Access to emergency contraception.

The introduction of emergency contraception (EC) has encountered barriers derived from the erroneous perception of EC as an abortificient and conservative attitudes. In several countries, "prolife" groups have initiated lawsuits against national regulatory bodies for approving EC. Other barriers are limited availability and high price of dedicated products, lack of information among providers about EC and the requirement of medical prescription for EC. The availability of EC has increased in the last years due to efforts of multiple stakeholders. Facilitating factors include the acceptability of EC by users and providers; dissemination of information about EC; advocacy among policymakers; training of providers; registration of dedicated products; over the counter sales and inclusion of EC in the national norms. By 2005, 109 countries have registered around 50 dedicated products that are available in public services, pharmacies, NGOs or through social marketing and 45 countries have included EC in their national norms.

Breast-feeding duration and growth of fully breast-fed infants in a poor urban Chilean population.

The duration of breast-feeding and the growth of fully breast-fed infants during the first year of life were analyzed according to sex, birth weight, characteristics of the mother, and breast-feeding pattern. All infants (n = 1217) were healthy and fully breast-fed at 30 d postpartum and 63% and 24% were still fully breast-fed at 6 and 12 mo, respectively. The median ages at introduction of nondairy food and of milk supplements were 6.0 and 7.4 mo, respectively. The probability of remaining fully breast-fed for 12 mo was significantly higher in infants with higher birth weight and higher maternal weight, and in infants who breast-fed seven times a day or more in the first 6 mo. The comparison of the monthly weight and length of fully breast-fed infants with the World Health Organization/National Center for Health Statistics reference data showed the adequacy of breastfeeding to support infant growth. When mothers and infants are healthy, breast milk is sufficient to support adequate infant growth and health during the first months of life. The main variables that affect the duration of breast-feeding, nutrition and suckling frequency, are susceptible to interventions by health services. The results reinforce the need to care for maternal nutrition during pregnancy and to provide the support that women need to sustain a high suckling frequency.

Luteinizing hormone pulsatile release and the length of lactational amenorrhoea.

The pattern of luteinizing hormone (LH) pulsatile release and the mean concentrations of follicle-stimulating hormone, oestradiol and progesterone were studied in nursing and non-nursing women. Blood samples were drawn at 5 min intervals between 10:00 and 14:00 h and between 22:00 and 02:00 h at months 3-4, 5-6, 7-8 and 9-10 postpartum in nursing women and in the follicular phase in non-nursing women. In nursing women, mean LH concentrations at months 3-4 were significantly lower than in non-nursing cycling women only in the subgroup which subsequently experienced > 6 months of lactational amenorrhoea, although all were fully nursing with a similar suckling frequency. LH pulses in plasma were found at all times in nursing women. There were no significant differences in the frequency (about four pulses every 4 h), amplitude or duration of LH pulses related to the duration of amenorrhoea, nor did these parameters vary significantly between amenorrhoeic or cycling nursing women and non-nursing women. Nursing amenorrhoeic women exhibited a normal frequency of LH pulse well in advance of the resumption of the first post-partum menses, suggesting that mechanisms other than the suppression of the gonadotrophin-releasing hormone pulse generator intervened in the inhibition of ovarian function during lactation.

Clinical trial with Nestorone subdermal contraceptive implants.

The clinical performance and the in vivo release rate of a single 4-cm Nestorone subdermal implant were investigated. Implants manufactured by two different procedures were compared. Volunteers were 70 healthy women of proven fertility. Forty women provided blood samples twice a week in the pretreatment cycle and for 5-6 weeks at 6-month intervals during treatment. Additional control cycles (n = 31) were studied in 19 Copper T users. No pregnancy occurred in 1570 woman-months. Nestorone plasma levels (x +/- S.E.) declined from 112 +/- 8 to 86 +/- 3 pmol/L (Implant A) and from 145 +/- 8 to 57 +/- 5 pmol/L (Implant B) from the first to the 24th month. Progesterone levels were < 9.5 nmol/L in 166 (93%) of 178 blood samplings taken during treatment. Progesterone levels > 16 nmol/L were found in only 7 sampling periods (3.9%) in treated women and in 70 (98.6%) out of 71 control cycles. No ovulation occurred with Nestorone plasma levels above 105 pmol/L. No abnormal changes were observed in plasma lipoproteins or other clinical chemistry parameters during treatment. The implants were well tolerated. The most frequent complaint was the occurrence of irregular bleeding. Enlarged follicles found during pelvic examination in 8 subjects (11.4%) disappeared spontaneously in 10 days to 6 weeks. Implants were removed because of medical (n = 10, 14.3%) or personal reasons (n = 6, 8.6%) or at the 24th month of treatment (n = 54, 77.1%). The estimated average daily in vivo release rate of Nestorone was 45-50 micrograms/day. A single Nestorone subdermal implant affords efficient contraceptive protection during two years.

[Papillary cystic tumor of the pancreas: an infrequent carcinoma of good prognosis]. / Tumor papilar quístico del páncreas: un carcinoma infrecuente de buen pronóstico.

Papillary cystic tumor of the pancreas is a rare low grade carcinoma, with only 130 cases reported in the English literature. We report a 22 years old female presenting with a palpable mass and abdominal pain. Abdominal ultrasound and CAT scan showed a solid-cystic lesion in the head of the pancreas. The patient was subjected to a partial pancreatoduodenectomy and the histological study of the surgical specimen disclosed a papillary cystic carcinoma. Post op course was uneventful and the patient is well at 8 months follow up.

[Usefulness of ultrasonics in the diagnosis of pleuro-pulmonary diseases]. / Utilidad del ultrasonido en el diagnóstico de la patología pleuropulmonar.

We performed ultrasound studies in 67 patients with opacities adjacent to the thoracic wall. An accurate diagnosis of the nature of the lesion was made in 95% of cases. The yield of thoracocentesis was increased by marking guided by ultrasound.

Contraceptive efficacy of lactational amenorrhea in urban Chilean women.

The contraceptive efficacy of breastfeeding was assessed in 236 healthy urban women who were followed at monthly intervals during the first postpartum year. Proportional hazard models were used to evaluate the influence of time postpartum, menstrual status and breastfeeding pattern upon the risk of pregnancy. Time and menstrual status had a highly significant effect on this risk. Those women who remained in amenorrhea had cumulative probabilities of pregnancy of 0.9% and 17% at 6 and 12 months postpartum, respectively. In those who recovered menstrual cycles, the risk rose to 36% and 55% at 6 and 12 months, respectively. Milk supplementation also increased significantly the risk when considered alone but not when time and/or menstrual status were included in the analysis. However, amenorrheic women who introduced bottle feeding, had a higher risk of pregnancy after 6 months postpartum than those who remained fully nursing. The analysis was unable to detect a significant influence of the nursing frequency. The results confirm that lactational amenorrhea is an effective contraceptive during the first six months postpartum. The first postpartum bleeding marks a great increase in the risk of pregnancy. Supplementation also increases the risk, particularly in amenorrheic women.

Early difference in the endocrine profile of long and short lactational amenorrhea.

The endocrine profiles associated with long and short lactational amenorrhea were assessed in a longitudinal study in which morning blood samples were drawn in 48 women from the first postpartum month until the recovery of ovulation and in a cross-sectional study in which the samples were drawn throughout 24 h at the end of the third postpartum month in 10 fully nursing and amenorrheic women. PRL, LH, FSH, estradiol (E2), progesterone, cortisol, and dehydroepiandrosterone sulfate were measured. In both studies we detected a smaller PRL increase in response to suckling (P less than 0.001) and higher E2 levels (P less than 0.001) in nursing women who ovulated within 6 months postpartum compared to those in women who did not. Such differences were observed early after delivery when all women were fully nursing and amenorrheic. These results suggest some probable sources of variability in the duration of lactational amenorrhea in our population. The greater PRL response to suckling associated with longer amenorrhea may be due to higher sensitivity of the breast-hypothalamus-pituitary system or a stronger suckling stimulus in this group. Differences in plasma E2 levels between longer and shorter periods of amenorrhea may reflect dissimilar endogenous production, intake, or clearance of estrogens.

Circadian variation of basal plasma prolactin, prolactin response to suckling, and length of amenorrhea in nursing women.

The circadian pattern of plasma PRL levels and the PRL response to suckling were examined at various times during the first postpartum year and related to the length of lactational amenorrhea. Ten healthy women whose infants were breast-fed exclusively and who were amenorrheic 3 months postpartum were studied 3, 6, and 9-11 months postpartum. The women and their babies were admitted to a metabolic unit for 48 h. On the second day, blood samples were drawn at 2-h intervals for 26 h starting at 0800 h and also 10 and 30 min after the initiation of six of the nursing episodes. During the three postpartum periods, there was a circadian rhythm of basal plasma PRL concentrations; the peak concentrations occurred between 2400-0600 h. Suckling induced a significant rise in plasma PRL levels at all hours except 0800 h. There was a positive correlation between the duration of the nursing episode and the suckling-induced PRL increase at 30 min. Both the basal plasma PRL levels and the PRL responses to suckling diminished with time after delivery. This trend was less evident at 0400 h and was not fully explained by changes in the nursing pattern. The five women in whom menstrual cycles resumed before day 180 postpartum had lower basal and suckling-induced plasma PRL levels than the women who had amenorrhea for a longer period. This difference was present in the third month, when all women were amenorrheic and fully nursing and when the frequency and duration of nursing episodes and infant growth rates were similar. The results indicate that comparable nursing patterns may be associated with different plasma PRL levels, which are associated with different lengths of lactational amenorrhea. An early difference in the sensitivity of the breast-hypothalamus-pituitary system to suckling may explain the differences in the duration of lactational amenorrhea, which are not dependant on the breastfeeding pattern. The magnitude of the PRL response to suckling may predict the likelihood of recovering ovarian function during lactation.

Breastfeeding pattern and the duration of lactational amenorrhea in urban Chilean women.

The influence of the breastfeeding pattern and several clinical variables upon the duration of postpartum amenorrhea was assessed in a group of healthy women selected for having had a normal pregnancy and delivery and being highly motivated for prolonged breastfeeding on demand. 676 women who were fully nursing at the second month postpartum entered the study. Supplements were administered to 11% and 48% of the infants by the end of the 3rd and 6th month, respectively. The first bleeding was experienced before the end of the sixth month postpartum by 57% of the cases. Supplementation had a strong negative influence while nursing frequency had a significant positive influence upon the length of amenorrhea. Notwithstanding, a frequency of 8+ suckling episodes per 24 h could not maintain amenorrhea in around half of the subjects. Age and parity had a moderate negative influence upon the risk of experiencing the first postpartum bleeding. Maternal weight and ponderal index, infant sex, birth weight and growth rate showed no significant influence upon the length of amenorrhea. In this urban population selected for having the highest motivation and best breastfeeding performance, the association of breastfeeding with amenorrhea was weak in comparison with what has been described for other populations. The risk of experiencing the first bleeding was reduced while fully breastfeeding with a high number of nursing episodes per day and night, particularly in older women with higher parity. But even in such situation 25% and 50% of the women had started to cycle by the end of the fifth and eight postpartum month.

Mamografia. / Mammography

El articulo es una revision del estado actual de la mamografia enfocado especialmente hacia el diagnostico del cancer mamario. De manera sucinta se analizan sus avances tecnicos, indicaciones y limitaciones; el rol que desempena la mamografia en el diagnostico precoz del cancer y los riesgos carcinogenicos potenciales del examen