Absceso hepatico amibiano en 84 enfermos estudiados en el Instituto Nacional de la Nutricion Salvador Zubiran, en los ultimos 5 anos. / Hepatic amebic abcess in 84 patients studied in the Instituto Nacional de la Nutricion Salvador Zubiran, in the last 5 years

Se analizan 84 casos de absceso hepatico amibiano en sus caracteristicas clinicas, de laboratorio y de gabinete, fundamentalmente la centelleografia y la ultrasonografia, con el fin de valorar la utilidad de estos dos ultimos procedimientos en forma comparativa. Ademas se analizan las variaciones en cuanto a frecuencia, la etapa de la enfermedad en que las pacientes asisten al hospital y los resultados terapeuticos. El numero de casos vistos en los 5 anos fue de 17 por ano en comparacion con 35.7 que se encontraron en los 5 anos previos. La proporcion de hombres es un poco menor: de 4 a 1. Previamente eran de 6 a 1, el diagnostico se sospecho clinicamente en el 97% de los casos. Las reacciones de hemaglutinacion, la centelleografia y la ultrasonografia vinieron a confirmar el diagnostico. Utilizando los dos ultimos procedimientos se corroboro la impresion clinica en todos los casos estudiados. Podemos considerar que debido a la oportunidad del diagnostico y a la efectividad del tratamiento, la mortalidad ha venido disminuyendo, ya que en los ultimos 5 anos no hubieron casos de muerte en el Instituto

Salpingitis associated with the presence of nonmedicated IUDs.

Fallopian tube tissue obtained at Pomeroy sterilization of 75 normally cycling women, 75 women 2 to 3 days postpartum, and 75 asymptomatic women who had used a nonmedicated IUD for at least a year was examined histologically. There was an increased frequency of tissue edema and congestion in the postpartum group only. The frequency and extent of acute inflammatory changes in the three groups was not significantly different.

PIP: The histology of the Fallopian tubes in asymptomatic women using an IUD for at least 1 year was studied, using asymptomatic postpartum women and normally menstruating women scheduled for Pomeroy sterilization as controls. 225 patients, 75 with inert IUD in place, 75 undergoing salpingectomy 2-3 days after delivery, and 75 normally menstruating women undergoing elective salpingectomy, provided tissue samples. There was no difference in the frequency of edema and congestion in tissue of control vs. those with an IUD (P .05); on the other hand, the higher frequency of this alteration in postpartum subjects was statistically significant (P .02). The frequency of acute inflammatory infiltrate ranged from 29 in controls-37% in IUD subjects, but these differences were not statistically significant (P .05). The distribution of patchy, moderate, or marked acute inflammatory infiltrate was 68, 27, and 4.5%, respectively, in the control group. There was no statistically significant difference between this distribution and that observed in the IUD or postpartum subjects.

Absence of capillary microangiopathy in oral contraceptive users with glucose intolerance.

The possible vascular hazard associated with carbohydrate intolerance produced by long-term use of oral contraceptives was investigated by examining the capillary basement membrane thickness in quadriceps muscle biopsies, a highly sensitive and reliable indicator of diabetic microangiopathy. The average basement thickness of 18 long-term (4-9 years) contraceptive users with diminished carbohydrate tolerance was 1644 A, compared to normal pregnant women (1711 A) prediabetic pregnant women (1854 A), and overt diabetic women (2593 A). Contraceptive steroid-induced carbohydrate intolerance appears to carry little, if any, increased risk for the development of diabetic vascular disease, even as assessed by the sensitive electron microscopic technique.

PIP: A study was directed at determining the possible relationship between contraceptive steroid-induced glucose intolerance and microangiopathy. Data on the individual subjects are summarized. The study examined the capillary basement membrane thickness in quadriceps muscle biopsies, which has been proven to be a reliable and sensitive indicator of diabetic microangiopathy. The numbers in the study were too small for a statistically significant conclusion to be reached. All data did, however, conform to normal distribution expectations. Results suggest that individuals on an oral contraceptive regimen have little, if any, increased risk of developing diabetic vascular disease.

Histology of the baboon endometrium during the menstrual cycle and pregnancy.

The histologic characteristics of baboon endometrium during the menstrual cycle and pregnancy were studied and compared with those of human endometrium. Eight phases of endometrial change during the menstrual cycle are described. The samples were dated on the basis of sex skin changes. The basic histology of the baboon endometrium is similar to that of human endometrium, but some differences were observed. The growth of baboon endometrium is more sluggish, secretion is less intense, and many of the changes, especially in the stroma, are localized, less diffuse than they are in human endometrium. During pregnancy, decidual transformation in the baboon is much less intense than that in the human. No differences were observed between endometrium in association with preimplantation embryos and that from nonpregnant animals at comparable times following ovulation.

Comparative studies of the ethynyl estrogens used in oral contraceptives. I. Endometrial response.

Reproductive-age women were given identically prepared mestranol or ethynylestradiol orally for two consecutive 21 day cycles in doses ranging from 50 to 100 mug per day. Endometrial biopsies were obtained at the end of the second cycle and assessed for estrogenic effect. At these dose levels and with this treatment regimen, no differences could be detected between doses or between drugs, indicating that a plateau in endometrial response was reached.

PIP: The effect of 50-100 mcg of mestranol or ethinyl estradiol (EE) on the endometrium was studied in normal women who had never used oral contraceptives. Endometrial biopsies were obtained at the end of the 2nd cycle and assessed for estrogenic effect. Women using the low EE dose also used an IUD for contraception. Also, biopsies were obtained from women using IUDs alone. No histologic differences were found between different doses of the same drug (50, 80, 100 mcg mestranol; 50, 80 mcg EE). No histologic differences could be found between equal doses of mestranol and EE. The treated IUD users showed a delayed maturation of the secretory endometrium and an increased tendency towards predecidualization. The findings suggest that an endometrial plateau is reached with the 50 mcg dose, and that the tissue is relatively insensitive to increased dosage.

Endometrial morphology in women exposed to uterine systems releasing progesterone.

A blind study was done in 402 endometrial biopsies of women who had intrauterine devices releasing different daily amounts of progesterone or a placebo (empty device): 175 were obtained in what presumably was the proliferative phase and 227 in the secretory stage, as all these subjects were normal, healthy women with a history of previous fertility. With all dose levels of the progesterone-releasing devices there was variation of the endometrium general pattern and the over-all picture varied from normal secretory to suppressed endometrium. In addition to these changes of the endometrial pattern, in 231 specimens there was significant inflammatory infiltration and in six cases even plasma cells were seen. Predecidual reaction was frequently seen and in 45 cases it was diffuse and marked. The significance of these data is discussed on the grounds of the frequent similarities of the changes here reported with those in women using combined oral steroids for contraception.

[Injectable contraceptives. 10 years' clinical experience]. / Anticonceptivos inyectables. Diez años de experiencia clínica.

PIP: 3 parenteral progestogens (medroxyprogesterone acetate, northisterone enanthate, and dehydroxyprogesterone acetophenide with estradiol enanthate, DPA) were studied in 907 women during 14,958 cycles over a 10-year period. The findings are summarized in 9 diagrams. The frequency of the principal side effects - intermenstrual bleeding, amenorrhea, headache, dizziness and nervousness - varied with the different substances. Intermenstrual bleeding and amenorrhea were least serious using DPA. When the injections were administered at the appropriate intervals, the drugs were effective and no pregnancies occurred. After suspending the treatment, the menstrual pattern returned to normal and the endometrium was fully regenerated. To date no fetal abnormalities have been reported after discontinuing the treatment.^ieng

Ovarian morphologyy after prolonged use of steroid contraceptive agents.

PIP: To assess the effect of oral contraceptives on ovarian morphology, 125 users (average age 30) and 42 controls (average age 24) were studied histologically. The duration of the steroid treatment in the 125 subjects varied from 2 to 91 months. 60 used combination oral contraceptives, 28 used sequential, 21 received depot progestins, and 16 used continuous low dose progestin. Investigation was directed to the presence or absence of the various ovarian structures. In all specimens primary follicles were seen. Women using combined and depot progestins showed disturbance in the secondary follicles development. Tertiary follicles were common in the low dose progestin, occurring occasionally with sequential and combination treatment, and never with depot progestin. Ovaries from steroid treated patients appeared to have a large number of atretic follicles with cystic dilatations. An increase in ovarian connective tissue occurred in half of the cases using combined preparations, one third of those using sequential, and almost all of those using depot progestin.^ieng