Cardiac and neurologic complications in malignant hypertension due to oral contraceptive use.

Malignant hypertension is a rare consequence of contraceptive use. We report here on two young women with malignant hypertension secondary to contraceptive use whose main symptomatology was neurological. Both patients had renal failure, severe left ventricle hypertrophy, and hemorrhagic stroke, all reversible after control of blood pressure and discontinuation of the contraceptive pill.

PIP: Although an association between oral contraceptives (OCs) and arterial hypertension has been well-documented, most studies have found only mild or moderate hypertension with reversal to normal levels 3 months after OC discontinuation. This paper presents two cases in which young women developed severe left ventricular hypertrophy and renal failure due to OC-induced malignization of hypertension. The first patient, a 23-year-old, was admitted to the hospital with a 3-day history of headache, mental confusion, and aggressiveness. 6 months before presentation, severe arterial hypertension had been diagnosed. At that time, she was advised to discontinue OCs (30 mcg of ethinyl estradiol and 150 mcg of levonorgestrel), which she had been taking for a year; she did not comply with this directive. The second patient, 21 years old, was admitted with accelerating hypertension. She had initiated OC use (30 mg of ethinyl estradiol and 150 mcg of levonorgestrel) 6 months earlier. 3 months after starting OC use, she developed headache and fatigue. Both women had a hemorrhagic cerebral accident as a complication of malignant hypertension. All neurologic, renal, and cardiovascular complications were reversible after OC discontinuation. OC-related malignant hypertension can be averted through effective control of blood pressure in OC users.

Argentinian doctors accused of spreading AIDS.

PIP: The provincial ministry of health has taken over a dialysis center in La Plata, Argentina, following the discovery that at least 20 of the clinic's 34 regular patients have been infected with the human immunodeficiency virus (HIV). Catheters of the clinic's dialysis machines were found to be contaminated with HIV. The 5 physicians associated with the Centro Modelo de Dialisis have been discharged for negligence. 20 of the regular patients also contracted hepatitis C. Argentinian law stipulates that filters for the same patient must be changed after 4 times and prohibits the use of the same vessel to administer medication to more than 1 patient. Testimony from nurses at the La Plata clinic revealed that filters were reused for several patients and basic sanitary procedures were not followed. In 1990, 33 kidney disease patients at a dialysis center in Cordoba became infected with HIV and it was discovered that filters had been used up to 8 times for different patients. The 5 La Plata physicians stand accused of "the culpable propagation of dangerous diseases."^ieng

[Urinary tract infections in children]. / Infeccion de vias urinarias en ninos.

PIP: The incidence of urinary tract infection (UTI) varies depending on the age of the child. In 1984 a review of 1000 school children in the city of Santo Domingo found an incidence of 0.4%. In a prospective study 109 patients were investigated who presented at the outpatient consulting ward of nephrology of the Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic, with fever and/or clinical symptoms suggestive of UTI. Uroculture was taken by means of suprapubic punction in all those cases which had not received antimicrobial therapy at least 72 hours before taking the specimens. The signs of UTI in the 109 patients were dysuria, urinary incontinence, and enuresis. 41 patients had urocultures positive for UTI bacteria, while the remaining 68 children's urocultures did not show bacterial growth, therefore they were judged not to have UTI. In the 41 patients with UTI the etiologic agents were Escherichia coli in 20 (48.78%), Enterobacter in 14 (34.15%), Klebsiella in 4 (9.76%), Staphylococcus in 4 (9.76%), Pseudomonas in 4 (9.76%), and Salmonella in 3 (7.32%). In all cases of positive uroculture more than 10 leukocytes were observed in the urinary sediment. Only 15 of the 41 patients with positive uroculture had leukocytosis. Fever as a clinical symptom was found in 7 of the 109 cases, and in 3 of these bacteria were grown in the uroculture. In 40 patients out of 109 the fever was associated with clinical signs of UTI, finding positive uroculture in 20 of these patients.^ieng

A comparative clinical trial of Norinyl 1/35 versus Brevicon in Rio Clara, Brazil.

A comparative clinical trial of two combined oral contraceptives (OCs) with equivalent estrogen content, but different amounts of progestogens, was conducted at the Centro Medico Especializado em Planejamento Familiar in Rio Clara, Brazil. The study was designed to determine the differences in discontinuation rates between Norinyl 1/35 (Syntex) and Brevicon (Syntex) as well as the frequency of selected side effects which might contribute to method discontinuation. Both OCs contain 0.035 mg of ethinyl estradiol; Brevicon contains 0.5 mg and Norinyl 1/35 contains 1 mg norethindrone. Three-hundred women enrolled in the study were randomly assigned to either the Norinyl 1/35 or Brevicon OCs and follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. Intermenstrual bleeding was reported by significantly more women in the Brevicon group than in the Norinyl group (p less than 0.05), and significantly more Brevicon users reported an increase in intermenstrual bleeding. At the end of the study period, no differences were found between the two OC groups in terms of discontinuation rates, but a large number of women in each group discontinued for menstrual problems. The total discontinuation rates at 11 months for both groups were extremely high: 68.2 for the Norinyl 1/35 group and 75.2 for the Brevicon users. The largest group of discontinuations were comprised of those discontinuing for menstrual problems, other personal reasons, planned pregnancy and side effects.

The mode of action of IUDs.

In women, IUDs produce alterations of the uterine environment in terms of a pronounced foreign body reaction. This biological response may interfere with steps of the reproductive process that normally take place before the ovum reaches the uterine cavity. In order to discuss this hypothesis on the mechanism of action of IUDs, this review is focussed on 1) detection in urine and blood of substances alleged to be specifically produced by the embryo, 2) migration of gametes in the female genital tract, and 3) microscopic features of ova recovered from the genital tract.

PIP: This review delves into the mode of action of IUDs in greater detail than the commonly held theory that IUDs prevent implantation: it discusses whether IUDs affect fertilization, gamete migration or development of fertilized ova. In order to determine whether IUDs prevent fertilization, noninvasive methods of detecting fertilization, or very early pregnancy tests, would be necessary. Two approaches are to assay an alleged immunosuppressive early pregnancy factor, and to design extremely sensitive assays for trophoblastic gonadotrophin (hCG). In fertile cycles, such studies found a 6 to 57% incidence of fertilized ova that did not result in pregnancy. Comparable studies in IUD users sought a transient rise in hCG. Some researchers have seen a fleeting hCG with standard assays, but one laboratory using a new immunoradiometric assay found hCG in only 0.9% of cycles in IUD users. Following sperm or egg migration in women is possible by flushing the vagina and endocervix, or the tubes during surgery. Normally sperm can reach the oviduct in 2 hours and remain viable as long as 85 hours. With an IUD in place, several searches recovered no sperm in the tubes, presumably they were phagocytosed. Copper IUDs especially reduced numbers of sperm, and those found often had heads decapitated from tails. Ovum migration in IUD wearers was not appreciably affected through the oviduct, but few eggs were found in the uterus, again far fewer were found in copper IUD users. Looking at ova that were detected in IUD users, none were developing normally, the rest were classified as either abnormal or uncertain. Ova from copper IUD users were distinctive for being without vitellus and surrounded by macrophages. This preliminary research as a whole suggests that IUDs affect events prior to implantation, specifically ovum development in the tubes, sperm migration, and ovum transport in the uterus.

[Intrauterine adhesion: analysis of 28 cases]. / Sinequia intra-uterina: analise de 28 casos.

PIP: Intrauterine adhesions are frequent in women with puerperal or post-abortion curettages. In rare cases there are adhesions due to inflammatory processes, particularly due to endometrial tuberculosis. The adhesions occur in patients in the menacme, without any endocrinological complaints. The disease affects women of different ethnic backgrounds; however this study is comprised of white females. A histopathological exam of the endometrial material revealed different histological varieties of the uterine wall including fibrous leukocytic exudate. In 89 cases studied, an increase was noted in the vascularity of fragments of the miometrium and fibrosis as well as changes of the miometrium in accordance with the cycle. These findings indicate that there are no endocrinological changes in women with intrauterine adhesions. Regarding treatment carried out by means of curettages, IUD insertion and estrogen treatment, good results were obtained in the normalization of the menstrual cycle in more than 60.8% cases. However, only 3 women were able to get pregnant, 2 had spontaneous abortions, and only 1 achieved a full term gestation.^ieng

[Calcium lonazolac and blood loss in users of intrauterine devices. Preliminary report]. / Lonazolac cálcico y pérdida sanguínea en usuarias de dispositivos intrauterinos. Informe preliminar.

PIP: 3 groups of IUD users participated in a preliminary study to evaluate the effect of calcium lonazolac, a nonsteroid antiinflammatory agent, on excessive menstrual bleeding. All participants were parous women aged 20-30 years in good health. Multiload 250 IUDs were inserted in 15 women averaging 24.5 years of age. They were also supplied with calcium lonazolac tablets in 200 mg doses to be taken continuously 3 times daily. 15 women averaging 26.1 years also had multiload 250 IUDs inserted. They were given the same instructions but their medication was a placebo. A third group of 30 women averaging 26.2 years of age who had experienced heavy bleeding during 6-36 months of IUD use were given 200 mg tablets of calcium lonazolac to be taken 3 times daily. The 30 women used various types of IUDs. All 60 women were provided with sanitary pads to be returned at their regular clinic visits. Hemoglobin and hematocrit levels were also determined at each visit. The method of Hallberg and Nilsson was used to measure menstrual blood loss. There were no significant changes in the volume or duration of bleeding or hemoglobin or hematocrit levels in the 15 women given the drug. The 15 women given the placebo had a significant increase in the quantity of blood loss and a significant increase in the duration bleeding in the 3rd month. The 30 women with histories of heavy bleeding had significant decreases in volume and duration of bleeding. Modifications in hemoglobin were not especially significant, while the hematocrit levels increased in the 2nd and 3rd months. None of the women reported significant side effects except 1 woman with a prior history of gastritis. Her gastric distress was controlled by an antacid after meals for 1 week. Comparison of results between the treated and control groups suggests that calcium lonazolac gives good results. Its use should be evaluated at lower doses with consumption limited to days of bleeding only.^ieng

[Injectable contraceptive: nuclear effects after use]. / Anticoncepcional injetavel: modificacoes nucleares apos o uso.

PIP: Contraceptive hormonal injectable action of medroxy-progesterone acetate ciprionate estradiol (MPACE) in the reproductive system of female rats was studied. The female rats were selected in 2 groups: A and B, castrated and non castrated, respectively, and according to dose numbers in 6 subgroups: A0, A1, A2, A3, A4, A5 and B0, B1, B2, B3, B4, B5. Karyometric studies of nuclei from uterine epithelial tunica mucosa endometrial glands, myometrium, exocervix and vaginal epithelium were made. For each subgroup females were selected and 3 slides analyzed for each 1, which means 9 observations per subgroup. From uterine epithelial tunica mucosa, endometrial glands, and myometrium kariometric, 20 nuclei were measured per slide, in a total of 60. When dealing with vaginal and exocervical epithelia, 120 nuclei were measured as both are stratified epithelia. Karyometric studies were made in 15,120 nuclei and the results statistically analyzed. Nearly a 2-fold increase in nuclear volume was observed in female rats at the estrual phase as compared with castrated female controls. A higher significant MPACE effect was found in cells covering uterine epithelial tunica mucosa, endometric glands, and myometrium. The MPACE action on the exocervix and vaginal cells was not significant. As statistically assessed, the MPACE combination showed a predominance of the estrogenic portion with an increase of nuclear volumes but this action was balanced by the progestagenic fraction, as mitoses were unusual.^ieng

[Endometrial cytology of IUD smears: endometrial reaction study]. / Citologia endometrial de esfregacos de DIU: estudo da reacao endometrial.

PIP: The objective of this research was to ascertain possible abnormal endometrial reactions to the IUD. The Family Planning Clinic of the Gynecology and Obstetrics Department of the Federal University of Minas Gerais, Brazil, used 110 cases from patients with IUDs who used the clinics from July 1981 to December 1982. Pap smears from 102 of these cases were made from material contained on the IUD. Several parameters were used, represented by endometrial cells and associated elements, including the IUD model, the user's age, and the day of the menstrual cycle on which the IUD was removed. The breakdown of endometrial cells was greater in Lippes Loop users than in TCu 200 and Copper 7 users. There was no significant difference in the amount of endometrial cells in the various stages of the menstrual cycle. The large number of cells in 90% of the smears leads to the suggestion that these smears be used for determining exclusion or diagnosis of cancer in the perimenopausal age group when the IUD is removed. A special histiocyte reaction was evident only in Lippes Loop users. A greater frequency of plasmocytes and leukocytes in the pre- and postmenstrual stages should be considered as physiological. A greater frequency of plasmocytes was found in Lippes Loop users, and a smaller frequency of lymphocytes observed from the 8th to 14th days of the menstrual cycle should be considered physiological. The lymphocytes were more frequent in users of the TCu 200 and Copper 7, but not significant enough to suggest the use of medicated IUDs.^ieng

[Changes in menstrual pattern following tubal ligation]. / Alteraciones del patrón menstrual, consecutivas a ligadura tubaria.

PIP: 50 women undergoing tubal sterilization by the modified Pomeroy technique at a hospital in Toluca, Mexico, were selected at random and followed for 6 months postoperative to detect changes in menstrual patterns. The women had normal menstrual histories and had not used contraceptive medications for at least 3 months prior to operation. Analgesia was provided by peridural block with 2% lidocaine. There were 45 cases of interval and 5 of immediate postpartum sterilization. The women ranged in age from 25 to 44 years and averaged 34.5.16 women, or 32%, had altered menstrual patterns. There were 12 cases of hypermenorrhea and 1 each of oligomenorrhea, polymenorrhea, amenorrhea, and proiomenorrhea. Age at menarche, parity, and obstetric history were unrelated to menstrual changes. Changes in menstrual patterns after surgical tubal occlusion have been attributed to damage in the uterine and ovarian blood vessels leading to reduced blood supply and ultimately to abnormal maturation of ovarian follicles and hormonal changes. Psychogenic factors may play a role. The extent of surgical damage after various techniques of tubal occlusion and the materials used for suturing should be assessed as possible sources of local or regional inflammation that could have repercussions in blood perfusion and nervous function.^ieng

[Intra-uterine contraceptive devices in nulliparous women: a retrospective study]. / Dispositivo intra-uterino na contracepcao de mulheres nuligestas: um estudo retrospectivo.

PIP: The insertion of intrauterine devices (IUDs) in nulliparous women is a controversial subject, with no unanimous opinion on whether or not to use this method. A study was undertaken to analyze retrospectively the complications of the TCu-200 IUD in nulliparous women compared to complications encountered in multiparous women using the same device. In 1982 and 1983, the Family Planning and Human Reproduction Clinic of the UFMG Medical School in Belo Horizonte, Brazil, inserted 114 IUDs in nulliparas. The principle characteristics of the study group were a low socioeconomic condition, regularity of menstrual flow, and absence of vaginal infection at the time of examination. The choice of method was the spontaneous decision of the women. It was noted that nulliparas requested IUD insertion after previous unsatisfactory experience with other contraceptive methods. 56% of the group were single and 38% married. For comparison, 300 records of multiparous TCU-200 IUD users were studied retrospectively. All insertions were made by the same clinic. The racial, social, and economical characteristics were typical of the users of any free family planning service. Among early complications, pain and lipothymia were encountered at an elevated incidence in nulliparous women when compared to multiparas (p0.01). Among late complications, the appearance of vaginal discharge and metrorrhagia were significant when compared to multiparas (p0.05). Pelvic infection and dysmenorrhea, although more frequent in nulliparas, were not statistically significant. The authors concluded that the IUD should not be used as the contraceptive method of 1st choice in nulliparous women, using it only in exceptional situations.^ieng

Chlamydia trachomatis: important relationships to race, contraception, lower genital tract infection, and Papanicolaou smear.

Chlamydia trachomatis is a common cause of sexually transmitted disease in adolescent girls. Of 366 adolescent patients screened, 15.3% were found to have chlamydial endocervical infections, with an infection rate of 23.3% in blacks, 14.3% in Hispanics, and 10.3% in whites (P = 0.01, excess for blacks). Of Chlamydia-positive patients, 63.6% had a diagnosis of lower genital tract infection, compared with 35.4% of Chlamydia-negative patients (P = 0.004). Oral contraceptive users had a higher prevalence of infection (23.8%) compared with those using a barrier method (16.2%) or with nonusers (9.3%) (P = 0.004). Inflammatory changes on Papanicolaou smears were associated with chlamydial infection (P = 0.0001). Other variables identified as risk factors for chlamydial infection included both a younger age at first intercourse (P = 0.02) and more years of sexual activity (P = 0.02). Chronologic, menarchal, and gynecologic age, biologic age of the cervix, the number of sexual partners in the last month and during a lifetime, and parity were not found to be associated with recovery of Chlamydia.

PIP: Chlamydia trachomatis is a common cause of sexually transmitted disease in adolescent girls. Of 366 adolescent patients screened, 15.3% were found to have chlamydial endocervical infections, with an infection rate of 23.3% in blacks, 14.3% in Hispanics, and 10.3% in whites (P=0.01, excess for blacks). Of Chlamydia-positive patients, 63.6% had a diagnosis of lower genital tract infection, compared with 35.4% of Chlamydia-negative patients (P=0.004). Oral contraceptive users had a higher prevalence of infection (23.8%) compared with those using a barrier method (16.2%) or with nonusers (9.3%) (P=0.004). Inflammatory changes on Papanicolaou smears were associated with chlamydial infection (P=0.0001). Other variables identified as risk factors for chlamydial infection included both a younger age at 1st intercourse (P=0.02) and more years of sexual activity (P=0.02). Chronologic, menarchal, and gynecologic age, biologic age of the cervix, number of sexual prtners in the last month, and during a lifetime, and parity were not found to be associated with recovery of Chlamydia.

Estimates of the worldwide frequency of twelve major cancers.

PIP: By examination of incidence, mortality, and relative frequency data, an estimate has been made of the number of cancer cases in 12 common sites and of all cancers that occurred in 1975 and in the 24 areas of the world for which the UN publishes population data. While several cancers are of importance in localized areas or regions; e.g., cancer of the larynx, these are infrequent on the world level and are not included here. While the relative importance of the selected sites varies from 1 area to another, on a global basis, the 1st 6 ranking cancer sites in males are lings, stomach, colon/rectum, mouth/pharynx, prostate, and esophagus; in females, they are breast, cervix uteri, stomach, colon/rectum, lung, and mouth/pharynx. Cancers of these sites, together with leukemias and cancers of the liver, bladder, and lymphatic tissues, account for 75% of the estimated 5.9 million cancers that occurred in 1975. When the 2 sexes are combined, stomach cancers are in 1st rank, followed closely by lung; it is suggested that, given current trends, their rank order will soon be reversed. There are clear opportunities for cancer prevention by controlling tobacco smoking, reducing infection by hepatitis B virus, and curbing the excessive intake of alcohol. The increasing adoption of high fat diets may lead to more cancers of the large bowel, breast, and prostate.^ieng

[Use and effectiveness of norethisterone enanthate for family planning in a rural area]. / Uso y efectividad del enantato de noretisterona para la planificación familiar en el área rural.

PIP: The objective of this study was to analyze the acceptability, effectiveness, and continuation of long-acting progestagens in certain sectors of the population where its advantages are more obvious by virtue of certain socioeconomic, cultural, and geographic characteristics, and by lack of availability of family planning services, as in rural areas and urban marginal zones. The study was performed using females of reproductive age residing in rural areas of the Mexican States of Hidalgo, Puebla, and Yucatan between July 1981 and September 1982. Originally the investigation included a total of 462 women, of whom 94 were lost to follow-up, leaving a total of 368 patients (79.6%) with effective follow-up. The contraceptive used was 19-Nor progestagen, norethisterone enanthate (NET), in 200 mg doses administered intramuscularly. The 1st dose was applied between the 1st to the 5th day of the menstrual cycle and each 60 calendar days thereafter. Of a total of 94 discontinuations, 2/3 occurred during the 1st 6 months of the study. The final discontinuation rate was 14.46%. The studied population showed a continuation rate of 85.54% after 12 months of use. Observing rates by reasons for discontinuation, the principal causes in descending order were nonmedical reasons, amenorrhea, pregnancy, bleeding and other secondary effects. The greatest number of discontinuations, considering each particular reason, occurred predominantly during the 1st 6 months of the study. Distribution of users by age group show that more than 2/3 (71.8%) were between 20 and 34 years old. Distribution by number of previous pregnancies show 56.5% with 5 or more gestations. To analyze behavior of menstrual cycles, "cycles" were defined as period of 30 calendar days. Under this concept, more than 2/3 (70.9%) of the users had from 1 to 7 days of bleeding per cycle. On the basis of the results of the study, it is possible to conclude the following: 1) Continuation of NET use is greater than that observed with other long-lasting progestagens. This seems to be especially so when employed in areas where limitations exist for the utilization of other contraceptive means. 2) Contraceptive effectiveness is greater when administration is scheduled at 60 day intervals rather than longer intervals. 3) Unlike other long-acting progestagens, NET conserves the normal menstrual pattern in the majority of users, which favorably influences its continuation.^ieng

[Clinical evaluation of the progesterone T intrauterine device]. / Evaluación clínica del dispositivo intrauterino "T de progesterona".

PIP: This study describes a clinical evaluation of the Progesterone T IUD which releases a daily dose of 65 mcg of progesterone. The device is made of a copolymer of ethylene vinyl and has a transversal arm measuring 3.18 cm and a longitudinal arm 3.61 cm. The longitudinal arm contains 38 mg of natural progesterone, Barium sulfate, and silicone acetate. 146 new users of the Progesterone T were compared with 149 using the Copper 7 Gravigarde. Patients in both groups ranged in age from 17-40 years with an average of 27.2 for Progesterone T and 27.1 for Copper 7 users. Parity ranged from 1-11 with an average of 2.8 for the Progesterone T group and from 1-10 with an average of 2.7 for the Copper 7 group. The average number of spontaneous abortions was .7 for the Progesterone T group and .5 for the Copper 7 group. The groups were also comparable in previous contraceptive usage. In another study, 51 Lippes Loop D users, 52 Progesterone T users, and 50 Copper 7 users were evaluated for menstrual and intermenstrual blood loss in the 3 months prior to and the 1st, 2nd, 4th, 6th, 9th, and 12th months after insertion. At the end of 12 months, the Progesterone T and Copper 7 users respectively had pregnancy rates of 1.4 and 1.5, expulsion rates of 4.2 and 5.8, rates of removal for medical reasons of 2.8 and 3.0, and continuation rates of 87.2 and 84.6. After 1569 women-months of Progesterone T use and 1558 of Copper 7 use there were no statistically significant differences. With the Progesterone T there was 1 removal for pain, 1 for pelvic inflammation, and 2 for menstrual alterations. 4 Copper 7s were removed for bleeding. The average duration of menstrual bleeding was 6.0 days with the Progesterone T and 6.2 with the Copper 7. The number of days of true bleeding were 4.8 on average for the Progesterone T and 5.3 for the Copper 7. Intermenstrual bleeding was twice as common for the Progesterone T. There was no statistically significant difference in incidence of pain reported by the 2 groups at the beginning and end of the study. Both groups had a decline in pain at the end of the study, with the Progesterone T having a slightly more pronounced decline. The average volume of menstrual blood loss increased by 87.8% after insertion of the Lippes Loop D and by 24.3% with the Copper 7 but declined by 44.5% for the Progesterone T.^ieng

[Contribution to the study of pregnancy, abortion and childbirth among the coastal Mataco Indians]. / Contribucion al estudio del proceso de gestacion, aborto y alumbramiento entre los Mataco costaneros.

PIP: The native concepts of conception, pregnancy, abortion, and childbirth of the Mataco Indians of the Pilcomayo River in Argentina are described. The Mataco view the man as playing the more active role in conception through contribution of seminal fluid, while the woman's uterus is more of a passive receptacle for accumulation of sperm. The embryo develops in a bag which the woman expels shortly after delivery. The number of children is believed to correspond to the number of bags a woman has. The possibility of reproduction for the Mataco is believed to result from actions of Tokjuaj, the central character in an extensive narrative cycle, in the earliest times. Tokjuaj showed the primitive human beings how to have coitus, supplied men with semen, and removed teeth around the vagina that prevented sexual contact. Sterility is always viewed as a feminine shortcoming, although not hopeless since the therapy of a shaman may cure it. The Mataco attribute sterility to the lack of the container in which the embryo develops with successive deposits of seminal fluid. Sterility is just 1 of the diseases believed to result from malevolent intentions of the supernatural. The shaman cures it by interceding with the spirit who caused it, and the woman responds with a payment. The shaman sucks and blows on the affected part to remove the illness and construct a new bag to hold the embryo. Pregnancy can result within a month. The parents must copulate frequently during the first part of pregnancy so that the embryo can develop. The embryo has a soul from the time it arrives in the mother's body. It is able to move because it has a soul. The Mataco appear to have a mythical rather than a physiological vision of pregnancy, although they recognize that the suspension of menstruation can signal pregnancy. Fathers are obliged to observe various prescriptions, primarily regarding dietary taboos, to avoid harming the future child. Sexual relations are discontinued in the later part of the Pregnancy to avoid conceiving another child, twins being subject to infanticide. Abortion is common among the Mataco, particularly among single women and those abandoned by their husbands. Mechanical means are used to induce abortion in the last months of pregnancy. Births are assisted by 1 or more midwives. The list of prescriptions for fathers multiplies at the time of delivery. Any accident during delivery is understood to result from violation of 1 or more of the norms surrounding pregnancy and delivery. For the Mataco, the possibility of conceiving a child, the desire to seek an abortion, or a successful delivery do not depend on the individual's will but on a combination of human intentions and those of the ruling spirits.^ieng

[Hermeneutic approach to ideas about conception, pregnancy and birth among the Pilago of the Central Chaco].

PIP: The processes of conception, gestation, and birth among the Pilaga Indians of the north central part of the Province of Formosa, Argentina, were studied in late 1975. The Pilaga have an empirical and mythic notion of the processes of gestation, but no true physiological concept. The idea of the uterus as an organ and its function are lacking. The womb is regarded as a bag in which the embryo develops. The baby develops and grows through successive deposits of semen, which also cause the placenta to be created. Native opinions vary as to the chronology of development of different parts of the body. The death of an embryo is believed to result from intentional damage inflicted by a shaman or spirit. Conception and pregnancy are believed to result from intervention of spirits called payak acting in concert with human actions. The Pilaga consult shamans, preferably in the family, in order to assure the good will of the payak. The souls of children to be born are sent to the mother's body. The payak provide men with supplemental strength so that their forces will not be exhausted in coitus. Twin births are believed to result from the bad intentions of the payak. It is not believed possible to develop more than 1 embryo at a time because of the diminution of physical strength caused by loss of vital fluids in each ejaculation. The second and subsequent infants in multiple births are considered children of the payak and must be eliminated. Sterility is always attributed to the female and may be due to her requests to a payak to intercede and prevent pregnancy or to bad intentions of a payak, which comes in the form of a small insect and ties off her womb so that the embryo cannot receive the successive deposits of semen that cause it to develop. Sterility can sometimes be cured by intervention of a shaman, if the payak can be persuaded to leave the woman alone. Otherwise sterility is cause for breakup of a marriage. The cultural ideal is to have a son first and then to have an equal number of sons and daughters. Both parents must observe a variety of dietary and other tabus during the pregnancy. The woman must not leave the house lot by herself in the prenatal and postnatal periods for fear that the payak will harm her. If she briefly goes out, she must disguise herself head to toe and must be accompained by her mother or grandmother. An older widow assists in the birth according to techniques laid down by the first humans in ancient times. Care of the umbilicus, burial of the placenta, and washing of the newborn and mother are especially surrounded by danger and must be carefully done so as to prevent harm to either.^ieng

Presence of serotonin in the rat vas deferens: its influence on contractile responses.

Serotonin has been detected in the rat vas deferens. Increase in the serotonin concentration by exposure of the rat vas deferens to L-tryptophan occurs in vitro. p-chlorophenylalanine partly blocks the increase in serotonin concentration induced by tryptophan in vitro but not in vivo. Chronic sympathetic denervation induces an increase in 5-HT concentration. Responses of the vas deferens to transmural stimulation are depressed by pretreatment of rats with p-chlorophenylalanine, and the depression is reversed by incubation in vitro with 5-hydroxytryptophan or serotonin. Serotonin can enhance the response to transmural stimulation at low concentrations but has no effect at higher concentrations. Physostigmine-induced enhancement of the response to stimulation is depressed only by higher concentrations of serotonin. The results raise the question whether endogenous serotonin can act as a modulator of neurotransmission in the rat vas deferens.

PIP: Various experiments were conducted to evaluate the influence of serotonin (5-HT) on contractile responses of the rat vas deferens in vitro and in vivo. In vitro exposure of the vas deferens to L-tryptophan increased serotonin concentration. p-Chlorophenylalanine partially blocked this increase in vitro but not in vivo. The concentration of 5-HT was also increased by chronic sympathetic denervation. Pretreatment with p-chlorophenylalanine depressed the contractile response to transmural stimulation, while incubation with 5-hydroxytryptophan or serotonin reversed this effect. Low, but not high, concentrations of serotonin enhanced the response to transmural stimulation. However, only high concentrations of serotonin depressed the physostigmine-induced enhancement of the contractile response to transmural stimulation. The results suggest that endogenous serotonin may modulate neurotransmission in the rat vas deferens.