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Unlabelled: Frequent isolated ventricular premature complexes (VPCs) in patients without major structural heart disease are generally associated with benign prognosis, however can lead to serious symptoms and also to the development of left ventricular dysfunction. Purpose of this study is to present mapping findings and immediate results of catheter ablation of frequent idiopathic VPCs, and evaluation of long-term clinical outcome and the role of catheter ablation in clinical practice., Methods: Twenty-seven patients, aged 48 +/- 14 years without major structural heart disease, presenting with frequent VPCs, were investigated electrophysiologically in 28 procedures. Twenty-five patients underwent catheter ablation., Results: In 19 patients, the ectopic focus was found in the right ventricular outflow tract (RVOT) and could be reached from the endocardial approach. In these patients, VPCs were successfully eliminated by the ablation. Comparison of 24-hour Holter ECG recordings showed complete elimination of the target VPCs in all the cases [18,483 +/- 12,790 (2,152-48,820)/17 +/- 10 (3-42) % VPCs before ablation vs. 94 +/- 219 (0-763)/0.01 +/- 0.2 (0-0.7) % VPCs after ablation]. In 5 patients, mapping revealed epicardial localization of the ectopic focus in the OT. Ablation endocardially from the RVOT failed in 2 of the patients, cryoablation epicardially from the venous system was partially successful in 1 patient, and no ablation was attempted in 2 patients. In another 3 patients, ectopic foci were found in other parts of the ventricles and ablation was completely successful in one case. During the 14 +/- 9 (1-34) month follow-up period, full elimination of the target VPCs and elimination or significant reduction of symptoms was achieved in 20 (74%) patients. The procedures were accomplished without complications and with fluoroscopy time of 8,2 +/- 5,9 minutes., Conclusion: Catheter ablation of frequent idiopathic VPCs was performed effectively and safely, particularly, if the ectopic focus was localized on the endocardial aspect of the RVOT. Efficacy of catheter ablation ofVPCs arising from the epicardium of ventricular OT or other atypical sites is limited by inaccessibility or proximity to the conduction system. Indication to more aggressive mapping and ablation methods like intrapericardial approach or ablation from inside the venous system should be always critically considered with regard to the symptoms or other clinical risk factors.

Treatment of naive children with GH deficiency has relied upon long-term replacement therapy with daily injections of GH. The daily schedule may be inconvenient for patients and their caregivers, possibly promoting nonadherence with the treatment regimen or premature termination of treatment. We studied a new sustained release GH formulation, administered once or twice monthly, to determine its efficacy and safety in this population. Seventy-four prepubertal patients with documented GH deficiency were randomized to receive sustained release recombinant human GH at either 1.5 mg/kg once monthly or 0.75 mg/kg twice monthly by sc injection in a 6-month open-label study. Efficacy was determined by growth data from 69 patients completing 6 months and 56 patients completing 12 months in an extension study. Growth rates were significantly increased over baseline and were similar for the two dosage groups. The mean (+/-SD) annualized growth rate (pooled data) was 8.4 +/- 2.1 cm/yr at 6 months, and the growth rate was 7.8 +/- 1.8 at 12 months compared with 4.5 +/- 2.3 at baseline. Standardized height, bone age, and predicted adult height assessments demonstrated catch-up growth without excessive skeletal maturation. Injection site-related events (including pain, erythema, and nodules) were the most commonly reported adverse events; no serious adverse events related to treatment were reported. Laboratory studies documented no accumulation of trough GH or IGF-I levels during treatment, nor did glucose intolerance or persistent hyperinsulinism develop. Sustained release recombinant human GH is safe and effective for long-term GH replacement in children with GH deficiency. Patients achieved similar growth velocities when sustained release GH was given once or twice monthly. The enhanced convenience of this dosage form may result in greater long-term adherence to the treatment regimen.

Background: Endometrial ablation is a relatively new technique for treating abnormal uterine bleeding not associated with malignancy. Long-term outcome data after endometrial ablation are limited, and incidence of endometrial adenocarcinoma after ablation is unknown., Case: A 55-year-old black woman who had endometrial ablation for abnormal uterine bleeding after excluding uterine cancer presented 5 years later with similar symptoms and a histologic diagnosis of well-differentiated adenocarcinoma of the uterus. She refused surgery and had radiation treatment for probable stage I endometrial adenocarcinoma., Conclusion: It is unlikely in this high-risk patient that the endometrial ablation masked an undetected malignancy or delayed the diagnosis. Given the interval, the adenocarcinoma might have occurred de novo.

Objective: To assess the reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility when compared to infertile couples with a normal cavity at hysteroscopy.Material and Methods: All patients with a diagnosis of infertility who underwent hysteroscopic evaluation by a single surgeon between 1975 and 1996 were sent a questionnaire as routine follow-up regarding their reproductive history. All 100 subjects who were located responded to the questionnaire, and 78 subjects met the inclusion criteria; age <45 years, 12 months of infertility, and 18 months of follow-up with attempts to conceive including in vitro fertilization in patients with bilateral tubal occlusion.Results: Of the 78 subjects, 36 had undergone a myomectomy, 23 a polypectomy, and 19 had a normal cavity. Among the three groups there was no significant difference in their ages, types of infertility, length of infertility, or follow-up after the procedure. Using the Cox proportional hazard model, and adjusting for age, polypectomy patients had a significantly higher pregnancy rate (RR 3.89, P <.01) and a higher live birth rate (RR 2.42, P =.06) than patients with a normal cavity. Patients who had undergone a myomectomy also had a higher pregnancy rate (RR 2.02, P =.11) and live birth rate, but this did not achieve statistical significance. Pregnancy following a hysteroscopic myomectomy was associated with a larger fibroid resection (3.15 cm vs 2.5 cm P =.05). The spontaneous abortion rate following the myomectomy, polypectomy, or a normal study was equivalent, 28.1%, 23.1%, and 29.2%, respectively.Conclusions: Both hysteroscopic polypectomy and hysteroscopic myomectomy appear to enhance fertility when compared to infertile patients with a normal cavity. Despite concern that hysteroscopic resection of a large myoma may ablate a large surface area of the endometrial cavity, patients with larger myomas were more likely to conceive following resection.

Objective: To evaluate the safety and efficacy of thermal balloon therapy for menorrhagia., Design: Prospective, observational study., Setting: Fifteen centres in Canada and Europe., Population: Two hundred and ninety-six eligible women for whom follow up data were available for three months or more. Eligible women included those for whom further fertility was not a concern, were not postmenopausal, suffered from intractable menorrhagia, had a normal uterine cavity, and who were fully informed regarding the investigational nature of uterine thermal balloon therapy., Methods: Three hundred and twenty-one procedures of balloon endometrial ablation were performed using the same protocol between June 1994 and August 1996. Exclusion criteria included structural uterine abnormality or (pre) malignant lesions. Treatment entailed controlled heating of fluid in an intrauterine balloon. General anaesthesia was employed in the 61% of procedures while local anaesthesia with or without sedation was used in 39% of cases., Analysis: Follow up data at 3 and/or 6, and/or 12 months were required for inclusion in the analysis. A paired t test, Wilcoxon signed-ranks test, and multiple and logistic regression analyses were used to evaluate the changes in bleeding and dysmenorrhoea patterns, and possible confounding variables, respectively. Success was defined as the subjective reduction of menses to eumenorrhoea or less., Results: No intra-operative complications occurred, and post-operative morbidity was minimal. Success of the procedure was constant over the year (range 88%-91%). Treatment led to a significant decrease in the duration of menstrual flow and severity of pain (P < 0.0001). Increasing age, higher balloon pressure, smaller uterine cavity, and a lesser degree of pre-procedure menorrhagia were associated with significantly improved results. Pre-treatment with gonadotrophin releasing hormone agonists increased amenorrhoea and spotting rates (P = 0.03), but was only used in 5% of cases., Conclusion: Thermal balloon endometrial ablation appears to be safe, as well as effective in properly selected women with menorrhagia and is potentially an outpatient procedure.

Symptomatic submucous myomata are now diagnosed and evaluated with hysteroscopy in the office or operating room. Excision under hysteroscopic control using a resectoscope or other equipment and techniques is described and the long term outcome is reported. The hysteroscopic approach to the symptomatic submucous myoma has dramatically changed the treatment options for patients who classically would be offered abdominal myomectomy or hysterectomy.

The chemotaxis of alveolar macrophages (AM) and blood monocytes (BM) is important in the elimination of particles and microorganisms which have invaded the lung. The effect of nitrogen dioxide (NO2) on chemotaxis was tested on AM obtained by diagnostic bronchoscopy from five patients suspected of having bronchial carcinoma (four men, one woman; mean age 59 +/- 10 years). Blood monocytes were also studied with blood from seven healthy subjects (five men, two women; mean age 32 +/- 10 years). These cells were placed on polycarbonate membranes for 15 min each, exposed to NO2 concentrations between 1.0 and 5.0 parts per million (ppm), and then incubated with complement component C5a as chemotactically active agent. The number of AM or BM which actively migrated through the polycarbonate membrane under the influence of C5a was measured by means of a light microscope. The migration rate of AM (compared to air exposure) was reduced by 33% with 1.0 ppm NO2 and by 61% with 5.0 ppm. The migration rate of BM in similar conditions was reduced by as much as 55%. There was no significant cytotoxic effect of NO2 exposure at 1.0 and 3.0 ppm. With 5.0 ppm 13.0 +/- 3.0 cells were no longer viable. These results indicate that NO2 concentrations relevant to indoor conditions affect the chemotaxis of AM and BM after short-time NO2 exposures. The data further suggest that NO2 exposures of these cells depressed chemotactic mechanisms without relevant cytotoxicity.

A thermal balloon and control system designed to produce endometrial ablation blindly is described. A latex balloon on a plastic catheter is inserted into the uterus and connected to a control unit. The unit monitors the pressure and temperature of 5% dextrose in water, which has been injected into the balloon to make it conform to the size and shape of the endometrial cavity. The balloon contains a shielded heating element that is activated to heat the liquid in the balloon to a temperature of 92C. The pressure control deactivates the heating element if the pressure falls below 45 mmHg or rises above 165 mmHg. A timer controls and measures the elapsed interval of heating. The device was tested in human uterine specimens for the potential for uterine perforation, uterine rupture, and thermal effects. Subsequently, the device was tested in six patients in Mexico and four patients in London during hysterectomy just after the abdomen was opened. Thermistor probes were placed at various loci in the uterus to monitor temperature during activation of the thermal balloon. Serosal temperatures were unchanged and endometrial temperatures rose to about 90C. The extent of uterine tissue damage was determined in Mexico City by the zone of visible coagulation of the cut wall of the uterus following removal. In London, tissue diaphorase was measured to determine the depth of destruction of the cellular oxidative enzymes. These measurements varied from 3.3-10 mm under the conditions of time and temperature used. The safety features and the potential for clinical application are discussed.

Objective: To evaluate the clinical effectiveness and safety of a thermal balloon system to ablate the endometrium., Methods: All 18 patients were candidates for hysteroscopic endometrial ablation or hysterectomy for menorrhagia and consented to a trial of the balloon technique of ablation. All procedures were done in the operating room under general anesthesia, except in one patient who had regional and another who had local anesthesia with analgesia. Follow-up of 6-34 months is reported., Results: Fifteen subjects (83%) reported significant reduction in bleeding or amenorrhea. Two patients underwent subsequent hysterectomy and one a follow-up hysteroscopic examination with biopsy. Histology in these three cases showed areas of scar as well as areas of normal endometrial histology. In one uterus, the entire cavity and the endometrium were normal. The others had endometrial bands of scar and some contraction of the cavity., Conclusions: Based on follow-up results, the frequency of successful reduction of bleeding and/or amenorrhea in this small series is comparable to hysteroscopic methods of endometrial ablation. There were no complications. A larger trial is warranted to compare this method to hysteroscopic endometrial ablation.

Asherman's Syndrome was described by Asherman in 1948 as Amenorrhea Traumatica. Since the introduction of hysteroscopic surgery about 1970, an enlarging experience with the repair as well as the induction of intrauterine adhesions has been collected. The pathology and histologic processes involved in surgical repair and induction of scar in the uterus are discussed. The influence of the hormonal milieu as well as the special nature of endometrial repair as observed from the histologic evolution of the endometrium in menstruation are thought to be important factors in the induction and correction of intrauterine scar. While probably a special case, the endometrial model for healing appears to be fundamentally the same as other tissues.

Objective: To evaluate the contribution of mild to moderate hypertension to progressive loss of renal function by analysis of renal function data from the Multiple Risk Factor Intervention Trial., Design: The cohort of men with mild to moderate hypertension (baseline diastolic blood pressure > or = 90 mm Hg), randomized to a special intervention (SI) group or usual care (UC) group, were examined for change in renal function based on individual reciprocal creatinine slopes over an average of 7 years' follow-up as the outcome measure. Contribution of blood pressure control during follow-up, age, race, and blood pressure at entry were assessed., Participants: The cohort of 5524 (463 black, 5061 nonblack) hypertensive men receiving no therapy at entry provided the data for the present analysis., Results: Blood pressure control was similar for black and white participants, but significant decline in reciprocal creatinine slope was found for black men (mean slope, -0.0090 +/- 0.0013 dL/mg/y) compared with white men (+0.0018 +/- 0.0004 dL/mg/y) (P < .001 for difference between blacks and whites). Decline in renal function was also greater among individuals with elevated systolic (P < .001) as well as diastolic blood pressure (P < .001), and older individuals (P < .001). No difference between the SI and UC groups was seen in reciprocal creatinine slopes, but in both groups combined, treatment that maintained diastolic blood pressure below an average value of 95 mm Hg was associated with stable or improving renal function, whereas participants whose blood pressure remained 95 mm Hg or greater continued to decline at -0.0013 +/- 0.0009 dL/mg/y (P = .007 for difference). Separate examination of the subset of black men (n = 463) failed to show such a difference., Conclusions: Effective blood pressure control was associated with stable or improving renal function in nonblacks but not in blacks. These findings emphasize the importance of blood pressure control to maintain adequate renal function in hypertensive white men and raise important questions about the relationship of pressure reduction and renal function change in blacks.

One hundred fifty-six of 177 patients admitted to the St. Luke's/Roosevelt Hospital Center between November 1973 and November 1988 for hysteroscopic treatment of menorrhagia and/or uterine leiomyomas were followed for long-term complications and necessity for repeat surgery. Ninety-four patients underwent submucous resection alone and 62 patients underwent endometrial ablation with or without submucous resection. Among the submucous-resection group, 24.5% reported late postoperative problems and 15.9% underwent further surgery. After 9 years of followup, 83.9% of the patients had not required further surgery. Among the ablation group, 22.5% experienced recurrence of increased bleeding and 8.1% had another surgical procedure. After 6 years of follow-up, 91.3% of the patients had not required further surgery. Twenty-one patients became pregnant after submucous resection, with 18 infants delivered. No patients who underwent endometrial ablation became pregnant. This modality of treatment appears to be effective over the long term, although effectiveness appears to diminish with time.

The combination of a growing need for improved contraceptive technology, plus the new advances in endoscopic equipment, have resulted in widespread use of laparoscopic sterilization throughout the world. Recent developments have succeeded in making hysteroscopy a reliable technique and it too has been quickly evaluated for a new, simpler female sterilization method. This work is still in progress and no reliable clinical method is yet available. However, the use of a chemical, such as methyl cyanoacrylate, delivered by hysteroscope, or possibily by a blind method, does seem to be most promising as a new clinical technique shortly.

An instrument is described with which it is possible to deliver low-viscosity material consistently to the interstitial and isthmic portions of the Fallopian tube in a blind fashion on an outpatient basis. Considerable care with instrument design has been taken in order to reduce potential complications and to ensure precision. The efficiency of this system in delivering a variety of dyes has been demonstrated in hysterectomy specimens with the use of laparoscopic control. We believe this system is simple to use and may be found acceptable for application by relatively unskilled personnel. If it produces a high degree of tubal closure without significant complications or pregnancies, it should be an important addition to the techniques for limiting family size and population growth.

The authors describe a 5-year experience with 27 patients who had confirmed intrauterine scars at hysteroscopy, all of whom underwent resection of the scar. Of the 27, 14 became pregnant at least once, and 13 did not conceive. Hysteroscopic and hysterographic evidence of intrauterine scar was in general more severe in those who did not become pregnant. There were no cases of abdominal placentation in the 18 pregnancies after surgical repair, although there was 1 case of postpartum hemorrhage. Details of technique, including postoperative use of estrogen and the intrauterine device, are discussed.

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.

Hysteroscopy offers a new option in the diagnosis and management of submucus fibroids. The hysteroscopic excision of submucus fibroids in five cases is described. The problems and potentials of this approach are discussed.

The incidence of congenital anomalies of the uterus has generally been obtained from studies of women undergoing evaluation for infertility, and has been reported as 1-10%. However, the true incidence of uterine malformations is not known. This study reviews hysterosalpingograms obtained for evaluation of tubal closure after transcervical sterilization in normal multiparous women using methylcyanoacrylate and the FEMCEPT device. Of the 840 hysterosalpingograms studied, 16 congenital uterine anomalies were identified, for an incidence of 1.9%. The presence of anomalies in this population of women may more closely represent the incidence of congenital uterine anomalies in the general population.

Four patients with symptomatic intrauterine retention of fetal bones are discussed. Presenting complaints included infertility, irregular vaginal bleeding, vaginitis, and spontaneous passage of fetal bones. Two patients had uterine anomalies; 1 patient had a retained twin pregnancy. Pelvic ultrasound and x-ray films of the pelvic cavity are helpful in making a diagnosis. Hysteroscopy is invaluable both in confirming the diagnosis and in achieving successful removal of fetal bone.

Two intratubal devices, one covered with a flock made from ethylene vinyl acetate and the other constructed of titanium-aluminum-vanadium alloy with an etched surface were evaluated after being placed in the Fallopian tubes of pigtail monkeys. In some instances, the devices were medicated with 10% silver nitrate or 50% quinacrine hydrochloride. The microflock device anchored in the tube mechanically, but there is no evidence that either the polymeric or metal alloy device formed an actual attachment with Fallopian tube epithelium. It is suggested that a mechanical design approach to ITDs might be more productive than one which assumes a tissue-device bond.

About one third of our population is weather-sensitive. The specific symptoms depend from age, sex, health state and social class. A great number of meteorotropic diseases are either caused or intensified by certain meteorological events. The same is true for both alterations of common fitness and physiological parameters. The most important correlation-statistical results from different meteorological study-groups of the past decennials are summarized. By means of these tabularies the physician is able to recognize weather-dependent diseases. The telephone-service of the Deutschen Wetterdienst (bioprog) keeps him informed of the actual weather-situation. Taking advantage of these possibilities every physician can give prophylactic medicare.

MCA is a tissue adhesive which can be delivered transcervically to the Fallopian tubes by means of the FEMCEPT device. In the patients treated with this system, both prior to hysterectomy and on an ambulatory basis, there have been no significant complications or side effects. In the most recent series of ambulatory patients treated with the REMCEPT-MCA system, the bilateral tubal closure rate was 78%.

New instrumentation and a new technique are described which simplify the hysteroscopic removal of the pedunculated submucous fibroid and make possible the partial removal of the sessile variety. Experience with the method is presented including the follow-up of four patients.

The management of 540 patients with the diagnoses of "pelvic mass/uterine leiomyomata" was reviewed with respect to preoperative evaluation, surgical procedures, and final pathologic diagnosis. Approximately 6170 patients were admitted to the Gynecology Service at St. Luke's-Roosevelt Hospital Center from July 1984 to June 1985. During this period, 36 of 432 diagnostic laparoscopies (8.3%) and 503 of 1666 laparotomies (30.2%) were performed to evaluate or treat these women. The final diagnoses in the 249 patients admitted with the impression of leiomyomata were: leiomyomata, 235 (94.4%); benign adnexal masses, seven (2.8%); cancers, four (1.6%); and miscellaneous, three (1.2%). Of the 291 patients evaluated for pelvic mass, the findings were: benign ovarian or tubal cysts, 98 (33.7%); leiomyomata, 42 (14.4%); cancers, 40 (13.7%); benign cystic teratomas, 38 (13.1%); endometriosis, 28 (9.6%); miscellaneous, 23 (7.9%); and pelvic inflammatory disease, 22 (7.6%). Correlation between the patient's age, preoperative impression, and final diagnosis is presented with particular attention to the 44 patients (8.1%) in whom malignancy was found. All the possibilities that such masses may represent must be considered preoperatively, and the patient be informed of her risk of malignancy.

Over a period of 13 years the dates of hospitalization of 17,268 psychically sick persons were correlated with the decimal weather classification. Schizophrenics and neurotic depressives were affected particularly by warm westerly weather conditions, exhaustion and involution depressives and psychopaths by easterly weather conditions. Alcoholics and neurotics are more irritated by unsettled weather conditions, drug addicts by weather conditions with warm air advection from the southwest. In schizophrenics, high warm air advections in front of a belt of low pressure are of particular importance. Depressives too, seem to react to rising fronts which are partly combined with fally fronts.

A previous report described the development of a blind method to deliver methylcyanoacrylate (MCA) transcervically. Using 0.6 ml of a stable MCA whose polymerization time was closely controlled, we reported a 78% bilateral tubal closure rate in 23 cases with hysterosalpingographic control. Subsequent to the previous report, we initiated a study in which patients were randomly assigned to one of three treatment groups: a single MCA injection, a single MCA injection after uterine lavage, or two MCA injections 1 month apart. In addition, a radiopaque MCA has been developed with which it is possible to determine tubal entry after its application by means of the FEMCEPT device. Patients treated with radiopaque MCA have been studied to determine whether it is possible to predict tubal closure on the basis of tubal entry and distribution patterns. The results of these studies and their implications for contraceptive effectiveness of the FEMCEPT/MCA system will be reported.

Twenty-one female rabbits underwent laparotomy and a standardized injury was produced on the right uterine horn and Fallopian tube. Following the injury eight animals were used as controls and thirteen were injected intrapertoneally with 50 ml. of 32 per cent dextran 70. Six weeks later the animals were killed and the adhesions graded. All control animals had dense adhersions of the injured areas to bowel or peritoneum. The dextran animals showed marked reduction in the extent and degree of adhesions. Possible mechanisms for these findings are discussed and the problems raised, by adhesion formation, to the gynecologist are reviewed.

During treatment with benzbromaron in a dose of 100 mg/day a significant fall of uric acid was shown beginning on the second day. On the forth day in the evening or the fifth day in the morning a steady state for the uric acid level is reached. The morning value was 2,9 mg/100 ml, the evening value 2,6 mg/100 ml. During treatment, even when serum uric acid levels are decreased, an augmented renal uric acid elimination excists but a hyperuraturia was not found.

Twenty-eight patients who underwent resection of a submucous fibroid under hysteroscopic control are reported with a follow-up for one to seven years. Seven patients underwent subsequent hysterectomy for various reasons. Two required repeat hysteroscopic resection and 17 returned to normal menses without difficulty. Five of these patients subsequently had a total of eight pregnancies, with five living children. The implications of this option of therapy are discussed.