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PubMed2000

Tubal sterilization and risk of cancer of the endometrium.

OBJECTIVE: Surgical sterilization is a common method of contraception among U.S. women. Most surgical sterilizations are tubal ligations, but few studies have investigated their potential impact on endometrial cancer risk. METHODS: A case-control study included 405 women diagnosed with endometrial cancer at 5 U.S. medical centers between 1987 and 1990 and 297 age-, race-, and location-matched controls who were identified by random-digit-dialing. Questionnaires ascertained information on tubal sterilization, and logistic regression models generated odds ratios (ORs) to estimate relative risk. RESULTS: The OR and 95% confidence interval for tubal sterilization, which was reported by 47 cases and 40 controls, was 0.9 (0.6-1.4) before adjustment and 1. 4 (0.8-2.4) after adjustment for age, parity, and oral contraceptive use. Age at surgery, years since surgery, or calendar years of surgery were not associated with endometrial cancer, and associations did not vary according to parity or stage of disease at diagnosis. CONCLUSIONS: Tubal sterilization is not substantially associated with endometrial cancer.

Adult↗
PubMed1976

Laparoscopic sterilization in the immediate puerperium.

The safety and effectiveness of laparoscopic sterilization with electrocoagulation and separation of the tubes when performed within five days of a normal delivery is evaluated. The majority of patients (53.5%) were sterilized within 36 hours of delivery and were discharged on either the same day or the first post-sterilization day (91.0%). While some form of complications were reported for 9.5 percent of the patients, potentially serious complications occurred for only 2 patients (1.%). Most of the complications were probably unrelated to the laparoscopic procedure. At six months after sterilisation, complications were reported by 2.9 percent of the patients who returned for a follow-up visit. One patient became pregnant 3.5 months after sterilization. The results of this study suggest that performing laparoscopic sterilization in the immediate puerperium does not significantly increase the complication or failure rates of the procedure.

Electrocoagulation↗
PubMed1993

Nontraumatic tubal occlusion as a new technique for female voluntary sterilization.

Female voluntary sterilization is the most popular method of contraception worldwide. It is estimated that around 138 million or 16% of fertile couples, have been sterilized by this method. Female sterilization has been widely employed in Bali since 1970, in accord with '100' formula. The acceptance rate of female sterilization as a family planning method is 7.8% in Bali, and 5.1% nationally in Indonesia. But late complications associated with psychosomatic, psychosexual and menstrual disturbances are not infrequently found, complications attributed to the damage of ovarian blood vessels during the operation. Over the years the female sterilization acceptance rate has kept increasing, especially among the younger age group (around 30 years). A nontraumatic tubal occlusion technique has been developed to preserve the ovarian blood vessel during surgery. With the new technique, late complications could be overcome so women could enter a normal menopausal period. This new technique described here needs further study.

Fallopian Tubes↗
PubMed1995

Menstrual disorders and pelvic pain after sterilization.

Changes in menstrual cycle length, menstrual duration, number of pads, dysmenorrhea and non-cyclic pelvic pain were studied in 43 women following tubal sterilization with three different techniques. One group consisted of 17 women undergoing laparotomy by Pomeroy technique; the second group consisted of 11 women undergoing laparoscopy by Fallope rings; and the third group consisted of 15 women undergoing colpotomy by fimbriectomy. The differences before and after sterilization in cycle length were non-significant in all groups (p > 0.05). After sterilization, menstrual duration and number of pads were significantly increased in the laparotomy (p < 0.001) and laparoscopy (p < 0.01) groups but non-significantly in the colpotomy group (p > 0.05). Comparison of these parameters between the groups did not show any significant differences (p > 0.05). After sterilization, increases in the severity of dysmenorrhea and non-cyclic pelvic pain were non-significant in all groups (p > 0.05). We concluded that there were no significant differences in menstrual disorders after sterilization among these three different techniques.

Adult↗
PubMed1994

Mechanical devices for interval laparoscopic tubal sterilization in previous IUD users.

This retrospective analysis was conducted to determine whether IUD users are good candidates for laparoscopic sterilization using the tubal ring and the Filshie clip. The data set used for the analysis came from international multicenter clinical trials involving 1235 women who were sterilized by the tubal ring and 1892 women sterilized by the Filshie clip. Results indicate that former IUD use is not associated with an increased risk of surgical injuries, including uterine perforation, major complications, or postoperative infections, for either of these tubal occlusion techniques. The risk of a sterilization procedure ending in technical failure (defined as switching to laparotomy and/or a tubal occlusion technique not originally planned) among tubal ring cases was greater for former IUD users than for non-IUD users. However, this may be related to a center effect. Nine of the 10 ring cases with technical difficulties were successfully switched to electrocoagulation, and the operator did not have to resort to an unintended laparotomy. The incidence of surgical difficulties among the Filshie clip cases was also higher in former IUD users, but all of these difficulties were safely overcome without changing the tubal occlusion method. These findings lead us to believe that, in general, a woman's IUD use should not generally be a reason for an experienced service provider to hesitate in performing an interval laparoscopic sterilization using a mechanical tubal occlusion technique.

Adult↗
PubMed1995

Follow-up of women seeking sterilization reversal: a Brazilian experience.

OBJECTIVE: To analyze the follow-up of a cohort of women who requested reversal of surgical sterilization. METHODS: This retrospective study was carried out at the State University of Campinas, Brazil. A cohort of 394 women who requested sterilization reversal was followed up for one year after reversal surgery. The analysis includes the percentage of women who completed the steps between the initial consultation up to one year after reversal surgery. RESULTS: After an initial consultation, 55.1% of the patients decided not to continue with the procedures. Of the patients who did undergo laparoscopy (n = 177), 48.6% had no possibility of a successful surgical reversal because the Fallopian tubes were in very poor condition. Only 17.5% of the initial patients requesting reversal ultimately underwent surgery and 3.3% became pregnant. CONCLUSIONS: The analysis of regret about surgical sterilization should include not only women who undergo surgery but also women requesting surgery. Better patient selection and counseling prior to sterilization are necessary in order to prevent increasing rates of sterilization regret in Brazil.

Adult↗
PubMed2000

[Effect of various bone disinfection and sterilization methods on osteoblast function. A comparative in vitro study].

All sterilization and disinfection procedures for bone grafts are different in regard to influence of bone graft features, which may influence the function of different cell types. We used an in-vitro approach to assess the influence of bone matrix, which was sterilized or disinfected, on osteoblastic activities in-vitro by simulating a cell-transplant-interface. Primary bovine osteoblast cell cultures were established from periosteum. Bone graft specimens made of bovine cortical bone (O 15 mm, 300 microns thickness) were treated in 5 different ways: autoclaved, ethylene-oxide-sterilized, demineralized and low-temperature-plasma-sterilized (DEM-LTP), chemically sterilized (modified Tutoplast method), and 80 degrees C-temperature disinfected. The following cell function parameters were assayed: plating efficiency proliferation by measuring the DNA-content, and MTT-activity, soluble protein and extracellular matrix synthesis, alkaline phosphatase, and osteocalcin expression. All disinfected bone grafts were biocompatible with primary periosteal osteoblasts. Measured cell activities upon bone specimens showed better results than cells of the plastic surface control. The DEM-LTP-bone showed better results in comparison to other groups, and stimulated the proliferation and differentiation.

Animals↗
PubMed2003

Influence of ethylene oxide sterilization on the activity of native reindeer bone morphogenetic protein.

We studied the effects of ethylene oxide sterilization (Steri-Vac 4XL, temperature 29 degrees C, exposure time 4 h 10 min, ethylene oxide concentration 860 mg/l) on the osteoinductivity of partially purified native reindeer bone morphogenetic protein (BMP) in a hind leg muscle pouch model of male NMRI mice. BMP was administered in implants containing 3 mg in a collagen carrier. Implants without sterilization and without BMP served as controls. New bone formation was evaluated based on the calcium yield, radiographic and histological examination 3 weeks after implantation. The implants without BMP were not able to induce new bone visible in radiographs. In the sterilized BMP group, the mean area of new bone was 35% ( p=0.004) and density 32% ( p=0.000) smaller than in the nonsterilized group. Calcium yield was 20% lower in the sterilized group than in the nonsterilized group, but this difference was not significant ( p=0.22). It was many times lower in the group without BMP than in the above-mentioned groups ( p=0,001). We conclude that ethylene oxide gas sterilization reduces the bone-forming activity of native reindeer BMP by one third.

Animals↗
PubMed2005

Behavior of Hylamer polyethylene in hip arthroplasty: comparison of two gamma sterilization techniques.

Hylamer polyethylene was introduced in the 1990s as an alternative to conventional polyethylene. Its chemical and physical properties, and especially its high crystallinity, were claimed to improve resistance to wear. Initially Hylamer devices were sterilized by gamma radiation in air, then the technique was changed and gamma radiation was performed in the absence of oxygen. Clinical experience has shown the early loosening of some devices made from Hylamer. The aim of this study was to ascertain whether early wear and consequent osteolysis was linked to the sterilization method. We retrospectively compared 31 patients with hip prostheses with Hylamer liners sterilized by gamma radiation in air (group 1) with 30 patients with the same prosthesis, but sterilized in the absence of oxygen (group 2). The groups were similar for sex, age, disease, head diameter and material. Mean follow-up was 84 months and no clinical signs of failure were present. Radiographic measurement revealed that wear of group 1 was significantly greater than that of group 2 (0.23 mm/year vs 0.09 mm/year, p=0.001). Periacetabular and femoral osteolysis in group 1 was significantly greater than group 2. In conclusion, the method of sterilization might have influenced the outcome of Hylamer polyethylene liners.

Arthroplasty, Replacement, Hip↗
PubMed2006

Evaluation of the sterility test for detection of microbial contaminants of allografts.

Tissue banks routinely use a sterility test to determine the suitability of processed tissue prior to release. However, many tissue banks also accompany the sterility test with additional types of media to ensure detection of slower-growing or more fastidious organisms that may not be detected in the standard two media/two incubation temperature sterility test. This study was designed to determine if a standard sterility test is capable of detecting the wide variety of organisms that may be isolated from human tissue thereby making the additional plated media unnecessary. More than 100 isolates, representing more than 90 different species were tested. All isolates exhibited growth in at least one of the two standard sterility test media within the 14-day incubation period.

Fungi↗
PubMed2005

Validating a low dose gamma irradiation process for sterilizing allografts using ISO 11137 method 2B.

This paper describes the validation of an allograft sterilization method specifically designed for the processing methods used at AlloSource in Centennial, CO. The methods used for this validation followed ISO Standard 11137, Method 2B. Three hundred allografts, collected from three defined production batches were dosed using a series of five incremental doses, beginning at 1 kGy and increasing by 1 kGy until 5 kGy was achieved. Following sterilization dosing, each allograft test article was analyzed using a sterility test to identify any viable microorganisms. The number of positive sterility samples was used to calculate the verification dose (1.27 kGy), which was then verified by an additional batch of 100 allografts. The results from this validation indicate that sterility (10(-6) SAL) on human allograft tissue using gamma 60Co radiation can be achieved when a dose of at least 9.2 kGy is employed.

Animals↗
PubMed2006

Sterilization of allograft bone: is 25 kGy the gold standard for gamma irradiation?

For several decades, a dose of 25 kGy of gamma irradiation has been recommended for terminal sterilization of medical products, including bone allografts. Practically, the application of a given gamma dose varies from tissue bank to tissue bank. While many banks use 25 kGy, some have adopted a higher dose, while some choose lower doses, and others do not use irradiation for terminal sterilization. A revolution in quality control in the tissue banking industry has occurred in line with development of quality assurance standards. These have resulted in significant reductions in the risk of contamination by microorganisms of final graft products. In light of these developments, there is sufficient rationale to re-establish a new standard dose, sufficient enough to sterilize allograft bone, while minimizing the adverse effects of gamma radiation on tissue properties. Using valid modifications, several authors have applied ISO standards to establish a radiation dose for bone allografts that is specific to systems employed in bone banking. These standards, and their verification, suggest that the actual dose could be significantly reduced from 25 kGy, while maintaining a valid sterility assurance level (SAL) of 10(-6). The current paper reviews the methods that have been used to develop radiation doses for terminal sterilization of medical products, and the current trend for selection of a specific dose for tissue banks.

Animals↗
PubMed1979

Sterilization and contraceptive services in Catholic hospitals.

Sterilization and contraceptive practices in United States Catholic hospitals were surveyed by anonymous mail questionnaires, obtaining a 57% response rate (340 of 598). Twenty per cent of the hospitals permitted medically indicated sterilization operations. Forty-seven per cent of those hospitals not allowing sterilization procedures reported that their medical staffs were interested in performing medically indicated sterilizations. The types of contraceptive services offered varied widely. The rhythm method was most frequently available, with oral contraceptives in second place; many hospitals did not provide any family-planning services; 13% utilized all types of contraception. The thesis is advanced that improvement in availability of sterilization and contraceptive services is a duty of hospital medical staffs.

Catholicism↗
PubMed1991

Physicians' attitudes, recommendations and practice of male and female sterilization in São Paulo.

While prevalence of vasectomy is low in Brazil, female sterilization is very high. The potential for growth of vasectomy services may be related to attitudes and practices of physicians. In 1984, 660 physicians at seven major hospitals in São Paulo were randomly selected from a total population of 2207 physicians in these hospitals. They were interviewed about their attitudes towards family planning in general, and specifically towards voluntary sterilization. A high degree of vasectomy among this medical community is indicated by its relatively high prevalence among married physicians and their spouses; about one in ten reported that either they or their spouse had had a vasectomy. Half of the physicians who perform sterilizations perform vasectomies: 22% of obstetricians and gynecologists, 85% of surgeons, and all urologists. In general, physicians would recommend vasectomy and tubal ligation equally often to their clients. Depending on the circumstances, up to 85% of all physicians recommend some sterilization procedure. Recommendation was modified by the type of procedure a physician performed, and by the patient's characteristics. Physician's recommendations of sterilization increased with age and parity of patient and was related to the health conditions and socioeconomic circumstances of the couple.

Adult↗
PubMed1992

Declining mortality in international sterilization services.

Between 1973 and 1988, AVSC supported 1,516,478 female sterilizations and 401,856 vasectomies in 50 countries. Overall, 73 deaths were attributable to voluntary sterilization procedures (yielding mortality rates of 4.7 deaths per 100,000 female sterilizations and 0.5 per 100,000 vasectomies). Causes of death, in order of frequency, were anesthesia (22), intestinal injury (20), infection (19), intra-abdominal hemorrhage (6) and other (6). The female sterilization mortality rate declined from 7.1 per 100,000 procedures in 1973-1981 to 3.7 per 100,000 in 1982-1988. Safer anesthesia practices and improved infection control contributed most to this decline. The mortality rate related to surgical errors declined proportionately less than the rates related to anesthesia and infection. Contraceptive sterilization has become a very safe procedure in these 50 countries, where anesthesia (local and general), surgical technique (minilaparotomy and laparoscopy) and timing of the procedure (interval and postpartum) vary substantially. Future deaths will probably be rare. However, expert surgeons should review each case because identifying the most likely cause of death is always complex and these analyses help shape surgical contraception practices.

Cause of Death↗
PubMed1995

Transcervical quinacrine sterilization: clinical experience.

OBJECTIVE: To review the use of quinacrine pellets for non-surgical female sterilization. BACKGROUND: The transcervical insertion of quinacrine pellets has been under study for over 15 years. It could potentially expand access to sterilization services, because it is relatively simple to administer, with the use of a modified IUD inserter, and is inexpensive. METHODS: Published and unpublished data are reviewed. RESULTS: The short-term safety of transcervical quinacrine appears to be better than surgical sterilization, but it is less effective, especially among women under 35, and there are virtually no data on its reversibility. Thus, it is probably most appropriate for older women, aged 35 and over, but it could be an option for others where access to surgical sterilization is limited. CONCLUSION: The use of quinacrine pellets for female sterilization needs to be reviewed by appropriate regulatory authorities, especially with regard to long-term safety issues, and additional clinical studies are needed to better define a standardized regimen.

Cervix Uteri↗
PubMed1991

Cutting effectiveness of diamond instruments subjected to cyclic sterilization methods.

The effect of repeated sterilization on the cutting effectiveness of one brand of rotary dental diamond cutting instruments was measured. Four groups of five diamond burs were sterilized by four methods: (1) sterilization with a chemical agent (Sporicidin); (2) steam under pressure (autoclave); (3) dry heat (Dri-Clave); or (4) chemical vapor (Chemiclave). Each group of diamond instruments made a timed cut in a ceramic block. This cut and all subsequent cuts were measured and were used to determine a baseline cutting effectiveness. Each group of diamond burs was then ultrasonically cleaned, sterilized, and another cut was made. At the end of 10 cycles there was no difference in cutting efficiency of the dental diamond instruments. However, there are differences in the cutting efficiency of individual diamond instruments. The SEM evaluation made prior to cutting and at the end of the 10 cycles of sterilization demonstrated that diamond wear was similar in all groups and that little diamond particle loss occurred in any group.

Analysis of Variance↗
PubMed1996

Clinical and pathologic characteristics of women undergoing hysterectomy after tubal sterilization.

OBJECTIVE: To examine differences in clinical and pathologic characteristics between women undergoing hysterectomy who had had prior tubal sterilization and those who had not. METHODS: One thousand eight hundred fifty-one women undergoing hysterectomy were enrolled as part of a multicenter, prospective cohort study. We used logistic regression to describe the association between prior tubal sterilization and patient characteristics at hysterectomy. RESULTS: Although sterilized women were not more likely than nonsterilized women to have a menstrual disorder as a presenting complaint, they were more likely to have a primary discharge diagnosis of menstrual disorder (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-2.0). After adjustment for menstrual indices, sterilized women had an increased probability of having normal findings on pathologic examination, which differed by age (women less than 30 years: OR 3.4, 95% CI 2.0-5.8; women 30 years of age and older: OR 1.7, 95% CI 1.3-2.3). CONCLUSION: Differences in clinical and pathologic characteristics between sterilized and nonsterilized women suggest that nonbiologic factors may influence decision making regarding hysterectomy among sterlized women.

Adult↗