Some metabolic and hormonal changes in women using long acting injectable contraceptives.

Some metabolic and hormonal changes in women using longacting injectables as a contraceptive method were examined. The 2 main injectables utilized were depomedroxyprogesterone acetate (DMPA), given every 90 +or- 5 days, and norethisterone enanthate (NET/EN) injected every 60 +or- 5 days. None of the studied cases became pregnant during injectable use, indicating the high contraceptive efficacy of the method. No statistically significant changes were observed in hemoglobin, hematocrit, all protein fractions including albumin, alpha1, alpha2 beta, gamma immunoglobulins IgG, IgA, and IgM after 6 and 12 months in both groups of injectable users as compared with the preinjection values. Statistically significant suppression of the estimated hormones, Follitropin, Luteotropin, and Estradiol-17beta were detected in both groups of NET/EN and DMPA users, after 6 and 12 months, as compared with the preinjection values.

Haemolytic streptococcus infection of chronic maxillary sinusitis. An immunological study using the skin window test.

The SWT was performed on 30 patients with chronic haemolytic streptococcus maxillary sinusitis, and 5 controls with no streptococcus in their nose and throat. Foreign and patient's own organism were used as antigen. The lymphoblastic transformation was higher in control streptococcus free patients than in chronic maxillary sinusitis, more when using foreign than patient's own organism. The failure of cellular immune response as a contributory factor to chronicity of maxillary sinusitis is discussed. The possible value of prepared foreign streptococcus vaccine in prevention and treatment is mentioned.

The human nasal mucosa in the menopause (a histochemical and electron microscopic study).

Ten menopausal females were studied. Histopathologically, the nasal mucosa was normal, except for the tunical glands which were reduced in number, more localized and showed hyperfunction. Histochemically, there was an increased activity of succinic dehydrogenase, alpha esterase, acid and alkaline phosphatase and choline esterase, indicating an increase in carbohydrate metabolism, lipid breakdown, phagocytic activity, vascularity, secretory activity and parasympathetic hyperactivity which may be responsible for these changes, reflecting the emotional disturbances common in the menopause. These changes were not related to the ovarian steroid hormones. The change in the PAS stain was due to the low estrogen blood level.

Experimental inoculation of Klebsiella rhinoscleromatis bacilli in albino mice.

72 albino mice were intranasally inoculated with Klebsiella rhinoscleromatis suspension with or without the addition of hog mucin. Scleroma-like lesions developed in their lungs more frequently with hog mucin. A liver affection was detected only in 1 animal. K. rhinoscleromatis organisms were recovered from the lung lesions. A possible potentiating effect of hog mucin is discussed.

The effect of streptomycin and irradiation on rhinoscleroma (electron microscopic study).

Irradiation of scleromatous lesions produces its effect by destroying the organisms, whereas Streptomycin improves the mucosal defence mechanisms. A combination of both lines of treatment seems to be indicated for the arrest of the pathological process.

The human respiratory nasal mucosa in nasal syphilis. An ultra-microscopic study.

The fine structure of the human tertiary syphilitic nasal mucosa was studied in 5 patients. The epithelium showed variations in thickness, loss of cilia, irregular cell contours, widened intercellular spaces, rare goblet cells. The seromucinous glands were in three forms. The arterioles and capillaries varied in relation to the pathology of the surrounding tissue. The venules were least affected. The stroma was infiltrated by macrophages, plasma cells with some areas having excessive fibrosis and others partially necrotic. These findings were correlated to the histochemical reactions. Scattered Treponema pallidum were seen, demonstrating the blood-borne dissemination and the infective nasal secretions.

The human respiratory nasal mucosa in nasal syphilis. A histochemical study.

The enzymatic changes in tertiary nasal syphilis were studied in 5 patients. The cholinesterase was increased in the subepithelium, around the glands and blood vessels, denoting parasympathetic hyperactivity. Acid phosphatase was increased in the epithelium, stromal histiocytes, around the glands and ducts, indicating increased phagocytotic activity. Alkaline phosphatase was increased in the capillary endothelium and periglandular stroma, denoting marked vascular changes. Succinic dehydrogenase, alkaline phosphatase, alpha esterase and PAS-alcian blue were diminished in the epithelium and glands, denoting diminished secretory activity, hence a diminished natural defence mechanism of the nasal mucosa. When serological tests are inconclusive, these findings become an important adjuvant to a final diagnosis.

Acceptability study of the two versus three monthly injectable contraceptives.

PIP: The acceptability of 2 and 3 month injectable contraceptives was assessed and compared, and the acceptability of the injectables was further compared with that of oral contraceptives (OCs) and IUDs among a random sample of women, who attended a clinic in Alexandria, Egypt. The study was conducted by the University of Alexandria. The sample included 100 acceptors of the 2-month injectable, norethisterone oenanthate (NET-O EN), 100 acceptors of the 3-month injectable, depo-medroxy pregesterone acetate (DPMA), 60 OC acceptors, and 60 IUD acceptors. The women were interviewed prior to treatment and 2 or 3 times during the 6 months following their initial acceptance of the methods. Women who discontinued at any time during the 6-month period were interviewed concerning their reasons for discontinuing. The data was analyzed by calculating means and % distribution and by testing for significance. The percent lost to follow up was 12% for the NET-O EN group, 12% for DPMA users, and 0% for IUD and OC acceptors. The mean age of the acceptors was 30.4 years for NET-O EN, 30.7 years for DMPA, 28.3 years for OCs, and 25.2 years for IUDs. For these acceptor groups, the respective mean number of years of schooling was 6.1, 5.2, 7.2, and 7.5, and the respective mean number of pregnancies was 5.6, 5.4, 3.8, and 2.9. All 320 of the women were married, and 319 were Muslim. 99.4% lived in urban areas. 10% had no living male children, and 23.7% had no living female children. 2/3 of the injectable acceptors previously used 2 or more fertility control methods. A higher percent of IUD and OC acceptors, compared to injectable acceptors, reported using only 1 or no previous method. More than 1/2 of the injectable acceptors reported disruptions in their normal bleeding patterns. NET-O EN acceptors were more likely to experience heavy or prolonged bleeding while DPMA acceptors were more likely to report amenorrhea or a decreased flow. IUD acceptors were also bothered by bleeding problems. Almost all the women who reported changes in bleeding patterns were unhappy about the changes. Many of the women who reported amenorrhea worried that they might be pregnant. Women who experienced heavy or unpredictable bleeding worried about anemia and complained that bleeding interfered with their daily routines. 47.6% of the women reported weight gains, but this was generally viewed as an advantage. Nausea was the major side effect associated with OC use. 32% of the OC users, 28.0% of the NET-E ON users, 30.0% of the DMPA users, and none of the IUD users reported nausea. For all 4 groups, convenience and effectiveness were the major advantages the women attributed to their chosen method. Continuation rates were 68% for NET-O EN, 70% for DMPA, 75% for OCs, and 75% for IUDs. The major reason for discontinuation of injectables was bleeding problems. Among injectable users, a higher proportion of discontinuers (49%) than of continuers (20%) reported amenorrhea. The findings suggest that continuation for injectables could be improved if patients were given more detailed information about possible side effects and if they were advised to return to the clinic for treatment of any symptoms they experience.^ieng

The human respiratory nasal mucosa in females using contraceptive pills. An ultramicroscopic and histochemical study.

The ultrastructure and histochemical changes in 25 females using contraceptive pills were studied. Fifteen pill-using females developing no nasal symptoms showed similar changes to those observed in symptom-free pregnant females. Ten pill-using females developing nasal symptoms showed squamous metaplasia, interepithelial oedema, glandular hyperplasia, histiocytic proliferation and fibrous tissue deposition, all attributed to the action of oestrogen. Their histochemical reactions were similar to those of chronic hypertrophic non-allergic rhinitis.

PIP: This work examines ultrastructural and histochemical changes in the human nasal respiratory mucosa resulting from regular use of oral contraceptives (OCs). 25 healthy women aged 20-25 years were treated with Anovlar (4 mg norethisterone and .05 mg ethinyl estradiol) for 9 months. Biopsies were taken from 5 each of the 15 who did not develop nasal symptoms at 3, 6, and 9 months and from the 10 who developed symptoms at 9 months. A punch biopsy was taken from the lower border of the inferior turbinate, 1 cm behind its anterior end, using 4% xylocaine without adrenalization. The biopsy was divided into 2 parts for electron microscopic study and histochemical study. All symptom-free subjects developed the same changes: glandular hyperactivity, increased acid mucopolysaccharide content of the ground substance, and an increased defensive mechanism due to increased phagocytic activity. The ultrastructural changes and histochemical reactions were similar to those of symptom-free pregnant women. The 10 women developing nasal symptoms showed squamous metaplasia, interepithelial edema, glandular hyperplasia, histiocytic proliferation, and fibrous tissue deposition, all attributed to the action of estrogen. The histochemical reactions were similar to those of chronic hypertrophic nonallergenic rhinitis: increased choline esterase in the subepithelium and stroma; increased acid phosphatase in the epithelium, subepithelium, and around the glands; and increased succinic dehydrogenase, alkaline phosphatase and alpha esterase in the mucus glands.

A hematologic study of pregnant women in free and insurance hospital populations.

The prevalence of anemia among 631 women in late pregnancy was studied among two groups: those in the Medical Insurance Pregnancy Centre of the Alexandria clinic (320) and those in the free government hospitals (311). Some related demographic and social observations were also done. Complete medical and obstetric examinations and several laboratory tests were performed. Women in the insurance hospital had lower parity, smaller families, lower crowding index, better income and a healthier hematological picture than women in the free hospitals.

Blood hormone levels in egyptian women on norethisterone oenanthate.

Ten Egyptian women who were using the injectable contraceptive norethisterone oenanthate (NET-OEN) for at least 6 months were monitored weekly for a period of 12 weeks by measuring 3 pituitary hormones (FSH, LH and prolactin) and 2 ovarian hormones (oestradiol 17-B and progesterone). It was concluded that NET-OEN is a strong ovulation inhibitor, at least after its use for 6 months. Prolactin levels were depressed and this is in contradiction with the findings in rats.

PIP: 10 Egyptian women who were using the injectable contraceptive norethisterone enanthate (NET-EN) for at least 6 months were monitored weekly for a period of 12 weeks by measuring 3 pituitary hormones (FSH, LH, prolactin) and 2 ovarian hormones (estradiol 17-B and progesterone). It was concluded that NET-EN is a strong ovulation inhibitor, at least after its use for 6 months. Prolactin levels were depressed and this is in contrast to the findings in rats.

The human respiratory nasal mucosa in pregnancy. An electron microscopic and histochemical study.

The ultrastructural and histochemical changes in the respiratory nasal mucosa of thirty pregnant females have been studied. Symptoms-free pregnant females, regardless of the duration of pregnancy, showed glandular hyperactivity, increased phagocytic activity, and increased amount of acid mucopolysaccharides in the ground substance. These changes have been suggested to be due to the rise in the levels of female sex hormones during pregnancy. Pregnant females developing nasal symptoms during pregnancy have been proved by electron microscopy and histochemically to be allergic in origin. This allergy, being not due to the hypersensitization of the patient's own sex hormones, may be due to any of the factors previously mentioned.

A preliminary pharmacological trial of the monthly injectable contraceptive cycloprovera.

A comparative pharmacological pilot study of the monthly injectable contraceptive CycloProvera was carried out in 11 women in four centres. There were no significant differences in the results between the centres except that the injection-bleeding interval appeared to be shorter in Swedish women than in those in Havana and Mexico. Medroxyprogesterone acetate was detectable in blood for 28 to 62 days after injection of CycloProvera and although follicular activity returned in less than 28 days after injection in many of the women, corpus luteum function was suppressed for at least seven weeks in all women. Most of the women retained a regular menstrual pattern; six of 33 cycles were amenorrhoeic. There was no significant change in any of the biochemical and haematological analyses.

The epithelium and chronic inflammatory cells in scleroma. (An electron microscopic study).

The ultrastructure of 15 cases or rhinoscleroma have been studied. The epithelium showed intercellular edema, a reaction to the polysaccharide coat of intact bacilli, passing through defects in the basal lamina and subsequently inviting polymorph migration. The transitional stages between normal and 'reactive' plasma cells to the formation of the Russell body and the Unna cell were demonstrated, thus supporting the theory of an intracellular formation of the Russell bodies.