CORRESPONDENCE
with the copper contraceptive in situ after estrogen treatment when cytology revealed a negative response to estrogen; histologically active cervicitis with basal cell hyperplasia was found.
Is the copper-releasing intrauterine contraceptive device able to induce unphysiologic cell differentiation in the uterine cervix?
Elk
To the Editors: It is known from toxicologic studies that copper released in small amounts as ion locally irritates the tissue. In my’ previous study, the copper-releasing intrauterine contraceptive device (IUD) was found to induce cervicitis in !/ of previously healthy young women with normal cytology before the insertion of the copper contraceptive. The second step of the study on the local effect of copper on the cellular and tissue levels in the uterine cervix clearly confirms the early findings. In 528 young and healthy women with smears which were normal before the insertion of the copper IUD, the frequency of an acute inflammatory reaction in the uterine cervix induced by the copper IUD was found to be 26 per cent. This group of 140 women developed cervicitis 8 to 12 weeks after the insertion of the copper IUD. The patients tiere then given oral estrogen* treatment in doses of 1 mg. daily for 30 days. A positive response to estrogen treatment was found in 94 of the 140 women (67 per cent). The group of 46 of the 140 women (33 per cent) who were treated with oral estrogen but did not respond is of special interest and importance. This group of nonresponders has been followed up both cytologically and histologically with the copper-releasing IUD in situ, and, in a significant number of patients (60 per cent) developing cervicitis 8 to 12 weeks after the insertion of the copper contraceptive, the cytologic findings have been confirmed by histology (unpublished results).
M.D.
REFERENCE
1. Rubinstein,
E.: Contraception
10: 673,
1974.
Gonococcus in the cervix and culde-sac To the Editors: Since I am not a regular reader of your publication, it is probably likely that someone else has drawn attention to what I regard as a major methodologic error in a paper published in the August 1, 1975, issue. The article, “The bacteriology of acute pelvic inflammatory disease”, by Chow and associates (122: 876, 1975), was referred to at a Stanford Emergency departmental meeting as showing that fairly convincing evidence had been found that only a very poor correlation existed between the presence of gonococcus in the cervix as compared to that in the cul-de-sac. Careful review of the “Material and methods” section of the article reveals that though the cervical cultures were inoculated in Thayer-Martin medium those of the cul-de-sac aspirates were not so inoculated on a routine basis. Since the same conditions were not applied to the cultures of the two specific areas, it appears to me that the entire experiment is worthless. It is theoretically possible that the gonococcus bacterium growing in the cul-de-sac is different from that growing in the cervix, but I am unaware of any evidence to support this hypothesis. The authors, while noting their failure to carry out the experiment rigorously, substantiate their findings and conclusions by noting that these are similar to those of other investigators. I have not taken the trouble to review the latters’ descriptions of their methodology since my real object is to draw attention to the flaw in this specific paper. The condition known as acute pelvic inflammatory disease provides a continual source of confusion and complexity to emergency department physicians. It is
E. W., a 34-year-old woman, para 3, was previously healthy with normal smears before the insertion of the copper contraceptive and had a normal target-organ response to estrogen in midcycle smears. The first midcycle smear after the insertion of the copper contraceptive showed a decreasing estrogen response in the squamous epithelium, and the second smear showed cervicitis with low target-organ response to estrogen and an infiltration of polymorphonuclear leukocytes--over 100 cells per one microscopic field (2.5 sq. mm.) without histiocytes. A histologic examination was made *Ovestin,
Rubinstein,
Red Cross Laboratory Ztsen&.syydenkatu 54 Pori 13, Finland
Organon.
277
with the copper contraceptive in situ after estrogen treatment when cytology revealed a negative response to estrogen; histologically active cervicitis with basal cell hyperplasia was found.
Is the copper-releasing intrauterine contraceptive device able to induce unphysiologic cell differentiation in the uterine cervix?
Elk
To the Editors: It is known from toxicologic studies that copper released in small amounts as ion locally irritates the tissue. In my’ previous study, the copper-releasing intrauterine contraceptive device (IUD) was found to induce cervicitis in !/ of previously healthy young women with normal cytology before the insertion of the copper contraceptive. The second step of the study on the local effect of copper on the cellular and tissue levels in the uterine cervix clearly confirms the early findings. In 528 young and healthy women with smears which were normal before the insertion of the copper IUD, the frequency of an acute inflammatory reaction in the uterine cervix induced by the copper IUD was found to be 26 per cent. This group of 140 women developed cervicitis 8 to 12 weeks after the insertion of the copper IUD. The patients tiere then given oral estrogen* treatment in doses of 1 mg. daily for 30 days. A positive response to estrogen treatment was found in 94 of the 140 women (67 per cent). The group of 46 of the 140 women (33 per cent) who were treated with oral estrogen but did not respond is of special interest and importance. This group of nonresponders has been followed up both cytologically and histologically with the copper-releasing IUD in situ, and, in a significant number of patients (60 per cent) developing cervicitis 8 to 12 weeks after the insertion of the copper contraceptive, the cytologic findings have been confirmed by histology (unpublished results).
M.D.
REFERENCE
1. Rubinstein,
E.: Contraception
10: 673,
1974.
Gonococcus in the cervix and culde-sac To the Editors: Since I am not a regular reader of your publication, it is probably likely that someone else has drawn attention to what I regard as a major methodologic error in a paper published in the August 1, 1975, issue. The article, “The bacteriology of acute pelvic inflammatory disease”, by Chow and associates (122: 876, 1975), was referred to at a Stanford Emergency departmental meeting as showing that fairly convincing evidence had been found that only a very poor correlation existed between the presence of gonococcus in the cervix as compared to that in the cul-de-sac. Careful review of the “Material and methods” section of the article reveals that though the cervical cultures were inoculated in Thayer-Martin medium those of the cul-de-sac aspirates were not so inoculated on a routine basis. Since the same conditions were not applied to the cultures of the two specific areas, it appears to me that the entire experiment is worthless. It is theoretically possible that the gonococcus bacterium growing in the cul-de-sac is different from that growing in the cervix, but I am unaware of any evidence to support this hypothesis. The authors, while noting their failure to carry out the experiment rigorously, substantiate their findings and conclusions by noting that these are similar to those of other investigators. I have not taken the trouble to review the latters’ descriptions of their methodology since my real object is to draw attention to the flaw in this specific paper. The condition known as acute pelvic inflammatory disease provides a continual source of confusion and complexity to emergency department physicians. It is
E. W., a 34-year-old woman, para 3, was previously healthy with normal smears before the insertion of the copper contraceptive and had a normal target-organ response to estrogen in midcycle smears. The first midcycle smear after the insertion of the copper contraceptive showed a decreasing estrogen response in the squamous epithelium, and the second smear showed cervicitis with low target-organ response to estrogen and an infiltration of polymorphonuclear leukocytes--over 100 cells per one microscopic field (2.5 sq. mm.) without histiocytes. A histologic examination was made *Ovestin,
Rubinstein,
Red Cross Laboratory Ztsen&.syydenkatu 54 Pori 13, Finland
Organon.
277
