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PubMed1996

The provision of female sterilization in São Paulo, Brazil: a study among low income women.

This paper examines some problems involved in the provision of female sterilization procedures in Brazil, mainly those concerned with the ways in which this operation is offered. Female sterilization provision is analysed by reference to the broader institutional context and from the client's perspectives. These themes are discussed in the light of some recent survey findings. A survey was carried out between March and July, 1992 in two selected poor areas of São Paulo Metropolitan Region. 3149 women were asked about contraceptive use including 407 sterilized women under 40 years old who were also interviewed about their adaptation to sterilization. Further information was also obtained through in-depth interviews with 15 sterilized women who regretted the operation. The findings highlight a complex network of interests and misunderstandings which shape the nature of choice of female sterilization by Brazilian low income women.

Adolescent↗
PubMed1987

Behavior of differently sterilized allogenic lyophilized cartilage implants in dogs.

The behavior of beta-propriolactone-sterilized, radiation-sterilized, and gas-sterilized lyophilized cartilage implants was histiologically investigated at various intervals up to 328 days. Beta-propriolactone-sterilized lyophilized cartilage implants were completely resorbed after 230 days and had only undergone partial osseous substitution. The radiation-sterilized lyophilized cartilage implants behaved similarly after 125 days. Despite partial resorption of the gas-sterilized lyophilized cartilage after 328 days, constant form was maintained and complete bony substitution of the resorbed regions had occurred in each case.

Animals↗
PubMed2005

Barrier properties and cost implications of a single versus a double wrap for storing sterile instrument packs.

BACKGROUND: Materials for wrapping sterile items continue to evolve, but evaluation of such products under clinical conditions is rare. The purpose of the current study was to test a new product before introducing it to the hospital's sterilizing processing unit. METHODS: Four hundred packs containing 1199 items were prepared. Half were wrapped in linen and Kimguard sterile wrap (Kimberley-Clark Australia Pty, Ltd; Queensland, Australia), and half were wrapped in Kimguard One-Step sterile wrap (Kimberley-Clark). They were stored on shelves in 4 areas in the hospital. Items from the packs were periodically tested in the laboratory to evaluate shelf life. Time of wrapping was measured on a series of 50 packs (25 using each product), wrapped by 1 experienced person. These were unwrapped by an operating room nurse, and, again, the process was timed. RESULTS: Bacteria were cultured from 20 (1.7%) of the 1157 test items. There were no differences on this measure between the 2 products (P = .64). Coagulase-negative Staphylococcus was the most frequent isolate, accounting for 40% of the positive results. The average time taken to wrap the test tray with the double wrap was 56.4 seconds compared with 32.4 seconds with the single wrap (P < or = .000). Unwrapping the single pack (5.02 seconds) was also faster than unwrapping the double-wrap pack (6.92 seconds; P = .000). CONCLUSIONS: Wrapping sterile items using Kimguard one-step sterile wrap carries no greater risk of bacterial contamination than double-wrap methods and may lead to significant cost savings in both labor (time to wrap) and consumables (linen and recycling costs).

Bacteria↗
PubMed2005

Transcervical sterilization.

The transcervical approach to permanent female sterilization has been studied for more than 150 years. Methods for accessing the tubes via this approach include blind, radiological and visual (hysteroscopic) techniques. Modalities for occluding the fallopian tubes include thermal, chemical and mechanical means. Some combination of the approach and the occlusive method define all known procedures. Initial attempts at transcervical sterilization were not widely adopted due to an inability to occlude the tube reliably, resulting in pregnancy and/or high morbidity from the procedure. Quinacrine sterilization is a procedure that is widely used in the developing world, but this has not been taken up by the developed world. There are limitations in diagnosing tubal occlusion with this technique. New methods for transcervical sterilization include the Essure and the Adiana procedures. These methods involve hysteroscopic placement of devices that rely on both mechanical occlusion and stimulation of tissue ingrowth to effect tubal occlusion. These new devices can be delivered to more than 90% of tubes, have very high success rates of pregnancy prevention (>99% in studies to date) and are acceptable to patients. Most importantly, they can be fitted under local anaesthesia in an ambulatory setting. The cost advantages of transcervical sterilization have not yet been investigated. It is possible that such a modality for permanent female sterilization may be demonstrated to be highly cost-effective.

Ambulatory Surgical Procedures↗
PubMed2004

Use of erythromycin for nonsurgical female sterilization in West Bengal, India: a study of 790 cases.

OBJECTIVE: Determine if erythromycin is an effective agent for achieving occlusion of the Fallopian tube for nonsurgical female sterilization. METHODS: Two studies of 100 healthy volunteers requesting sterilization were planned, one in Julpia Andhermanik and the other in Kolkata (Calcutta). A readily available marketed tablet preparation containing 500 mg of the estolate salt of erythromycin was used for the trial. In one study (Bishnupur), the tablet was crushed before placing in a copper-T IUD inserter for placement at the fundus. In the other study (Kolkata), crushed tablets were processed into 50 mg pellets of the same diameter as standard quinacrine pellets and 10 pellets were inserted at the fundus using aseptic precautions. Procedures in each study were repeated at 30 days. Oral contraceptives were prescribed for three cycles following first insertion. No incentive was offered for participation in the trial. Follow-up treatment, including first-trimester abortion for pregnancy due to failure of the sterilization procedure, was assured without charge. Due to extraordinary patient demand, one study (Bishnupur) was expanded to 690 cases for reasons of compassion. RESULTS: At 12 months of use, the failure rate of the sterilization procedure for the crushed 500 mg tablets was 35.8% (SE = 1.8) with 417 women at risk. At 12 months of use, the failure rate for the erythromycin pellets was 28.6% (SE = 5.0) with 43 women at risk. There were no serious complications reported in either trial. All pregnancies resulting from failure of the sterilization procedure were terminated by menstrual regulation within 10 weeks gestation. CONCLUSIONS: The failure rate in this study is unacceptably high for erythromycin to be used as a sterilization method.

Erythromycin↗
PubMed2006

Hormone levels before and after tubal sterilization.

OBJECTIVE: The aim of this study was to determine whether women experience significant luteal phase hormonal changes following interval tubal sterilization. DESIGN: This is a partly randomized, prospective clinical study. SETTING: This study involved healthy volunteers in an academic research environment. PATIENTS: This study involved 118 fertile women seeking tubal sterilization and 57 fertile controls with at least three normal cyclic menstrual periods before entry into the study. INTERVENTIONS: The patients were randomized to bipolar cautery or Hulka clip as sterilization methods. Barrier contraception or abstinence was used by controls. MAIN OUTCOME MEASURES: The main outcome measures are serum estradiol and progesterone levels and urinary estradiol and pregnanediol levels obtained during the luteal phase before, 1 year and 2 years after sterilization. RESULTS: The women randomized to the bipolar cautery group had higher midluteal progesterone levels measured between Days 5 and 11 postovulation (15.5 ng/mL before sterilization, 14.5 ng/mL at 1 year and 14.5 ng/mL at 2 years) than did the other two groups. The clip group had progesterone levels of 14.1, 12.0 and 12.5 ng/mL at baseline, 1 year and 2 years, respectively, and the control group had levels of 12.0, 11.9 and 11.3 ng/mL for the same periods. Serum estradiol and progesterone and urinary pregnanediol and estradiol were not significantly changed over the 2-year period, nor were there significant differences between the two groups. CONCLUSIONS: There were no significant hormonal changes in sterilized women over a period of 2 years when compared with their baseline levels or when compared with unsterilized age-matched controls.

Adult↗
PubMed2006

Tubal sterilization: complications of laparoscopy and minilaparotomy.

OBJECTIVE: To evaluate whether intra- and post-operative morbidity varies according to the method used for female sterilization. STUDY DESIGN: The database of the Swiss obstetric study group was analyzed for a period of 9 years. After the exclusion of cases with extraneous factors that may have influenced the operative outcome, three groups of patients were identified: (1) interval laparoscopic sterilization unrelated to pregnancy (n=20,325); (2) postpartum laparoscopic sterilization (n=2233); (3) postpartum sterilization by minilaparotomy (n=5095). Intra-operative and post-operative complications were compared according to the surgical approach. RESULTS: A total of 27,653 patients were included in the study. The proportion of major complications was higher in group 3 than in group 1 (0.39% versus 0.10%, odds ratio 4.0, 95% CI 2.15-7.44, p<0.001) but not statistically different between groups 1 (0.10%) and 2 (0.18%). Minor complications were statistically significantly more frequent in group 3 (0.82%) than in group 1 (0.26%) or group 2 (0.27%). There was no case of intra-operative or post-operative death in the study population. CONCLUSION: When available, a laparoscopic approach should be chosen for female sterilization. After uneventful pregnancy course and delivery, it does not seem justified to delay the endoscopic sterilization to a later time.

Adult↗
PubMed2005

A comparison of post-operative complications following wisdom tooth surgery performed with sterile or clean gloves.

This randomised prospective study aimed at evaluating possible differences in the post-operative complication rate following lower wisdom tooth surgery performed with either sterile or clean surgical gloves. The microbiological profiles of the tooth sockets and glove surfaces were also evaluated and compared. A total of 275 ASA I, non-smoking and non-drinking patients consented to be randomly assigned into two groups for lower wisdom tooth surgery, performed by operators wearing either sterile or clean gloves. All the patients returned for a post-operative assessment visit one week later. An additional 40 patients were recruited and randomised into the sterile glove group (n = 20) or the clean glove group (n = 20) for the microbiology study. Specimens were taken from the glove surfaces and the post-operative socket wounds during wisdom tooth surgery. This clinical trial showed no significant difference between the sterile and clean glove groups in the incidence of acute inflammation, acute infection and dry sockets in the wounds. No single peri-operative factor had a statistically significant effect on post-operative pain intensity. Most of the bacterial isolates from the clean gloves were Gram-positive cocci or spore-forming bacilli. The total number of colony forming units and the variety of bacterial isolates from the socket wounds in the sterile and clean glove groups were similar. The study concluded that there was no advantage in using sterile surgical gloves rather than clean gloves to minimize post-operative complications in wisdom tooth surgery. There was also no apparent relationship between the bacteria contaminating the clean glove surfaces and those isolated from the socket wounds.

Adolescent↗
PubMed2006

Effective terminal sterilization using supercritical carbon dioxide.

Gentle alternatives to existing sterilization methods are called for by rapid advances in biomedical technologies. Supercritical fluid technologies have found applications in a wide range of areas and have been explored for use in the inactivation of medical contaminants. In particular, supercritical CO(2) is appealing for sterilization due to the ease at which the supercritical state is attained, the non-reactive nature, and the ability to readily penetrate substrates. However, rapid inactivation of bacterial endospores has proven a barrier to the use of this technology for effective terminal sterilization. We report the development of a supercritical CO(2) based sterilization process capable of achieving rapid inactivation of bacterial endospores while in terminal packaging. Moreover, this process is gentle; as the morphology, ultrastructure, and protein profiles of inactivated microbes are maintained. These properties of the sterilization process suit it for possible use on a wide range of biomedical products including: materials derived from animal tissues, protein based therapies, and other sensitive medical products requiring gentle terminal sterilization.

Carbon Dioxide↗
PubMed2005

Sterilization by gamma radiation impairs the tensile fatigue life of cortical bone by two orders of magnitude.

Cortical bone grafts are utilized frequently for skeletal reconstruction, spinal fusion and tumor surgery. Due to its efficacy and convenience terminal sterilization by gamma radiation is often essential to minimize disease transmission and infection. However, the impairment in the material properties of bone tissue secondary to gamma radiation sterilization is a concern since the mechanical functionality of a bone graft is of primary importance. While the extent of this impairment is well investigated for monotonic loading conditions, there does not seem to exist any information on the effects of gamma radiation sterilization on cortical bone's fatigue properties, the physiologically relevant mode of loading. In this study we investigated the degradation in the high-cycle and low-cycle tensile fatigue lives of cortical bone tissue secondary to gamma radiation sterilization at a dose of 36.4 kGy which approximately falls in the higher end of the standard dose range used in tissue banking. The high-cycle and the low-cycle fatigue tests were conducted under load control at initial strain levels of 0.2% and 0.4%, respectively. Monotonic tensile tests were also conducted to compare the impairment of fatigue properties with the impairment of monotonic properties. Results demonstrated that the impairment in both the high-cycle and the low-cycle fatigue lives were two orders of magnitude following sterilization, a change much more pronounced than that observed for monotonic loading. In conclusion, the results suggest that the impairment of the mechanical function of gamma radiation sterilized allografts is even worse in fatigue than monotonically. Therefore, grafts should be designed to minimize functional strains and avoid stress raisers to prevent premature fatigue failures.

Adult↗
PubMed2005

Effect of microwave sterilization and water storage on the Vickers hardness of acrylic resin denture teeth.

STATEMENT OF PROBLEM: Acrylic resin denture teeth soften upon immersion in water, and the heating generated during microwave sterilization may enhance this process. PURPOSE: Six brands of acrylic resin denture teeth were investigated with respect to the effect of microwave sterilization and water immersion on Vickers hardness (VHN). MATERIAL AND METHODS: The acrylic resin denture teeth (Dentron [D], Vipi Dent Plus [V], Postaris [P], Biolux [B], Trilux [T], and Artiplus [A]) were embedded in heat-polymerized acrylic resin within polyvinylchloride tubes. For each brand, the occlusal surfaces of 32 identical acrylic resin denture posterior teeth were ground flat with 1500-grit silicon carbide paper and polished on a wet polishing wheel with a slurry of tin oxide. Hardness tests were performed after polishing (control group, C), after polishing followed by 2 cycles of microwave sterilization at 650 W for 6 minutes (MwS group), after polishing followed by 90-day immersion in water (90-day Wim group), and after polishing followed by 90-day storage in water and 2 cycles of microwave sterilization (90-day Wim + MwS group). For each specimen, 8 hardness measurements were made and the mean was calculated. Data were analyzed with a 2-way analysis of variance followed by the Bonferroni procedure to determine any significance between pairs of mean values (alpha=.01). RESULTS: Microwave sterilization of specimens significantly decreased (P <.001) the hardness of the acrylic resin denture tooth specimens P (17.8 to 16.6 VHN), V (18.3 to 15.8 VHN), T (17.4 to 15.3 VHN), B (16.8 to 15.7 VHN), and A (17.3 to 15.7 VHN). For all acrylic resin denture teeth, no significant differences in hardness were found between the groups MwS, 90-day Wim, and 90-day Wim + MwS, with the exception of the 90-day Wim + MwS tooth A specimens (14.4 VHN), which demonstrated significant lower mean values (P <.001) than the 90-day Wim (15.8 VHN) and MwS (15.7 VHN) specimens. CONCLUSIONS: For specimens immersed in water for 90 days, 2 cycles of microwave sterilization had no effect on the hardness of most of the acrylic resin denture teeth.

Acrylic Resins↗
PubMed2005

The impact of health care providers on female sterilization among HIV-positive women in Brazil.

This paper explores the reproductive preferences and outcomes of HIV-positive women in two cities in Brazil. We used three types of data, all drawn from women who delivered in public sector hospitals: (1) clinical records of 427 HIV-positive women; (2) pre- and postpartum in-depth interviews with 60 HIV-positive women; and (3) a prospective survey carried out among 363 women drawn from the general population. The HIV-positive samples were collected on women who had prenatal care between July 1999 and June 2000, and the general population survey was conducted with women who started prenatal care between April 1998 and June 1999. Among the women in the clinic sample, we found dramatic differences in the proportion sterilized postpartum: 51% in Sao Paulo vs. 4% in Porto Alegre, compared to 3.4% and 1.1%, respectively, of women in the general population. Our qualitative data suggest that HIV-positive women in this study had strong preferences to have no more future children and that female sterilization was the preferred way to achieve this end. Therefore, we conclude that the large difference in rates is mainly due to HIV-positive women's differential access to sterilization in the two settings. In-depth interviews revealed that women in Sao Paulo were often encouraged by clinic staff to be sterilized postpartum. In contrast, HIV-positive women in Porto Alegre clinics were not offered sterilization as an option and those who requested it were repeatedly put off. The striking difference found in the frequency with which doctors provide postpartum sterilization to seropositive women in our study sites deserves attention and discussion in the respective medical communities. At the higher level of national policy on reproductive rights, there may be grounds for reopening discussion about the norms regarding postpartum procedures, and for devoting far more resources to expanding contraceptive options.

Adult↗
PubMed2004

The preparation of TiO2 nanometer photocatalyst film by a hydrothermal method and its sterilization performance for Giardia lamblia.

The photocatalytic property of TiO(2) is utilized to sterilize the Giardia lamblia in an aqueous solution in this study. The TiO(2) colloidal solution used for the film was prepared by the modified hydrothermal method and it was directly coated on a UV-lamp, which was set up using a photoreactor manufactured in our laboratory. The TiO(2) film was very stably attached to the UV-lamp, and it was transparent until 5-time coating. The size of the TiO(2) particle in the film was distributed around 20-30 nm and the film thickness was about 200 nm per 1-time coating. The G. lamblia cell was just partially damaged under UV-irradiation without a TiO(2) photocatalyst, but the dead cell became very small and the dead body finally disappeared with an increase in the intensity of UV-irradiation after 2 h. In addition, under the TiO(2)/UV-irradiation system, the sterilized (dead) rate of G. lamblia was very fast. The sterilizing power increased at lower pH in the initial step, but it rather increased at a higher pH in the final step. And the sterilization of G. lamblia was very sensitive to the temperature, and resulted in an increase in the sterilized rate at higher temperatures. On the basis of these experimental observations, it can be concluded that TiO(2) photocatalyst under UV-irradiation could be adopted as one of the sterilization modalities for the G. lamblia.

Animals↗
PubMed1984

Early readmission following elective laparoscopic sterilization: a brief analysis of a rare event.

This study examines some potential factors that are associated with occasional readmission soon after discharge for laparoscopic sterilization--a generally innocuous outpatient procedure. Thirty-six early readmissions among 22,000 cases of laparoscopic sterilization (an incidence rate of 1.6 per 1,000 procedures) in an international data set were investigated. Early follow-up (7 to 21 days after sterilization discharge) was 95%. The complications that led to readmission were of a more serious nature (e.g., intestinal burn/injury) among women sterilized by electrocoagulation (all unipolar) than among women sterilized with clips. Among electrocoagulation cases, women who were sterilized less than 42 days postabortion or postpartum were significantly more likely to be readmitted than were women who had not recently been pregnant. All readmitted women were discharged in satisfactory condition. The mean overall hospital stay during readmission was 7.3 days--10.6 days for electrocoagulation, 5.6 days for tubal ring, and 2.1 days for clip cases. A case-control analysis did not reveal a significantly higher relative risk for readmission among women with previous abdominal operations than among those without.

Abscess↗
PubMed2000

Luteal function declines after laparoscopic sterilization by Hulka or Filshie clips.

We evaluated the influence of laparoscopic sterilization by Hulka or Fishie clips on corpus luteum function. Changes in corpus luteum function were evaluated in 46 women, before and after sterilization by Hulka (n = 22) or Filshie clips (n = 24). The mean age of the participants was 37 years (range 31-43 years). All women were healthy with regular menstrual cycles. Serum progesterone (P) was measured in one cycle before, and 3 and 12 months after the sterilization on cycle day 20-24. Endometrial biopsies were performed in the luteal phase before and one year after the procedure. The women measured the basal body temperature daily and kept a menstrual diary. The luteal phase P concentrations declined after the sterilization and the values were at the lowest level 3 months after the procedure (27.9 +/- 14.3 nmol/L vs. 18.7 +/- 13.4 nmol/L, = 0.0016). The values seemed to have recovered by 12 months (23.0 +/- 14.0 nmol/L, = 0.114 vs. baseline). Endometrium tended to be out-of-phase more frequently 1 year after the sterilization than before the surgery (= 0.065). Laparoscopic tubal sterilization is associated with an increased risk of luteal phase deficiency. However, the change may be only temporary in nature.

Adult↗
PubMed1991

Effect of three sterilization techniques on finger pluggers.

The effects of different sterilization methods on the fatigue life of finger pluggers were investigated. Ninety finger pluggers for each of four sizes (A, B, C, and D) were subdivided into subgroups of 10. Each subgroup was subjected to 1, 8, or 15 cycles of steam autoclave, dry heat, or bead sterilization. Ten control pluggers for each size were not sterilized. After sterilization, experimental and control finger pluggers were subjected to cyclic bending until fracture. Only the A finger pluggers autoclaved for eight cycles had a significantly lower number of cycles to failure compared with that of the controls. Nine subgroups had significantly greater number of cycles before failure than did the control. Because all but one sterilized group had fatigue lifetimes statistically equal to or greater than nonsterilized controls, clinicians generally can use any of the three sterilization methods without fear of plugger failure.

Analysis of Variance↗
PubMed1998

An evaluation of sterilization of endodontic instruments in artificial sponges.

The ability to sterilize endodontic files inserted into synthetic sponges was tested. Sponges were subjected to 5 cycles of either dry heat (Driclave) or steam under pressure (autoclave) sterilization. Sterilization was corroborated by microbiological tests. The sponges and files were pre-sterilized separately using steam under pressure. One hundred eighty files contaminated with Bacillus stearothermophilus spores (experimental and positive control) and 60 noncontaminated files (negative control), were inserted into 60 sponges. After each cycle, each file and a portion of sponge surrounding the file were transferred aseptically to tubes containing trypticase soy broth culture medium for bacteriological analysis. None of the tubes containing files and portions of sponges that were subjected to autoclave grew Bacillus stearothermophilus spores. Two of 60 (3.33%) of the tubes that were subjected to sterilization by Driclave demonstrated bacterial growth. Although the sponges tolerated the dry heat cycles well physically, sterilization was achieved in only 96.67% of the cases.

Animals↗
PubMed1996

Microwave plasmas for low-temperature dry sterilization.

The use of microwave plasmas for dry sterilization has been investigated. The dry-sterilization process is a process similar to plasma etching. Bacteria and viruses can be killed by chemical reactions which disintegrate their bodies and remove them from the surface to be sterilized. The removal of bacteria or viruses from material surfaces is caused by the reaction of activated oxygen species in the plasma with hydrocarbon bonds of the cell wall of the bacteria or the capsid of the viruses. Preliminary experiments indicate that the low-temperature dry sterilization method is easy to use, requires much less time than other methods for sterilization, and is also non-toxic. It is feasible for use in the field of sterilization in dental and medical clinics.

Bacteria↗