Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus

Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.

Space Ultrasound: A Proposal for Competency-based Ultrasound Training for In-flight Space Medicine

Space travel has transformed in the past several years. Given the burgeoning market for space tourism, in-flight medical emergencies are likely to be expected. Ultrasound is one of the few diagnostic and therapeutic modalities available for astronauts in space. However, while point-of-care ultrasound (POCUS) is available, there is no current standard of training for astronaut preparation. We suggest an organized and structured methodology by which astronauts should best prepare for space with the medical equipment available on board. As technology continues to evolve, the assistance of other artificial intelligence and augmented reality systems are likely to facilitate training and dynamic real-time needs during space emergencies. Summary: As space tourism continues to evolve, an organized methodology for POCUS use is advised to best prepare astronauts for space.

The prognostic value of improving congestion on lung ultrasound during treatment for acute heart failure differs based on patient characteristics at admission

BACKGROUND

Lung ultrasound congestion scoring (LUS-CS) is a congestion severity biomarker. The BLUSHED-AHF trial demonstrated feasibility for LUS-CS-guided therapy in acute heart failure (AHF). We investigated two questions: 1) does change (∆) in LUS-CS from emergency department (ED) to hospital-discharge predict patient outcomes, and 2) is the relationship between in-hospital decongestion and adverse events moderated by baseline risk-factors at admission?

METHODS

We performed a secondary analysis of 933 observations/128 patients from 5 hospitals in the BLUSHED-AHF trial receiving daily LUS. ∆LUS-CS from ED arrival to inpatient discharge (scale -160 to +160, where negative = improving congestion) was compared to a primary outcome of 30-day death/AHF-rehospitalization. Cox regression was used to adjust for mortality risk at admission [Get-With-The-Guidelines HF risk score (GWTG-RS)] and the discharge LUS-CS. An interaction between ∆LUS-CS and GWTG-RS was included, under the hypothesis that the association between decongestion intensity (by ∆LUS-CS) and adverse outcomes would be stronger in admitted patients with low-mortality risk but high baseline congestion.

RESULTS

Median age was 65 years, GWTG-RS 36, left ventricular ejection fraction 36 %, and ∆LUS-CS -20. In the multivariable analysis ∆LUS-CS was associated with event-free survival (HR = 0.61; 95 % CI: 0.38-0.97), while discharge LUS-CS (HR = 1.00; 95%CI: 0.54-1.84) did not add incremental prognostic value to ∆LUS-CS alone. As GWTG-RS rose, benefits of LUS-CS reduction attenuated (interaction p < 0.05). ∆LUS-CS and event-free survival were most strongly correlated in patients without tachycardia, tachypnea, hypotension, hyponatremia, uremia, advanced age, or history of myocardial infarction at ED/baseline, and those with low daily loop diuretic requirements.

CONCLUSIONS

Reduction in ∆LUS-CS during AHF treatment was most associated with improved readmission-free survival in heavily congested patients with otherwise reassuring features at admission. ∆LUS-CS may be most useful as a measure to ensure adequate decongestion prior to discharge, to prevent early readmission, rather than modify survival.

Exploring the Role of Self-Control Across Distinct Patterns of Cyber-Deviance in Emerging Adolescence

A disproportionally large number of adolescents engage in cyber-deviance. However, it is unclear if distinct patterns of adolescent cyber-deviance are evident, and if so, whether and to what extent low self-control is associated with different patterns of cyber-deviance. The current study addressed this research gap by examining the relationship between self-control and distinct latent classes of adolescent cyber-deviance net of potential confounders among a cross-sectional sample of 1793 South Australian adolescents. Four latent classes were identified, each characterized by varying probabilities of involvement in six types of cyber-deviance that were measured. The versatile class (n = 413) had the lowest average level of self-control, followed by the harmful content users (n = 439) and digital piracy (n = 356) classes, with the abstainer class (n = 585) characterized by the highest self-control. Analysis of covariance indicated that the abstainer group had significantly higher self-control than other classes of cyber-deviance. Although the versatile class had noticeably lower average self-control scores than the harmful content users and digital piracy groups, this difference was not significant after correcting for multiple comparisons. Collectively, these findings suggest that self-control appears to distinguish between those who do and do not engage in cyber-deviance but may not distinguish between distinct patterns of cyber-deviance net of other factors.

Implementing Community-Based Prostate Cancer Education in Rural South Carolina: a Collaborative Approach Through a Statewide Cancer Alliance

The purpose of this study was to evaluate the impact of implementing community-based prostate health education programs in rural communities. Prostate cancer (PrCA) remains one of the most common cancers among men, and a growing body of literature demonstrates that large interracial differences in PrCA incidence and mortality rates consistently disfavor African Americans in comparison to European Americans. It also is evident, despite the overall decrease in cancer death rates in the USA in recent decades, rural areas are experiencing a reduction in death rates much more slowly. In this study, education session content focused on PrCA risk factors, symptoms, screening, healthy diet and exercise, treatment options, and provider communication strategies. Forty individuals participated and completed pre/post-education program surveys to assess changes in PrCA knowledge and cancer decision-making. Participants showed improvements in education and awareness following the session, and overall impressions of the program were consistently positive as exhibited by participants' answers on a satisfaction survey. The findings demonstrate the real need both in terms of research to understand the underlying problem and to provide practical solutions that can be implemented to reverse the current situation. The results obtained support community-based education programs as an effective means of delivering PrCA prevention, screening, and treatment information to rural communities.

A novel measure for characterizing ultrasound device use and wear

Point-of-care ultrasound (POCUS) equipment management is critical in optimizing daily clinical operations in emergency departments (EDs). Traditional consultative ultrasound laboratories are well practiced at operations management, but this is not the case for POCUS programs, because machine upgrade and replacement metrics have not been developed or tested. We present a data-driven method for assessment of POCUS equipment maintenance and replacement named the ULTrA (a data-driven approach to point-of-care ultrasound upgrade) score. This novel model of assessing each ultrasound machine by quantitative scoring in each of four mostly objective categories: use (U), likeability (L), trustworthiness (Tr), and age (A). We propose the ULTrA model as a method to identify underperforming devices which could be upgraded or eliminated, and to compare relative performance amongst a group of departmental ultrasound machines. This composite score may be a useful objective tool that could replace individual proxies for clinical effectiveness, such as age, use, or individual provider preference. Additional research in multiple centers would be needed to refine and validate the ULTrA score. Once fully developed, the ULTrA score could be deployed in EDs and other clinical settings where POCUS is used to help streamline resources to maintain a functional and state-of-the-art fleet of ultrasound machines over time.

A Novel Application of Ultrasound-Guided Interscalene Anesthesia for Proximal Humeral Fractures

BACKGROUND

Proximal humeral fractures are commonly encountered in the emergency department (ED). These injuries are often associated with significant pain, with patients often receiving multiple doses of opiate medications while awaiting definitive management. The interscalene nerve block has been efficacious as perioperative analgesia for patients undergoing operative shoulder repair. The utilization of the interscalene nerve block in the ED for proximal humeral fractures is largely unexplored.

DISCUSSION

We report the use of an ultrasound-guided interscalene nerve block in the ED for a patient presenting with significant pain from a proximal humerus fracture. The procedure provided excellent regional anesthesia with no additional need for intravenous or oral opiates during the rest of her ED course. With the significant risks associated with pain medication, particularly opiates, regional anesthesia may be an excellent option for the appropriate patient in the ED.

CONCLUSIONS

As documented in this report, the ultrasound-guided interscalene block, in particular, may be utilized as a means to provide adequate pain control for patients with proximal humerus fractures in the ED.

Validation of the NIH Toolbox in Individuals with Neurologic Disorders

OBJECTIVE

Individuals with spinal cord injury (SCI), traumatic brain injury (TBI), and stroke experience a variety of neurologically related deficits across multiple domains of function. The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) examines motor, sensation, cognition, and emotional functioning. The purpose of this paper is to establish the validity of the NIHTB in individuals with neurologic conditions.

METHODS

Community-dwelling individuals with SCI (n = 209), TBI (n = 184), or stroke (n = 211) completed the NIHTB. Relative risks for impaired performance were examined relative to a matched control groups.

RESULTS

The largest group differences were observed on the Motor domain and for the Fluid Cognition measures. All groups were at increased risk for motor impairment relative to normative standards and matched controls. Fluid cognitive abilities varied across groups such that individuals with stroke and TBI performed more poorly than individuals with SCI; increased relative risks for impaired fluid cognition were seen for individuals in the stroke and TBI groups, but not for those in the SCI group. All three neurologic groups performed normally on most measures in the Sensation Battery, although TBI participants evidenced increased risk for impaired odor identification and the stroke group showed more vision difficulties. On the Emotion Battery, participants in all three groups showed comparably poor psychological well-being, social satisfaction, and self-efficacy, whereas the TBI group also evidenced slightly increased negative affect.

CONCLUSIONS

Data provide support for the validity of the NIHTB in individuals with neurologic conditions.

Fear, fumbling and frustration

The dangers of doing fieldwork have received little consideration within the criminological literature. This article examines the author's experiences over the last five years studying policing and security in Colombia. It reflects upon a number of issues relating to the personal safety of the researcher and to the ongoing viability of doing field-based research in such an environment. The project `survival' skills of adaptability and methodological pluralism are contextualized and argued. The importance of local supports and acknowledging personal limits is also stressed. The need for criminology to look to anthropology and other field-oriented disciplines is suggested if criminology's quest for relevance in a globalizing world is to be successful.

Translocation portals for the substrates and products of a viral transcription complex: the bluetongue virus core

The bluetongue virus core is a molecular machine that simultaneously and repeatedly transcribes mRNA from 10 segments of viral double-stranded RNA, packaged in a liquid crystalline array. To determine how the logistical problems of transcription within a sealed shell are solved, core crystals were soaked with various ligands and analysed by X-ray crystallography. Mg(2+) ions produce a slight expansion of the capsid around the 5-fold axes. Oligonucleotide soaks demonstrate that the 5-fold pore, opened up by this expansion, is the exit site for mRNA, whilst nucleotide soaks pinpoint a separate binding site that appears to be a selective channel for the entry and exit of substrates and by-products. Finally, nucleotides also bind to the outer core layer, providing a substrate sink.

Pediatric temporal bone fractures

OBJECTIVE

To examine the etiology, presentation, and management of temporal bone fractures in children.

STUDY DESIGN

Case control.

METHOD

Retrospective review of a level I pediatric trauma center from July 1, 1990 to November 1, 1996 identified 680 patients. Inclusion criteria of age less than 14 years and only blunt temporal bone trauma identified 122 patients, with 97 charts available for review. The criteria for temporal bone fracture consisted of both clinical and radiologic information. Only patients with temporal bone fractures confirmed by computed tomography, a complete otolaryngology examination, and audiometric evaluations were included in the study. The data were analyzed with the Kruskal-Wallis analysis of variance (ANOVA) for examining the three separate age groups of fractures. Chi-squared analysis was used to compare these data with previously published adult and pediatric temporal bone fracture series and to examine the three separate age groups of fractures.

RESULTS

The review identified 72 children with 79 temporal bone fractures: 47 boys and 25 girls. The patients ranged from 6 months to 14 years of age, with a bimodal distribution of patients with peaks at 3 years and 12 years of age. The most common causes of fractures were motor vehicle accidents (47%), falls (40%), biking accidents (8%), and blows to the head (7%). Common presenting signs and symptoms included hearing loss (82%), hemotympanum (81%), loss of consciousness (63%), intracranial injuries (58%), bloody otorrhea (58%), extremity fractures (8%), and facial nerve weakness (3%). The most common causes of temporal bone fractures were falls and motor vehicle accidents. Forty-two patients were noted to have bloody otorrhea and possible cerebrospinal fluid leak. Twenty-four received intravenous antibiotics. No patient developed prolonged otorrhea or meningitis during hospitalization and the follow-up period. The classification of fracture patterns was longitudinal, 54%; transverse, 6%; oblique, 10%; squamous, 27%; and other, 3%. Hearing loss was found in 59 patients, with conductive hearing loss being the most common finding in 56% of the patients, followed by sensorineural hearing loss in 17% and mixed hearing loss in 10%.

CONCLUSIONS

Pediatric temporal bone fractures are associated with falls and motor vehicle accidents. There is a high incidence of associated intracranial injuries and hearing loss, but facial nerve injuries are uncommon. Timely management minimizes complications.

Natural and photoperiodically induced changes in plasma prolactin levels in male great tits

Plasma levels of prolactin showed a pronounced annual cycle in free-living male great tits (Parus major). During the period from August to April, levels were very low. Prolactin levels started to increase in mid-April, and maximal levels were reached in June. By mid-July prolactin levels had decreased to near basal levels. The exact breeding stage was known for all males captured during the breeding period, and prolactin levels increased continuously from the period of territorial defense to the nestling period. Males were exposed to different light regimes at three different times of the year (late August, late November, and early March). Males exposed to 14L:10D (14 h light:10 h darkness) and 20L:4D showed pronounced prolactin cycles at all times of the year, but the patterns differed markedly with the season. In November the 20L:4D and the 14L:10D prolactin patterns differed markedly from each other. In the 20L:4D group prolactin levels started to increase before testes had reached maximal size, whereas in the 14L:10D group prolactin levels did not start to increase until testes were almost completely regressed. In early March the prolactin pattern of change over time was the same for great tits kept on 20L:4D and 14L:10D. In both cases prolactin levels increased during the testicular growth period, and prolactin levels were maximal during the period of spermatogenesis. Prolactin levels did not change over time in males kept on 8L:16D in August and November. Males exposed to short days in early March showed a significant increase in prolactin levels about 3 weeks after the onset of the experiment. Plasma levels of prolactin in males castrated in late November and exposed to a 20L:4D light regime did not differ from those in intact males. In castrated males given a testosterone implant prolactin levels immediately increased to significantly higher levels than those observed in intact or castrated males. Prolactin levels remained significantly higher in the testosterone implanted males for about a month. In one group of castrated birds the testosterone implant was removed 13 days after the onset of the experiment. This removal resulted in a significant decrease in circulating levels of prolactin.

Cell-cell interactions influence oligosaccharide modifications on mucins and other large glycoproteins

Intratumoral phenotypic diversity is well documented with regard to tumor associated carbohydrate antigens (TACA). The factors which control the expression of these cell-surface oligosaccharides on different cells of the same tumor are not understood. We investigated the expression of a panel of mucin associated oligosaccharides in cell lines growing at different surface densities (number of cells per cm2 of growth flask). Results show that the apparent expression of extended Lea-Lex, Lea and Lex, sialyl Lea, Tn and sialyl Tn varies with density of growth by an invasive human squamous cell lung carcinoma cell line (NU6-1), a benign variant (NE-18) and the human lung epithelial cell line BEAS-2B. The results indicate that one of the factors influencing the apparent expression of mucin-associated oligosaccharides is cell-cell interactions.

Scratch and sniff. The dynamic duo

Are odors diagnostic? In this age of polymerase chain reactions, in situ hybridization, and immunohistochemical staining, is there any room left for the nose in diagnosing disease? Long ago, and perhaps far away, smell was crucial to describing an illness. Infectious diseases were known by their characteristics odors--scrofula as smelling like stale beer; typhoid, like freshly baked brown bread; rubella, like plucked feathers; and diphtheria, as "sweetish." Anosmics might be banned from medical school. Perhaps we have left the descriptions behind along with these illnesses we rarely encounter today. After all, how many young physicians, residents, or medical students have ever seen a case of diphtheria or even rubella, and how many fewer have ever plucked a chicken? We have learned that pellagra (that "must appear" diagnosis in our differential by rote, but not by example, for photosensitive dermatoses) should smell like sour bread and that the exotic favus should smell "mousy" (Table 1). What does Candida smell like--a "heavy sweetness"? Darier's disease in poor control--"organic"? Pseudomonal infections--"foul and biting"? And are not our patients with noninfected eczematous dermatitis distinct for lacking any peculiar odor, do they not actually smell "dry"? We cannot blame the abandonment of our olfactory skills on the younger generation, for how many of us could describe those odors we smell every day? Would we be able to detect a subtle change in the odor of our patient with psoriasis, a change perhaps signifying superinfection?

Estrogen metabolism and human papillomavirus-induced tumors of the larynx: chemo-prophylaxis with indole-3-carbinol

A relationship was established between estradiol 16 alpha-hydroxylation, papillomavirus and its malignant sequelae. In this study, we determined that 16 alpha-hydroxylation was substantial in normal larynx and further increased in laryngeal papillomas. Estradiol or 16 alpha-hydroxyestrone stimulated proliferation in both kinds of cells while 2-hydroxyestrone was antiproliferative. Indole-3-carbinol, which induces 2-hydroxylation, abrogated the proliferative effects of estradiol. In immunocompromised mice, papilloma cysts formed in HPV-11 infected laryngeal tissue implanted under the renal capsules in 100% of control mice but only in 25% of mice fed indole-3-carbinol.

Regulation of chloride transport in parotid secretory granules by membrane fluidity

Zymogen granule membranes contain Cl- conductance and Cl/anion exchange activities that become important for primary fluid production after fusion with the apical plasma membrane of the acinar cell. We have used steady-state fluorescence anisotropy of diphenylhexatriene derivatives and measurements of Cl- transport in isolated secretory granules to determine the contribution of membrane fluidity to the regulation of transport across the granule membrane. Secretory granules from several unstimulated glands (rat pancreas and parotid, rabbit gastric glands) were shown to have low membrane fluidity compared to plasma membranes. In addition, Cl- transport activity in different granule preparations showed a strong correlation to the membrane fluidity when measured with 1-[4-(trimethylammonio)phenyl]-6-phenyl-1,3,5-hexatriene p-toluenesulfonate (TMA-DPH), but not with 3-[p-(6-phenyl)-1,3,5-hexatrienyl)-phenyl]propionic acid (PA-DPH). These data suggest that TMA-DPH preferentially partitions into a specific lipid environment associated with, or which exerts an influence on, the Cl- transport proteins and that increases in the fluidity of this environment are associated with higher transport rates. Data from other types of plasma membranes indicate that TMA-DPH partitions much more than PA-DPH into the cytoplasmic leaflet, suggesting that this part of the granule membrane is involved in the observed fluidity changes. Furthermore, increasing the bulk membrane fluidity with the local anesthetics benzyl alcohol and n-alkanols increased the Cl- transport rates up to 10-fold. This increase was apparently through specific transporters as anion selectivity was maintained in spite of the higher absolute rates.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative evaluation of the safety and contraceptive effectiveness of 65 mg and 100 mg of 90-day norethindrone (NET) injectable microspheres: a multicenter study

The first of a second generation of slow-release injectable contraceptives is the norethindrone (NET) microspheres with a 90-day duration of action. It was evaluated at 65-mg and 100-mg doses for safety and contraceptive effectiveness in two randomized, single-blind trials among 131 women: 94 women for 12 months and 37 women for 6 months. The 6-month trial included additional evaluations of ovarian function and serum NET values. In the 6-month trial, no indication of ovulation was detected in the 100-mg dose group, while 3 of the 19 women in the 65-mg group showed signs of ovulation (progesterone greater than 3 ng/ml). No pregnancies were reported in the 100-mg group and one pregnancy in the 65-mg group resulted in a life-table pregnancy rate for that dose of 2.6 per 100 woman-years (95% confidence interval, 0 to 7.5). Days of vaginal bleeding were analyzed for 30 days before treatment and in 90-day reference periods after treatment. The mean number of vaginal bleeding and spotting days increased initially after the first injection in both dose groups, but decreased to below baseline in both dose groups after 6 months. The two doses appear comparable in clinical safety, side effects, vaginal bleeding patterns, and laboratory measures. With the preliminary estimate of efficacy, the 65-mg dose would be the minimally effective dose for the NET 90-day injectable contraceptive.

Intrauterine administration of methyl cyanoacrylate as an outpatient method of permanent female sterilization

Results are presented of multicenter studies on the intrauterine delivery of 0.6 ml methyl cyanoacrylate with the FEMCEPT device (BioNexus Inc., Raleigh, North Carolina) for the purpose of causing permanent obstruction of the fallopian tubes. The studies included 1279 women and were conducted under several different protocols that required either one or two methyl cyanoacrylate application procedures. Based on hysterosalpingograms obtained about 16 weeks after the last methyl cyanoacrylate application, one procedure resulted in a tubal closure rate of 71.4% and two procedures resulted in a tubal closure rate of 89.4%. Complications of the procedure were infrequent and none required surgical treatment. Cumulative pregnancy rates among women with hysterosalpingogram-demonstrated bilateral tubal closure were similar for the one- and two-application procedures that used nonradiopaque methyl cyanoacrylate and were significantly lower (p less than 0.05) compared with a single application of radiopaque methyl cyanoacrylate. The 3-year pregnancy rate for two applications of nonradiopaque methyl cyanoacrylate was 1.7 +/- 1.2 per 100 women.

Seasonal changes in prolactin and luteinizing hormone in the polyandrous spotted sandpiper, Actitis macularia

The polyandrous spotted sandpiper (Actitis macularia) is a species characterized by female dominance over males and predominant male parental care. Prolactin (Prl) and luteinizing hormone (LH) were analyzed in plasma samples obtained serially from individuals across different stages of the breeding season. The reproductive status of each sampled individual was known in detail. Similar Prl values were obtained independently by two different assays. Males tended to have higher plasma Prl levels than females throughout the breeding season. Prl was significantly elevated in both sexes by the first few days of incubation. This rapid rise in Prl may indicate its role in brood patch development and the onset of incubation behavior. In males Prl continued to rise during incubation, whereas it remained constant in females. Higher levels of Prl in males than females, especially late in incubation, reflects the greater contribution of males to incubation. LH declined markedly in males and females from prelaying to early incubation. There was a significant negative correlation between Prl and LH among males, especially from the prelaying to early incubation phases of the season. There was no such correlation among females.

The endocrine control of reproduction and molt in male and female emperor (Aptenodytes forsteri) and adelie (Pygoscelis adeliae) penguins. I. Annual changes in plasma levels of gonadal steroids and LH

Changes in plasma LH, testosterone, and estrogens were investigated throughout reproduction and molt in free-living male and female emperor (Aptenodytes forsteri) and adelie (Pygoscelis adeliae) penguins. In both sexes and species, plasma LH and gonadal steroids were severalfold above basal level at the time of arrival on the breeding grounds, suggesting that environmental cues (especially decreasing daylength in emperors) rather than mating and courting primarily stimulate gonadal development and reproduction. In both species a marked increase in plasma LH (both sexes), testosterone (males), and estrogens (females) corresponded with the time of maximum gonadal size, and peak values were obtained at the time of copulation, i.e., in emperors about 10-15 days prior to egg laying. In females, plasma LH and estrogens dropped to low levels between copulation and egg laying. Similarly, following copulation in males plasma testosterone fell to lower levels that in emperors were maintained during incubation and brooding of the non-thermally emancipated chick. Plasma LH levels followed the same trend as testosterone, falling after copulation and falling further prior to molt. Though lower than at copulation, plasma LH was higher in incubating (males) and brooding (males and females) emperors than during rearing of the thermally emancipated chicks, suggesting that plasma LH might be related to incubating, brooding, and territorial behavior. In male and female emperors and in male adelies, plasma gonadal steroids and LH were at basal levels throughout molt.

Transcutaneous procedures for male sterilization

Outside the People's Republic of China transcutaneous methods of male sterilization are not widely used, even though there are advantages of these methods over surgical vasectomy procedures. Methods of transcutaneous sterilization (intratesticular, intraepididymal, and intravasal) that have been evaluated in men are reviewed.

Lack of tubal occlusion by intrauterine quinacrine and tetracycline in the primate

The effects of slow- and fast-releasing quinacrine pellets and tetracycline tablets on the genital tracts of 20 cynomolgus monkeys was evaluated. After surgical implantation of the pellets, the primates were observed for three months. No signs of toxic effects to the drugs were observed during the three-month period and on autopsy. Histopathological evaluation of the fallopian tubes, cervix, ovaries and uterus (except the endometrium) indicated they were all within normal limits. In no case were the uterotubal junctions obstructed. Endometrial changes were more frequent for quinacrine-treated monkeys. The results of the study point to the need for additional research regarding the optimal dose and duration of quinacrine administration.

The effects of modifying incubation on prolactin secretion in free-living pied flycatchers

Plasma prolactin concentrations in female pied flycatchers are high during incubation, but fall from 156 +/- 27 to 67 +/- 6 ng/ml (P less than 0.01) between 2 and 4 days after the young hatch. The timing of the fall in prolactin could be determined by factors associated with the hatching of the eggs and growth of the offspring; alternatively, prolactin may remain high for a fixed period (16 days) after the onset of incubation. To distinguish between these possibilities, eggs were exchanged between nest boxes to ensure incubation periods of either 10, 14, or 19 days by different females. The results showed that the period of high prolactin secretion was shortened by 2-4 days where the eggs hatched early, but, conversely, was not lengthened in those females with extended incubation periods, the levels actually falling in these birds before the eggs hatched. There was, however, a secondary rise in prolactin 3 days after hatching, when the level of 114 +/- 11 ng/ml 22 days after the onset of incubation was much higher than that (30 +/- 4 ng/ml) at a comparable stage in the control females. Thus, high prolactin secretion cannot be maintained for longer than 16-17 days in incubating birds, but newly hatched, naked young can stimulate prolactin release in female flycatchers over a flexible period.

Postpartum contraception

Recently-delivered women who wish to avoid pregnancy should initiate contraception before ovulation. Since the return of ovulation is not predictable, regardless of the woman's lactation status and duration of postpartum amenorrhea, contraception should be initiated as soon as is reasonable after delivery. The choice of contraceptive method will depend on several factors, including: the woman's lactation status, the preference of the woman and her partner, and the health status of the newborns. For women who do not wish to have additional children, tubal sterilization through a minilaparotomy incision is the procedure of choice. For other women who are not lactating, all methods, with the exception of the use of cervical caps and diaphragms, may be initiated immediately after delivery. However, preference should be given to IUD use by lactating and non-lactating woman, especially for women who may not return for any additional postpartum care.

Female sterilization using the tubal ring

The surgical and early postoperative complications were evaluated in a study of 221 laparoscopies and 29 minilaparotomies in which tubal occlusions were performed with the application of tubal rings. For either procedure, complications were infrequent. None of the procedures had to be completed by another technique of tubal occlusion, and none of the patients required an extended hospitalization for the treatment of a complication. Among the 79 patients who have been followed up for more than 6 months, no pregnancies have been reported. The tubal ring technique appears to be safe and effective when used with either laparoscopy of minilaparotomy.

Quinacrine hydrochloride pellets: preliminary data on a nonsurgical method of female sterilization

The efficacy of transcervical insertions of quinacrine hydrochloride pellets to produce tubal occlusion has been evaluated in a study of 139 women in Santiago, Chile. At one year, the pregnancy rate was 3.1%, an acceptable rate for a nonsurgical method of female sterilization.

[Abortion or contraception (author's transl)]

The period immediately following an abortion, spontaneous or induced, has been considered favourable to the initiation of high efficicy contraception: sterilization, oral contraceptives, or intrauterine devices. The rate of post-abortal complications associated with these contraceptive methods was evaluated using data drawn from published and unpublished studies. The following conclusions were reached: sterilization is advisable only for women who do not desire additional children, and is obviously not recommended for young nulliparous women. The effective use of oral contraceptives requires a high motivational level and is therefore advisable only in cases where such motivation exists. The insertion of an intrauterine device seems to be the most adequate contraceptive method for women with low motivational level.

Tubal occlusion via laparoscopy in Latin America: an evaluation of 8186 cases

Ease of performance, safety and effectiveness of laparoscopic sterilization techniques are evaluated for 8186 procedures (6995 interval, 680 postabortion and 511 postpartum) performed in Latin America from June 1972 through February 1978. The tubes were occluded via electrocoagulation or application of the spring-loaded clip or the tubal ring. Less than 1% of the procedures were declared technical failures (ie, those which were not completed as planned). For all the tubal occlusion techniques, interval patients had the lowest rate of surgical complications. Pregnancy rates were low for the electrocoagulation and for the tubal ring techniques; patients sterilized by the spring-loaded clip, however, had a significantly higher pregnancy rate.

Advances in sterilization equipment

From the array of sterilization procedures that are safe, simple and effective, the service provider must select procedures that fit his or her logistical criteria, which include the cost and maintenance of equipment, availability of supplies, and training of the requisite personnel. In this paper, these criteria are discussed for each of the various sterilization procedures. Information about female sterilization equipment for conventional postpartum laparotomy, minilaparotomy, colpotomy, laparoscopy, and culdoscopy is presented, together with facts about the related tubal occlusion techniques. The standard ligation techniques for male sterilization are compared with the newer electrocoagulation and thermocoagulation methods. A variety of methods for both female and male sterilization that are in the research stage are also mentioned. It is concluded that, from a programmatic point of view, vasectomy and postpartum ligation via laparotomy are the optimal sterilization procedures. For women who have not recently been pregnant, minilaparotomy with a standard tubal ligation technique is recommended, except in large teaching hospitals where laparoscopy can be performed efficiently.