Preventing the heterosexual spread of AIDS: what is the best advice if compliance is taken into account?

It has been recently advocated that avoiding partners who may be at high risk of carrying HIV provides 5000-fold better protection against HIV infection than usage of condoms [1]. In this paper, it is demonstrated that this guideline is largely based on unrealistic assumptions. If the sensitivity of identifying high-risk partners, realistic estimates of the efficiency of mechanical and chemical barrier methods, and the compliance in following either strategy are taken into account, use of condoms and/or suppositories containing nonoxynol-9 might be more effective than the attempt to avoid high-risk partners. Thus, both barrier methods should be strongly recommended for casual sexual heterosexual contacts.

Contraception for the insulin-dependent diabetic woman: the view from one clinic

Experience in a large diabetic clinic has confirmed the suspicion that insulin-dependent diabetic women are at considerably increased risk of thromboembolic disease if they take combined estrogen/progestogen oral contraceptive preparations. The most obvious alternative, an intrauterine device, is associated with an unexpectedly high failure rate, probably because of an unusual metabolic interaction with the diabetic endometrium. In a small group of diabetic women the progestogen-only pill was found to be a successful form of contraception not associated with any side effects except for menstrual irregularities. For most diabetic women the choice of contraceptive should therefore be between a progestogen-only pill and a mechanical method. Female sterilization and injectable progesterone each have their place in particular circumstances. Careful counseling of each patient is essential to ensure the best choice of contraceptive and correct application of the chosen method.

Risk of exogenous estrogen therapy and endometrial cancer

A retrospective study was carried out on 431 patients with endometrial cancer and 431 control subjects matched as to age, race, and parity. They were seen at Duke University Medical Center from 1940 to 1975. The study was performed in order to evaluate the risk of exogenous estrogen therapy and the development of adenocarcinoma of the endometrium. The overall risk was 2.38, with certain subgroups demonstrating different degrees of risk. Increased risk was associated with estrogen therapy of longer than 5 years' duration in white patients. The risk also was confined to Stage I, grade 1 lesions and more superficial myometrial invasion. Five-year survival for patients who used estrogen replacement and had Stage I, grade 1 lesions was 94.7%. The risks associated with exogenous estrogens are real but should be considered in a risk/benefit context when prescribing for the needs of an individual patient.