Clinical Experience with the Margulies Intrauterine Contraceptive Device

There has been renewed interest in recent years in the use of intrauterine devices for contraception. The Margulies intrauterine device was inserted in 303 patients. Of 301 patients subsequently evaluated, 24 expelled the device spontaneously; in 21 others the device was removed for various reasons. No pregnancies occurred in the first 920 patient-months. There were no serious complications in the patients using the coil. From this experience we estimate that not more than 80% of patients will accept this technique. Intrauterine contraceptive devices are, however, a satisfactory addition to the various methods of birth control.     

Comparison of use of the Dalkon Shield in Dublin and Southampton.

The results of fitting Dalkon Shield I.U.D.s in Southampton and Dublin were compared. At 12 months the continuation rates were 77.4% and 93.4% respectively. There were also differences between the two cities in the major complication rates associated with the use of the device. At 12 months these rates for Southampton and Dublin were: pregnancy 5.6% and 1.4%, expulsion 4.0% and 0.9%, and removal for pain and/or bleeding 12.1% and 3.0%, respectively. Possible reasons for the difference in performance may include the older average age of the users in Dublin, and the greater number and more varied experience of the medical staff responsible for fitting in Southampton. We recommend that population factors be taken into account when comparing data relating to fertility regulation.     

宫内节育器与宫腔支撑球囊联合应用治疗中重度宫腔粘连中的临床效果

摘要 目的：探讨宫内节育器与宫腔支撑球囊联合应用治疗中重度宫腔粘连的临床效果。方法：选择2016年12月至2019年8月于西安交通大学第一附属医院宫腔镜诊疗中心接受宫腔镜下中重度宫腔粘连分解术的患者共96例,采用随机对照表法将其分为两组。对照组48例,术后宫腔内放置宫内节育器(intrauterine contraceptive device,IUD);研究组48例,术后放置宫腔支撑球囊(intrauterine support balloon,ISB),3~5 d后更换为宫内节育器。两组术后均给予为期3月的人工周期治疗。术后1月,复查宫腔镜了解宫腔有无再粘连并取出宫内节育器,以此评估手术效果是否有效,术后3月时随访其月经来潮情况。统计比较两组术后5 d内阴道出血量、C反应蛋白水平、发热、下腹痛以及节育器或支持球囊有无脱落等情况,术后1月手术效果及术后3月月经恢复情况。结果：研究组的手术有效率及月经改善比例均显著高于对照组(P<0.05),术后5 d内阴道出血量显著少于对照组(P<0.05);下腹痛及球囊脱落事件发生率显著低于对照组(P<0.05)。两组在C反应蛋白水平、发热发生率对比无统计学差异(P>0.05)。结论：与单独使用宫内节育器相比,联合使用宫腔支撑球囊能提高中重度宫腔粘连分解手术有效率,改善月经,减少术后出血,不增加感染风险,但球囊易于脱落且会增加患者下腹疼痛。     

Five Years' Experience with Intrauterine Transfusion

Five years'' experience with intrauterine transfusion involving 94 transfusions on 50 fetuses forms the basis of the paper. Twenty-three fetuses survived, which represents an overall salvage of 46%. Of 22 fetuses who received intrauterine transfusions before 28 weeks'' gestation, seven (31.9%) survived, which justifies the attempt. Of 28 fetuses who received intrauterine transfusions after 28 weeks'' gestation, 16 (57.1%) survived, which compares favourably with other series. A comparison of two different procedural techniques shows no statistically significant difference in ultimate results. Indications for amniocentesis are outlined and intrauterine transfusion was advised if the optical density difference fell in Liley''s zone III (or a very high zone II) and rose at a rate which anticipated a zone III reading prior to 32 weeks'' gestation. A pediatric assessment and therapeutic management of the 33 live births are presented. Twenty-eight babies received exchange transfusions. Five were excluded for reasons outlined in the text. Ten of the live-born died neonatally. The 23 survivors continue to thrive mentally and physically and follow-up continues.     

Gonorrhoea and the Intrauterine Contraceptive Device

Though pelvic infection in women fitted with an intrauterine device (I.U.C.D.) is reported to be rare, three cases, gonococcal in origin, are presented. These case histories suggest that the presence of an I.U.C.D. increases the severity of gonorrhoea, while removal of the device before antibiotic therapy is probably essential for proper management. The literature and our experience suggest that where pelvic infection and an I.U.C.D. coexist gonorrhoea should be considered a likely diagnosis.     

Clinical Experience with Dextro-Alprenolol

Experience with dextro-alprenolol in nine patients has shown that it is relatively ineffective in treating arrhythmias associated with acute myocardial infarction. Marginal effectiveness in the control of ventricular ectopic beats after myocardial infarction is outweighed by an appreciable hypotensive effect with risk of infarction. The drug was ineffective in the management of supraventricular arrhythmias.     

Clinical Laboratory Experience with the Improved Enterotube

The reactions elicited in this evaluation of the improved Enterotube indicate the efficacy of using this device for the differentiation of the members of the family Enterobacteriaceae.     

86例绝经后妇女取宫内节育器分析

目的探讨提高绝经后妇女取宫内节育器（IUD）的成功率,减少绝经后取器并发症发生的有效方法。方法对86例绝经后妇女取器者术前给予米非司酮25mg,每12h 1次,连续口服3天,服药前后2h禁食,第4天空腹口服米索前列醇600μg后2h取器。结果顺利取出IUD者59例,用宫颈扩张器扩张宫口为6号后顺利取出者23例;IUD嵌顿者4例,1例最终通过宫腔镜取器,余3例由宫颈扩宫器扩至6号后剪断不锈钢丝后取出。所有取器者术中腹痛和出血量正常,术后阴道出血2～5天。结论米非司酮联合米索前列醇在绝经后妇女取宫内节育器应用中,可有效扩张、软化宫颈,具有安全、有效的特点,值得基层推广。     

Clinical Experience with the Elema Vario Pacemaker

Early problems after implantation of an endocardial electrode for permanent pacing occur in many patients. Difficulties can be anticipated in many of these patients and their management made much easier by a knowledge of the daily endocardial threshold obtained in patients with an implanted Elema Verio pacing unit by a simple non-invasive technique using a magnet and electrocardiogram. Twenty patients are described in whom permanent pacing with an Elema Vario unit was undertaken. The practical advantages of this unit can be readily seen in the patient who developes exit block or in the patient with obstructive airways disease, in whom frequent coughing or right ventricular hypertrophy may make stable electrode placement difficult. The chief advantage of the Elema Vario pacemaker is the extreme simplicity with which knowledge of the endocardial threshold can be obtained.     

宫血宁治疗宫内节育器后异常出血的疗效观察

目的:探讨宫血宁胶囊用于治疗宫内放置节育器后异常子宫出血的临床疗效。方法:350例宫内置器后异常出血患者随机分为观察组(175例)与对照组(175例),其中观察组给予宫血宁胶囊治疗,对照组给予抗菌止血常规西药治疗,比较两组患者治疗前后月经异常变化情况及治疗效果。结果:①观察组治愈率、总有效率分别为56.00%和92.57%,对照组治愈率、总有效率为25.71%和75.43%,组间差异有统计学意义(P<0.01)。②经过治疗,观察组与对照组患者月经异常症状均得到明显缓解,与治疗前比较差异有显著性(P<0.01),其中观察组患者经量增多、经期延长和经间点滴出血等症状例数分别减少至9例、7例和1例,对照组减少至34例、30例和15例,组间差异有统计学意义(P<0.05)。③经过治疗,观察组患者平均月经持续时间从11.74±4.69d减少至6.92±2.34d,对照组从12.11±5.25d减少至9.28±3.14d,两组间差异有统计学意义(P<0.05)。结论:宫血宁胶囊可有效治疗因宫内放置节育器所引起的子宫异常出血,且疗效优于抗菌止血西药治疗,值得进一步推广。     

宫血宁治疗宫内节育器后异常出血的疗效观察

目的：探讨宫血宁胶囊用于治疗宫内放置节育器后异常子宫出血的临床疗效。方法：350例宫内置器后异常出血患者随机分为观察组（175例）与对照组（175例）,其中观察组给予宫血宁胶囊治疗,对照组给予抗菌止血常规西药治疗,比较两组患者治疗前后月经异常变化情况及治疗效果。结果：①观察组治愈率、总有效率分别为56.00%和92.57%,对照组治愈率、总有效率为25.71%和75.43%,组间差异有统计学意义（P〈0.01）。②经过治疗,观察组与对照组患者月经异常症状均得到明显缓解,与治疗前比较差异有显著性（P〈0.01）,其中观察组患者经量增多、经期延长和经间点滴出血等症状例数分别减少至9例、7例和1例,对照组减少至34例、30例和15例,组间差异有统计学意义（P〈0.05）。③经过治疗,观察组患者平均月经持续时间从11.74±4.69d减少至6.92±2.34d,对照组从12.11±5.25d减少至9.28±3.14d,两组间差异有统计学意义（P〈0.05）。结论：宫血宁胶囊可有效治疗因宫内放置节育器所引起的子宫异常出血,且疗效优于抗菌止血西药治疗,值得进一步推广。