Thermoregulatory effects of resiniferatoxin in the rat.

When administered acutely, the vanilloid (capsaicin) receptor agonist resiniferatoxin induces marked hypothermia in the ferret, rat and mouse. The aim of this study was to further characterise the thermoregulatory effects of resiniferatoxin in the rat in an attempt to understand the mechanism by which resiniferatoxin induces this hypothermic effect. Three doses of resiniferatoxin were administered (50, 100, 200 micrograms/kg s.c.) in separate animals at an ambient temperature (Ta) of 20 degrees C but there was no apparent dose-related effect on the decrease in colonic temperature over this range. Resiniferatoxin (50 micrograms/kg s.c.) decreased whole body oxygen consumption when measured below thermoneutrality (Ta = 20 degrees C) but not at thermoneutrality (Ta = 29 degrees C); likewise there was no hypothermic response to resiniferatoxin when measured at a Ta of 29 degrees C. Operant responding for radiant heat in a cold environment (-8 degrees C) was also measured in resiniferatoxin-treated (50 micrograms/kg s.c.) rats. These experiments showed that resiniferatoxin-treated rats attempted to defend body temperature by lever pressing for more radiant heat. However, this was not sufficient to reverse the hypothermia. Two repeat doses, 1 week apart, had little or no effect on colonic temperature, oxygen consumption or operant responding in the cold. Resiniferatoxin (50 micrograms/kg s.c.) also produced hypothermia (Ta = 20 degrees C) in neonatally capsaicinized adult rats. The exact site and mode of action is still under investigation, but it is postulated that resiniferatoxin activates, and then destroys or desensitizes warm thermoreceptors.

Cellular immunity in pregnant and non-pregnant women with malarial infection.

A study of lymphocyte subpopulation and leucocyte migration inhibition index (LMI) in 78 pregnant and 22 nonpregnant women with malarial infection (P. vivax 60% and P. falciparum 40%) was done in a hospital in Northern India. Eighty pregnant and 20 nonpregnant women without any infection were also included in the study as controls. T-cell percentage in controls decreased to its lowest in first trimester and gradually rose to nonpregnant levels by the end of puerperium. With malarial infection, there was further drop in T-cell percentage, more so in third trimester. LMI in controls corresponded with T-cell percentage and was depressed in pregnant patients. Enhancement in LMI with malarial infection was depressed in pregnant patients maximally in the third trimester. Parity did not have any influence on these cellular immune parameters. Thus, cellular immunity status in malarial patients was found to be depressed during pregnancy especially in the third trimester.

Histamine bronchoprovocation tests in subjects with gastro-oesophageal reflux disease.

The relationship of gastro oesophageal reflux (GER) with bronchial asthma has already been well documented in asthmatic subjects and it has been postulated that their asthma might have been caused by GER disease. Thus, it was planned to establish an association, if any, between GER and increased bronchial reactivity by histamine broncho provocation. The study was done in 25 GER disease patients and 15 controls. The difference in bronchial reactivity between the two groups was found to be significant (p less than 0.01). It was concluded that GER subjects expressed greater bronchial reactivity and it has been discussed that at a later stage of life they may be more prone to develop asthma.

Return of fertility in various types of IUD users.

The assessment of reversibility of a contraceptive method is of importance to both providers and users. Ninety-one women who discontinued IUD use because of desire of pregnancy were followed up for pregnancy and its outcome. Cumulative pregnancy rates at 3, 6, 12, and 18 months after IUD removal were 61.5%, 87.9%, 92.3%, and 96.7%, respectively. Mean interval from IUD removal to conception was 4.4 months (range, 1-18 months). These findings add further evidence that fertility of women is not impaired by use of IUDs as a spacing method.

PIP: Assessments of the return to fertility after IUD removal are especially critical given widespread use of this method for birth spacing. Data from 5 prospective studies of 8 types of IUDs (6 copper-bearing, 1 progesterone-releasing, and the Lippes Loop) conducted at India's Postgraduate Institute of Medical Education and Research in 1976-84 provide an opportunity for such as assessment. Of the 1300 women enrolled in these comparative trails, 110 requested IUD removal to achieve pregnancy and 91 were available for follow-up. 95% of these 91 women were para 1 or 2; the mean age at IUD removal was 27.6 years. The mean duration of IUD use was 22.9 months (range, 5-45 months). The cumulative pregnancy rates at 3, 6, 12, and 18 months after IUD removal were 62%, 88%, 92% and 97%, respectively, with a mean duration of 4.4 months until conception. 83 of the 88 women who conceived gave birth to healthy, full-term infants; the remaining 5 pregnancies ended in spontaneous abortion. Return to fertility showed no correlation with age at removal, duration of IUD use, timing of insertion, or type of IUD. Women with postabortion insertions and those aged 30 years and older required slightly longer to conceive than younger women with interval insertions, but the difference was not statistically significant.

Social problems of infertile women in India.

Female partners of 200 consecutively seen infertile couples attending our infertility clinic were interviewed on a structured, precoded form for the social problems faced by the childless women. One or more social problems were present in 34% couples, of whom 53% faced abandonment. Sixteen percent of the women had a strained relationship with their husbands. Social problems increased with duration of marriage and infertility, while these decreased with increase in age, education, and income of the husband. Similarly, the problems decreased with women's education and income. Only seven couples had requested AID.

Phase III-clinical trial with Norplant-2 (covered rods). Report of a 24-month study. National Programme of Research in Human Reproduction. Division of Human Resource Development Research Indian Council of Medical Research Ansari Nagar, New Delhi, India.

In a phase III multicentre clinical trial, the subdermal implant NorplantR-2 was studied for its clinical use effectiveness, safety and bleeding pattern. A total of 1466 healthy volunteers, with no contraindication to steroid use, were observed for 29,669 woman-months of use. One method failure was reported at 18 months of NorplantR-2 use. The method was associated with altered menstrual pattern with a trend towards reduced blood loss. The continuation rates were 88.1 and 73.5 per 100 users at 12 and 24 months of use, respectively. Menstrual disturbance, mainly prolonged bleeding, accounted for the majority of the discontinuations. Removal of NorplantR-2 due to local infection was rare (0.4 per 100 users at 24 months). In similar clinical trial conditions, the continuation rate with NorplantR-2 is significantly higher than those observed with LNG IUD and injectable contraceptives, norethisterone oenanthate 200 mg given every 60 +/- 5 days, and is comparable to that of CuT 200 IUD.

Clinical course of malaria in pregnancy--a prospective controlled study from India.

A prospective hospital-based study was conducted from June 1984 to November 1985 in northern India to study the morbidity pattern of malaria in pregnant women. 78 pregnant and 22 non-pregnant women with malarial infection (60% Plasmodium vivax and 40% P. falciparum) were included in the study. The results were analysed according to period of gestation, parity and type of infection. Severity of clinical illness was significantly higher in pregnant patients for both P. vivax and P. falciparum infections. Some striking differences were found in our study when compared with those from African countries. Multigravidas had a slightly higher morbidity than primigravidas, though the difference was not statistically significant. Even though only a small proportion (1.4%) of our pregnant patients were affected by malaria, cerebral malaria, maternal deaths, intrauterine foetal deaths and pre-term labours were much more common.

Study of vaginal delivery in patients with one previous lower segment caesarean section.

This retrospective study evaluated the prospects of having a vaginal delivery following a lower segment Caesarean section in Nehru Hospital; 685 (52%) of 1,315 patients with a previous Caesarean section were given a trial of vaginal delivery with a success rate of 69%. Vaginal breech delivery was allowed in 14 patients without affecting the outcome of term babies and without maternal morbidity or mortality. There were 12 cases (1.7% incidence) of scar disruption of which 4 were of scar rupture. There was no maternal or fetal death as a result of these disruptions even though 3 mothers had subtotal hysterectomy. Pitocin was used in 144 (21%) patients. Of the 12 cases of scar disruption 5 patients had received pitocin. There was no favourable influence of prior vaginal delivery on the success of the trial, and 3 patients with scar disruption had already had a vaginal delivery in addition to a lower segment Caesarean section.

Randomized comparison of different prostaglandin analogues and laminaria tent for preoperative cervical dilatation. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction: Task Force on Prostaglandins for Fertility Regulation.

In an eleven-centre study, 627 nulliparous subjects in the 8th to 12th week of gestation admitted for termination of pregnancy were allocated to one of five treatments to induce pre-operative cervical dilatation. The treatments were: 0.5 mg PGE2 methyl sulphonylamide; 1.0 mg PGE1 methyl ester; 30 mg 9-methylene PGE2 free acid, 0.5 mg 15-methyl PGF2 alpha; a single medium-sized laminaria tent. The results indicate that the three PGE analogues are at least equally effective as one medium sized laminaria tent and more effective than 0.5 mg 15-methyl PGF2 alpha in producing adequate pre-operative cervical dilatation prior to vacuum aspiration. It is concluded that both pre-treatment with prostaglandin analogues and laminaria tent are effective methods for preoperative cervical dilatation and both types of treatment are associated with a low incidence of side effects. Prostaglandin analogue treatment can be administered by paramedical personnel but laminaria tent insertion has to be performed by medical staff.

Management of translocated and incarcerated intrauterine contraceptive devices.

Thirty-seven consecutive patients who reported with absent or snapped strings and failed attempts at removal of intrauterine contraceptive devices (IUCD) by hooks or curette were posted for hysteroscopy/laparotomy following a plain X-ray of the pelvis to exclude unrecognized spontaneous expulsion. Direct visualization of the endometrial cavity was invaluable in locating and removing IUCDs, particularly the embedded and fragmented ones. Translocated medicated devices were associated with dense adhesions, suggesting the need for their prompt removal. There appears to be an increased risk of translocation in lactating women.

PIP: 37 consecutive patients who presented with absent or snapped strings and failed attempts at IUD removal by hooks or curette were referred for hysteroscopy/laparotomy following a pelvic x-ray to exclude unrecognized spontaneous expulsion of the device. The IUD was extrauterine in 19 patients and incarcerated in the uterine cavity in the remaining 18 patients. 17 of the 19 extrauterine devices were copper containing and 2 were inert Lippes Loop IUDs. In all cases, copper devices were associated with dense adhesions. Only 2 patients complained of any abdominal pain. The IUD type among the 18 patients with intrauterine translocated devices was the Lippes Loop in 15 cases and the Copper T in the remaining 3 cases. 6 of these patients had complained of excessive bleeding with pain. Hysteroscopy is invaluable to remove embedded and fragmented IUDs. It is suggested that all devices translocated into the abdomen be removed to avoid potential complications. Laparotomy is the method of choice to remove medicated devices given the dense adhesions often associated with bowel loops. Risk factors considered to be associated with translocation include postpartum insertion, inserter skill, insertion technique, and the status and configuration of the cervix and uterus.

Pathological changes in fallopian tubes following three different kinds of occlusive techniques in primates.

A comparative evaluation of three different techniques (Madlener's, Wood's and Filshie Clip Mark IV) for female sterilization was carried out in adult female rhesus monkeys with the aim of finding out the efficacy and the extent of tissue damage in the fallopian tube. The severity of pathological changes would indicate the chances of future successful reversal. The experiment was carried out in two phases. In Phase-I, no post-operative antibiotics were given whereas in Phase-II in addition to post-operative antibiotics, two sham-operated controls were also kept. This study revealed that the Filshie's clip is associated with significantly (p less than 0.01-0.001) greater tissue damage of the fallopian tubes with formation of dense adhesions as compared to the Madlener's or Wood's technique. Further, Filshie's clip had slipped off from 4 tubes out of 14 tubes where it was applied.