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BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1987; 65(6):817-27.Cervical cancer ranks as the 2nd most frequent cause of cancer in women. Research demonstrates that infection with the human papilloma virus (HPV) leads to cervical cancer. The clinical HPV lesion in both sexes is the pointed wart like tumor called condyloma acuminatum. Detecting subclinical lesions varies, however, based on the genital organ and on the methods of examination. Several types of HPV infect anogenital epithelia and the resultant disease is partially determined by HPV type. In vitro methods to detect HPV do not exist, so laboratory personnel must depend on biochemical diagnostic procedures--molecular hybridization and serological procedures. HPV lesions, especially HPV- 16 and HPV-18, may turn into carcinomas depending on the activation or inactivation of some unknown genes perhaps influenced by tobacco smoking, oral contraceptives, other genital infections, or other unknown cofactors. Clinicians need to realize the potential gravity of HPV infection including the pathogenesis of lesions and its transmission through sexual contact. They must also be able to perform those diagnostic procedures that can detect HPV infection. Treatment of HPV lesions (e.g., cryosurgery, cautery, etc.) aims to either cure a repulsive, infectious, yet uncomplicated condition or prevent invasive cancer if HPV is connected with intraepithelial neoplasia. The results of the few well controlled studies of treatment of anogenital HPV- induced lesions show that 15-60% of lesions return with 3 months of treatment. Researchers must discover if humoral immunity can protect against HPV infection, and if it can, a vaccine using purified structural proteins should quickly be developed and approved.
[Voluntary sterilization in France and in the world] La sterilisation volontaire en France et dans le monde.
Paris, Masson, 1981. 277 p.This monograph, directed not only to medical and paramedical personnel but to sterilization seekers as well, touches upon all aspects of voluntary sexual sterilization. The history of sterilization is follwed by a review of female and male anatomy and physiology, and of present available and reversible methods of contraception. All surgical, laparoscopic, tubal, electrocoagulation, culdoscopic, or hysteroscopic methods of female sterilization are described, and results, including morbidity and mortality, complication rates, side effects, and failure rates are presented. This part of the monograph is illustrated with clear and schematic drawings. Problems related to demand for reversal of sterilization are discussed. The same is done for male sterilization, its techniques and complications. The monograph discusses the ever increasing demographic problem in the world , and the role and the extent of voluntary sexual sterilization in industrialized countries and in third world countries, stressing the efforts of those international agencies, such as WHO, IPPF, the Population Council, the European Council, UNFPA, and the World Federation of Associations for Voluntary Sterilization, which promote sterilization around the world, and offer sterilization services. The authors then investigate the role of the physician in the decision to recur to sterilization as a permanent contraceptive method, and in deciding the proper surgical technique. A special chapter discusses the psychological conflicts related to sterilization, especially those which arise before the intervention, and which may very well represent the strongest contraindication to sterilization. A final chapter is devoted to France and to the sociocultural aspects which make sterilization more or less acceptable, the existing legislation, and the professional problems linked to sterilization interventions.
In: Phillips JM, ed. Endoscopy in gynecology: the proceedings of the Third International Congress on Gynecologic Endoscopy, San Francisco. Downey, California, American Association of Gynecologic Laparoscopists, 1978. 213-25.The Office of Population of the U.S. AID (Agency for International Development) has given priority to the development of new and improved means of fertility control and to their rapid dissemination and utilization throughout the developing world. Dr. Clifford Wheeless of Johns Hopkins developed a laparoscopic technique of sterilization by electrocoagulation which he publicized in 1967. USAID established a center at Johns Hopkins for the training of developing country physicians in this technque for laparoscopic sterilization under local anesthesia. USAID has provided funds for the establishment of other training centers in female sterilization, development of an improved laparoscope package, and provision of laparoscopic equipment to developing countries. Tables present the dollar value of support for various AID-funded, population-related activities since 1967. So far, 1228 physicians from 68 countries have received AID-sponsored laparoscopic training. More than 800 AID-purchased laparoscopes have been distributed to training gynecologists in 62 countries during the period 1972-77. Other sterilizing techniques and equipment which will accomplish the purpose more easily and safely are under investigation. The effect of the program has been to accelerate the use of female sterilization.
Guide to equipment selection for M/F sterilization procedures. Guide du materiel utilise pour les procedures de sterilisation des hommes et des femmes.
Population Reports. Series M: Special Topics. 1977 Sep; (1): p.This is a guide to aid in selecting and maintaining the proper equipment used in the following sterilization procedures: 1) minilaparotomy, 2) laparoscopy, 3) conventional laparotomy, 4) colpotomy, 5) culdoscopy, and 6) vasectomy. Prototype, experimental, or infrequently used instruments are not discussed. Colpotomy, minilaparotomy, and conventional vasectomy are low-technology procedures requiring relatively simple, locally produced instruments, e.g., retractors, forceps, and scalpels. High-technology equipment consists of specialized items, e.g., laparoscopes and culdoscopes. These are produced in a limited number of technically advanced countries. Equipment donor agencies are discussed. The following factors must be considered in selecting equipment: 1) suitability for the intended procedures, 2) quality of the instrument, 3) ease of repair, and 4) initial cost. Each type of equipment is pictured, diagrammed, described, and charted against others of its kind. Maintenance and repair guidelines are provided.