata with dimension, in the range between 4 and 600 mm2, had a negative urine pregnancy test, were aged 18 years or older, and were willing to comply with the treatment schedule. Treatment cycles consisted of weekly intervals whereby the medication was self-applied twice daily for the first 3 days, followed by a 4-day rest period with no application. All patients were examined weekly for treatment efficacy and aftereffects. For the purpose of this study, a complete response was considered when all original warts were eradicated; a partial response was recorded as a reduction in the number and/or size of the original warts. Result(s): In total, 20 patients were recruited for this study; 2 defaulted and 18 completed the study. The age range was 24-62 (median, 35.5) years. Fifteen patients (75%) were first infected, and 5 (25%) were recurrent cases in which electrocauterization had previously been performed. The complete response rate after the 4- and 8-week treatments was 61.1% (11/1 8) and 88.9% (16/18), respectively, and 44.4% (8/18) showed mild local adverse reactions. The overall response rate, including both the complete and partial responses, of the 8-week treatment was 100% (18/1 8). In this study, no recurrence was observed during the 6-month follow-up. Conclusion(s): This study shows that 0.15% podophyllotoxin (Wartec® Cream) is a safe, effective, and convenient first-line home treatment for genital condyloma eradication.

A four-year study of clomiphene citrate challenge test results

Objective: The aim of this study was to review our clomiphene citrate challenge test (CCCT) results to determine whether borderline or abnormal test results are an adequate basis for denying admittance into an In Vitro Fertilization (IVF) program. Design: A retrospective study of 84 patients, excluding donor egg and donor embryo recipients, having had a CCCT and having undergone one or more IVF cycles between 1997 and 2001. Materials and Methods: CCCT was performed according to the following clinic guidelines: 1) Serum Estradiol and follicle stimulating hormone (FSH) levels were obtained on the third day of menses. 2) On cycle day five Clomiphene Citrate (100mg) was administered daily for a total of five days. 3) On cycle day 10 another serum FSH level was obtained. Serum Estradiol and FSH levels were determined by Enzyme-linked fluorescent immunoassay (ELFA). An abnormal CCCT was defined as a FSH level above 10.0 mIu/ml on day three or day 10 and/or an Estradiol level greater than 60 pg/ml on day three. The test results were reviewed for each patient and compared to the number of eggs retrieved and the outcome of each cycle. Results: Eighty-four patients undergoing 114 IVF cycles were divided into two groups, normal CCCT and abnormal CCCT, and compared to establish a correlation between the test result and achieving a pregnancy with IVF. No significant difference was noted between the abnormal and normal CCCT groups for patients’ age (35, range 27–44 vs. 34, range 27–44), or average number of oocytes retrieved (10.6 vs 10.8). Five of the cycles were cancelled due to poor stimulation. Two of the five had a normal CCCT and three had an abnormal test. Sixty-four retrievals were performed in the abnormal group with 32 (50%) achieving a positive serum pregnancy test, 27 (42%) having at least one gestational sac, and 20 (31%) having a live birth. Patients with an abnormal result achieving pregnancy included FSH levels on day three and day 10 ranging from 1.0–25.8 mIu/ml and Estradiol levels on day three ranging from 10–282 pg/ml. It is interesting to note that ten of the 12 patients (83%), who had a positive serum pregnancy test but did not deliver, failed the Estradiol portion of the CCCT. Fifteen of the 32 (47%) who had negative serum pregnancy tests also failed the Estradiol portion of the test. The normal CCCT group consisted of 44 retrievals with 19 (43%) achieving a positive serum pregnancy test, 16 (36%) having at least one gestational sac, and 13 (29%) having a live birth. Chi square and T-test analysis does not show this data to be significantly different. Conclusion: The clomiphene citrate challenge test, when used with other deciding factors such as microfollicle count, previous stimulation response, etc., can be a useful tool in patient education in IVF cycles. Used alone the CCCT is not a desirable selection criteria for denying admittance into an IVF program. Despite indications of diminished ovarian reserve, fifty percent of the abnormal CCCT patient group achieved positive serum pregnancy levels. There does appear to be a correlation between patients who fail the Estradiol portion of the test and increased rate of miscarriage.

Women in Early Phase Trials: An IRB's Deliberations

he University of Nebraska Medical Center institutional review board (UNMC IRB) recently gave considerable attention to issues concerning respect for persons, justice, and beneficence. Our deliberations were occasioned by review of a protocol of a new biological agent for treatment of Type II diabetes, specifically the protocol's inclusion criteria regarding women of childbearing potential. The study was a randomized Phase I/II study of the safety and efficacy of three doses of a specific agent, compared to placebo, given in combination with other agents over a three-month period in patients with a particular condition. Among the inclusion criteria was a requirement that while on study women of childbearing potential (i.e., premenopausal females capable of becoming pregnant) use either oral contraceptives or an IUD as the only acceptable method of contraception. Prior to the start of study medication, women of childbearing potential must have had a negative urine pregnancy test. Animal teratogenicity studies of the agent had not been completed at the time of the IRB review.

Panic Attacks During Escalation of Mirtazapine.

Sir: Mirtazapine is a unique antidepressant that involves both serotonergic and noradrenergic enhancement through blockade of the α2-autoreceptor and α2-heteroreceptor.1 It is also a 5-HT2 blocker, which makes it a potential anxiolytic agent.2 Overall, mirtazapine appears to be a useful agent in patients with depression coexisting with anxiety symptoms.3 The following case describes a patient diagnosed with dysthymia who experienced panic attacks upon increasing her dose of mirtazapine, an effect not previously described. Case report. Ms. A was a 23-year-old married woman diagnosed with dysthymia (DSM-IV). Prior to her presentation she had taken no psychotropic agents. She described an unremarkable medical history and was taking no prescribed medications; did not abuse alcohol; denied the use of any illicit substances, tobacco products, or herbal medications; and drank 1 to 2 cups of coffee per day. Ms. A denied any significant psychosocial stressors or significant family psychiatric history. A review of recent laboratory results included a negative pregnancy test and a complete blood count, serum chemistries, and thyroid-stimulating hormone all within normal limits. Ms. A agreed to a trial of mirtazapine initiated at 15 mg/day for 2 weeks and tolerated the dosage without event. At her follow-up appointment, the mirtazapine dose was increased to 30 mg/day to target her residual depressive symptoms. Within 2 days of the dose increase, Ms. A experienced a panic attack consisting of palpitations, shortness of breath, sweating, nausea, hot flushes, and thoughts of losing her mind. Her husband took her to an emergency room where she was evaluated, prescribed alprazolam 0.5 mg to be taken on an as needed basis, and released. Ms. A had several panic attacks over the next week, and these too were alleviated by taking alprazolam. It was decided to decrease the mirtazapine back to 15 mg/day to see if the increased dose might be responsible for the panic attacks; the panic attacks subsequently stopped. After 1 week, the mirtazapine was increased to 30 mg/day to treat the residual depressive symptoms. Unfortunately, the patient experienced panic attacks 1 day within the dose escalation. A decision was made to change agents, and venlafaxine extended release (XR) was initiated at 37.5 mg/day after a 4-day washout period. The venlafaxine XR was increased to 75 mg/day at 2 weeks and titrated to 150 mg/day after 1 month with no panic attacks. Mirtazapine has been looked at in the treatment of panic disorder in a double-blind study of 27 patients treated with either mirtazapine or fluoxetine.4 Mirtazapine has shown favorable results in 4 open-label studies and a case series.5–9 However, there is a case report of a panic attack that occurred during the discontinuation of mirtazapine.10 The panic attacks were unexpected but could have occurred due to increasing serotonergic transmission that produced a short-lived anxiety similar to that sometimes seen when using serotonin reuptake inhibitors.10 The presented case underscores the need for clinicians to be vigilant for side effects when prescribing antidepressant agents.

Chemical pregnancies: immunologic and ultrasonographic studies.

Implantation of the embryo determines successful from unsuccessful cycles after in vitro fertilization (IVF) and embryo transfer (ET). The purpose of this study was to compare immunologic risk factors among women experiencing implanation failure characterized by a negative pregnancy test after IVF/ET and those experiencing chemical pregnancies. In addition ultrasonographic measurement of gestational sac size from 24 to 35 days from last menstrual period (LMP) were compared between chemical pregnancies and other pregnancy outcomes. Blood samples from 122 women experiencing IVF implantation failure with a negative pregnancy test after ET and 20 women with chemical pregnancies were evaluated for the presence of antiphospholipid antibodies (APA), antinuclear antibodies (ANA), circulating embryotoxins (ETA) and elevated levels of natural killer (NK) cells. Gestational sac size measured from 24 to 35 days form LMP were compared according to pregnancy outcome: term birth (n = 46), ectopic pregnancy (n = 49), spontaneous abortion (n = 56) and chemical pregnancy (n = 20). Women experiencing chemical pregnancies had a higher frequency of APA than women with implantation failure associated with a negative pregnancy test (80% versus 28%, P < 0.0001). The prevalence of ANA, elevated NK cells and ETA was not different between the two groups. The mean gestational sac size from 24 to 35 days from LMP did not differ when chemical pregnancies were compared with pregnancies progressing longer than 35 days. The maximal gestational sac diameter among chemical pregnancies was 3.8 mm. Mechanisms involved in implantation failure associated with a negative pregnancy test may be different from those involved in chemical pregnancies. Chemical pregnancies may be the result of defective angiogenesis.

Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result

Ectopic pregnancy has been increasing in frequency over the past 2 decades. The sudden rupture of a fallopian tube caused by ectopic pregnancy can lead to hemorrhagic shock and death if not diagnosed and treated in a timely fashion. The emergency physician is often the health professional that is called on to make the diagnosis and coordinate timely and effective intervention. The first step in the diagnosis of ectopic pregnancy is demonstration of pregnancy by means of a rapidly performed and sensitive qualitative urine test for the β-subunit of human chorionic gonadotropin (β-hCG). A negative urine pregnancy test result will generally be used to exclude ectopic pregnancy from further consideration. The following is a report of a patient presenting to an emergency department with hypovolemic shock in conjunction with 2 negative urine β-hCG analysis results and a quantitative serum β-hCG level of 7 mIU/mL, a value less than the lower limit of detection for the highly sensitive qualitative urine and serum tests. This case report demonstrates the importance of further consideration of the diagnosis of ectopic pregnancy in the setting of a negative urine pregnancy test result. [Kalinski MA, Guss DA. Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result. Ann Emerg Med. July 2002;40:102-105.]

Pregnant African-American Teens Are Less Likely Than Their Nonpregnant Peers to Use Condoms

Objective. The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition.Methods. Sexually active African-American females (N = 522), ages 14–18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded.Results. Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%).Conclusions. Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.

Early pregnancy loss in in vitro fertilization (IVF) is a positive predictor of subsequent IVF success

Objective: To determine the significance of biochemical pregnancy losses and clinical spontaneous abortion (SAB) on outcomes of future IVF cycles. Design: Retrospective cohort study. Setting: Academic IVF program. Patient(s): Women with a history of unsuccessful IVF attempts undergoing IVF. Intervention(s): None. Main Outcome Measure(s): Clinical pregnancy rate. Result(s): Patients with an early pregnancy loss had a greater ongoing clinical pregnancy rate in the immediate next cycle when compared with those women who had a negative pregnancy test (37.3% vs. 27.3%). Patients with a history of a biochemical pregnancy or a clinical spontaneous abortion had an ongoing clinical pregnancy rate in the next cycle of 38.4% and 42.3%, respectively, compared with 27.3% in women who had a history of a negative pregnancy test. The cumulative pregnancy rate after the first IVF attempt was 54.1% in patients with a previous biochemical pregnancy loss, 61.4% in those with a previous clinical SAB, and 46.5% in women with a previous negative pregnancy test. Conclusion(s): Women who experience an early pregnancy loss after IVF have a greater likelihood of success in subsequent IVF cycles when compared with patients who fail to conceive.

Delaying the initiation of progesterone supplementation results in decreased pregnancy rates following in vitro fertilization: a randomized, prospective study.

Objective: To compare in vitro fertilization outcome between two protocols for luteal phase progesterone supplementation: one beginning on day 3 following retrieval and the other beginning on day 6 following retrieval. Design: Prospective, randomized study. Materials/Methods: 126 consecutive patients undergoing IVF at our institution between January and July 2000 were randomized to receive one of two luteal phase progesterone supplementation protocols. All patients underwent ovarian hyperstimulation using a luteal GnRH-agonist protocol, a ‘stop’ GnRH-agonist protocol, or a GnRH agonist microdose flare protocol, depending on individual patient characteristics. Patients began using 200 mg micronized progesterone vaginally TID beginning the morning of either day 3 following oocyte retrieval or beginning on day 6 following oocyte retrieval. All patients continued progesterone supplementation daily until a negative serum pregnancy test, or, if the patient became pregnant, until 10 weeks of gestation. Clinical pregnancy and implantation rates were compared. Results: All patients undergoing randomization received an embryo transfer. There were no differences in patient age, BMI, oocytes retrieved, or number of embryos transferred between the two groups. Those patients beginning progesterone support on day 6 following retrieval had a significantly lower pregnancy rate compared to those beginning on day 3 following retrieval (44.8% vs. 61.0%, p < 0.05). This difference in pregnancy rates was greater in those patients undergoing a luteal GnRH-agonist downregulation protocol (47.5% vs. 71.4%, day 6 vs. day 3, P = 0.03). Beginning progesterone on day 6 also significantly decreased implantation rates in the GnRH-agonist group (21.0% vs. 34.0%, day 6 vs. day 3, P = 0.02). Conclusions: Pregnancy rates are significantly decreased by initiating luteal phase supplementation later than day 3 following retrieval during IVF cycles. Despite elevated progesterone levels at the time of embryo transfer, progesterone supplementation should continue to be initiated at this time. Efforts to simplify medication regimens or to decrease treatment costs by decreasing the duration of progesterone supplementation should not be undertaken.

Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer.

We sought to evaluate the effects of chemotherapy-induced ovarian failure on bone loss and markers of skeletal turnover in a prospective longitudinal study of young women with breast cancer receiving adjuvant chemotherapy. Forty-nine premenopausal women with stage I/II breast cancers receiving adjuvant chemotherapy were evaluated within 4 weeks of starting chemotherapy (baseline), and 6 and 12 months after starting chemotherapy with dual-energy absorptiometry and markers of skeletal turnover osteocalcin and bone-specific alkaline phosphatase. Chemotherapy-induced ovarian failure was defined as a negative pregnancy test, greater than 3 months of amenorrhea, and a follicle-stimulating hormone > or = 30 MIU/mL at the 12-month evaluation. Among the 35 women who were defined as having ovarian failure, highly significant bone loss was observed in the lumbar spine by 6 months and increased further at 12 months. The median percentage decrease of bone mineral density in the spine from 0 to 6 months and 6 to 12 months was -4.0 (range, -10.4 to +1.0; P =.0001) and -3.7 (range, -10.1 to 9.2; P =.0001), respectively. In contrast, there were no significant decreases in bone mineral density in the 14 patients who retained ovarian function. Serum osteocalcin and bone specific alkaline phosphatase, markers of skeletal turnover, increased significantly in the women who developed ovarian failure. Chemotherapy-induced ovarian failure causes rapid and highly significant bone loss in the spine. This may have implications for long-term breast cancer survivors who may be at higher risk for osteopenia, and subsequently osteoporosis. Women with breast cancer who develop chemotherapy-induced ovarian failure should have their bone density monitored and treatments to attenuate bone loss should be evaluated.

Update on therapy--thalidomide in the treatment of lupus.

Thalidomide has been shown to be an effective treatment for cutaneous forms of lupus erythematous refractory to other therapies. Thalidomide has very serious side effects, including teratogenicity and neuropathy, which limit its clinical use in lupus to such severe refractory cases. Efficacy has been confirmed in several studies, although recurrence after discontinuation of treatment is frequent. More recent experience suggests that lower doses than originally used may be effective, which may result in a reduction in side effects. Much effort has been expended in studying the mechanisms of action of thalidomide, although as yet it is unclear which of the mechanisms identified to date contribute to its efficacy in treating cutaneous forms of lupus erythematosus. Identification of patients suitable for thalidomide therapy requires a rigorous selection process. Potential side effects should be clearly explained, particularly teratogenicity as many patients are young women. Written consent and a negative pregnancy test must be obtained prior to commencement of therapy. Reliable contraceptive measures should be strictly observed by patients taking thalidomide. Close clinical and neurophysiological supervision using nerve conduction studies should be undertaken.

Perceived knowledge and training needs in adolescent pregnancy prevention: results from a multidisciplinary survey.

To examine health care professionals' knowledge and interest in training in adolescent pregnancy prevention and whether an association exists between perceived knowledge and interest in training. A cross-sectional mailed survey. Random, stratified sample design that identified 800 psychologists, 800 social workers, 1,000 nurses, and 400 pediatricians from national professional membership lists. Response rate to the mailed survey was 51%. After removing respondents who did not currently work with adolescents, 1,242 surveys (41%) were available for analyses. Descriptive analyses were conducted on self-report data concerning perceived knowledge and interest in training about adolescent pregnancy prevention separately for each of the 4 disciplines. Within disciplines, perceived knowledge and interest in training were correlated for each of 3 content areas (ie, sex education and contraceptive counseling, adolescent pregnancy, and counseling after a negative pregnancy test) and for a summary measure of the content areas. Less than half of the nursing, pediatrics, psychology, and social work professionals reported high perceived knowledge in the 3 content areas. Psychologists and social workers reported the lowest perceived knowledge. However, with the exception of psychologists, more than two thirds of the other respondents reported moderate or high interest in training in the 3 content areas. Interest in training was not strongly correlated with perceived knowledge within any discipline. The need to integrate psychosocial components into adolescent health care is a core assumption in the field, yet these data indicate that psychologists and social workers perceive low levels of knowledge and interest in training. These disciplines may benefit from more targeted professional training about their role in preventing adolescent pregnancy.

Prevalence of home pregnancy testing among adolescents

This study estimated the prevalence of home pregnancy testing among adolescents. A survey was administered in 11 urban clinics to 600 females aged 13 to 19 years. The prevalence of home pregnancy test use was 34% among 474 sexually experienced youths; 77% of the users had received at least 1 negative pregnancy test result, and 48% took no further action for confirmation. Compared with those who had never used such tests, users were older, younger at sexual debut, less likely to consistently use effective birth control, and more likely to have ever been pregnant. Health care clinics are important sources for pregnancy prevention, but clinics may have limited opportunity to intervene with some youths who use home pregnancy tests.

Clinicians' perspectives on reproductive health care services for adolescents with negative pregnancy tests

Clinicians' perspectives on reproductive health care services for adolescents with negative pregnancy tests