Updating the clinical experience in endometriosis--the Brazilian perspective.

In an open-label, multicentre, randomized, parallel group study, 164 women with endometriosis were assigned to treatment. Out of these women, 81 received danazol (600 mg daily for 8 weeks, then 400 mg for 16 weeks) and 83 were given gestrinone (2.5 mg twice a week for 24 weeks). Five weeks before the start of treatment clinical evaluation and diagnostic laparoscopy were performed during the screening visit. Drug assignment and laboratory data assessment were carried out within 3 days of the estimated onset of the menstrual cycle at baseline visit. The response to treatment was assessed during visits at weeks 2, 4, 8, 12, 16, 20 and 24; at the last visit a second laparoscopy was performed. Therapeutic efficacy was evaluated by analysis of the laparoscopic scores assessed according to the revised American Fertility Society classification. Symptomatic response was measured by clinical scores and laboratory data. In one centre, bone mineral density was also recorded. One patient in the danazol group discontinued treatment due to a cutaneous rash as a probable adverse reaction at the beginning of the study. The therapeutic efficacy of danazol and gestrinone did not differ significantly when the revised American Fertility Society scores were compared. The symptomatic response also showed no statistical difference when clinical examination scores were analysed. There was no significant difference between the drugs in laboratory data, including bone mineral density, with respect to adverse events. Analysis of clinical scores showed that danazol was superior to gestrinone with respect to acne and irregular bleeding. Based on these data, we conclude that both danazol and gestrinone are reliable in the treatment of endometriosis and offer similar results.

Establishing a program of oocyte donation in Brazil.

Oocyte donation is a novel alternative for the treatment of patients who have infertility associated with ovarian failure. Both IVF-ET and GIFT represent new techniques of treatment for this group of patients. Synchronization between donor and recipient is very simple and also flexible. In our study population, four patients received oocyte or embryo donation after at least 20 days of E replacement, and two of them conceived a clinical pregnancy. Apparently, the flexibility of our protocol of E replacement allows an extension of the proliferative phase in cases that need to have additional time to synchronize the recipient's cycle to that of the donors.

Access to postpartum sterilization in southeast Brazil.

All women hospitalized for delivery over a ten-week period at the largest maternity hospital in Campinas in the State of São Paulo, Brazil, were questioned about their interest in and plans for sterilization. Results from a categorical data analysis indicate that among the study variables, cesarean delivery was the necessary condition for postpartum sterilization and was significantly associated with the patient's ability to pay for services. Further, the variability in the proportion of women sterilized postpartum was almost perfectly explained by a linear model with main effects for parity and for the patient's ability to pay for services.

PIP: A study was undertaken at a large maternity hospital in Campinas in the State of Sao Paulo, Brazil in an effort to obtain more information concerning access to sterilization. This hospital was chosen because it serves patients of widely varied socioeconomic status, and, consequently of different abilities to pay for surgery. The study was conducted over the December 1979 through February 1980 period. Interviews were completed with 2194 women after they gave birth and before discharge from the hospital. Analysis proceeds in 3 steps: a description concerning distributions of age, parity (after delivery), monthly family income, type of payment for medical services, and method of delivery among the 927 women who desire no more children; a description of how the population desiring no more children chooses sterilization as the preferred family planning method; and focus on the subset of women preferring sterilization services, making use of methods of estimation and hypothesis testing from cross-classified data. Almost 9 of 10 women who want no more children have heard of sterilization. Indigent patients are least likely (79%) and private patients are most likely (98%) to have heard of sterilization. Women who had cesarean deliveries are more likely to have heard of sterilization (95%) than those giving birth vaginally (86%). Of all women who want no more children and have heard of sterilization, 58% stated that they had planned to be sterilized. Of the 375 women who planned to be sterilized and knew about available services, 40% were not sterilized postpartum. The most frequent reason given was type of delivery (38%). Of the women who had vaginal deliveries, 48% gave this as a reason for failure to be sterilized. Study data show that the method of payment for care substantially influences the eventuality of sterilization. Wealthier women who are private or convenio (all women who pay for their care through a privately financed insurance plan but do not stay in a private room) patients are more likely to be sterilized than are the poor, whose care is financed through government insurance or who are indigent. Results also show that women sterilized postpartum almost always have had cesarean deliveries. Regardless of whether she is sterilized, a cesarean delivery is more likely as the socioeconomic status of the woman rises. A more liberal interpretation of the Medical Ethics Code that would consider women to be at high risk for reasons other than those associated with previous cesarean birth would improve access to postpartum sterilization.

[Family planning in Brazil]. / Planejamento familiar no Brasil.

PIP: In 1970, 41.6% of the Brazilian population was represented by children aged 0-14, and by 21.3% of women in fertile age; the birth rate was 36.9/1000. Without an appropriate national program of family planning, Brazil will have in the year 2000, 218.8 million inhabitants. The need for family planning services in Brazil is evident, even more so since abortion is forbidden, unless for therapeutic reasons. A national family planning program should include a complete range of maternal and child services, and screening for high-risk women; in other words, family planning should be thought of and used as preventive medicine. Family planning is not so much a right as a duty of the couple. The Catholic church, largely prevalent in Brazil, approves of family planning when practiced with the means allowed by the church itself.^ieng

[Post-pill syndrome]. / Sindrome pos-pilula.

PIP: In a survey of 993 patients complaining of sterility and infertility, 365 were found to suffer from ovulatory disorders, and 133 of the latter were taking oral contraceptives. The patients were subjected to the following tests: basal temperature (monophasic curve in 33.08% of the cases), cervical mucus (negative crystallization in 40.60%), endometrium biopsy (Proliferative in 45.11%), and vaginal cytology (anovulatory pattern in 16.53% of the cases). Laparoscopy was used in 35 cases and biopsy of the ovaries in 18. After treatment with various drugs (such as cyclophenyl, clomiphene, human menopausal gonadotropin, human chorionic gonadotropin, estrogen, progestogen, corticoids, oral contraceptives), improvements were obtained in 82.93% of the cases with respect to basal temperature (from monophasic to biphasic), in 90.90% for cervical mucus (positive crystallization), in 35.28% for endometrium biopsy (from proliferative to sectretory), and in 42.86% for vaginal cytology (from anovulatory to ovulatory pattern). 45 pregnancies were obtianed. It is conluded that oral contraceptives can inhibit ovulation after suspending treatment, irrespective of its duration, especially in women previously suffering from menstrual disorders. The overall incidence of this syndrome is low, and it is generally reversible. It is desirable, however, to identify the women exposed to high risk of its occurrence, should the patient desire to stop the contraceptive treatment and have more children.^ieng