[Endometrial aspiration biopsy]. / Biopsia endometrial por aspiración.

The factuality and diagnostic accuracy of aspiration endometrial biopsy with Karman's cannula, as compared with the curetted sample with Novak's cannula, were evaluated. Two hundred and thirty endometrial biopsies, were taken, as part of the study in women with fertility problems, at the Assisted Reproduction Clinic and Sterility Clinic, Instituto Nacional de Perinatología. The samples taken with Karman's cannula, Group I (n = 115); and with Novak's cannula, Group II (n = 115), were compared: procedure's time, pain intensity, quantity and quality of samples, macro and microscopically. In 92.2% of group I, tissue adequate for diagnosis, was obtained, as compared with 84.4% in Group II; likewise, the sample was better quantitatively and qualitatively, in Group I; and required time was less than one minute in 90% in Group I, an 83% in Group II. With the use of Karman's cannula, 20% of the patients had no pain, and 0.9% with the use of Novak's cannula. So, it can be concluded that endometrial aspiration with Karman's is reasonable and reliable in the functional histological diagnosis; it permits the obtention of adequate samples, in quantity and quality, and offering as advantages less pain and more security for the patients.

[Levonorgestrel releasing subcutaneous implants. 1st year's experience]. / Implantes subdérmicos liberadores de levonorgestrel. Primer año de experiencia.

This multicentric study was done in order to know the contraceptive efficacy and side effects of subdermal implants liberating levonorgestrel, in Mexican women. Results analysis, at one year, of 246 women, at four medical centers of Mexican Institute of Social Security (IMSS), showed that this contraceptive is highly efficacious, as there were no pregnancies in 2326 months of observation. The main side effects were: menstrual disorders in 34.8% of women; soreness in implantation site in 3.6%; headache in 13.4% and nausea, dizziness and vomiting in 11.6%. The most frequent causes for implant retirement were menstrual cycle alterations, and soreness at implantation site, with 7.3 and 3.5 respectively. The continuity rate at one year was 84.3, which was higher to what has been seen at the Institution with other temporal contraceptive methods, so the implants may be considered as one more alternative in family planning methods.

[Levonorgestrel-releasing subcutaneous implants. First year's experience]. / Implantes subdérmicos liberadores de levonorgestrel. Primer año de experiencia.

This multicentric study was done in order to know the anticonceptive efficacy and side effects of subdermic implants liberating levonorgestrel, in Mexican women. Results analysis, at one year, of 246 women, at four medical centers of Mexican Institute of Social Security (IMSS), showed that this anticonceptive is highly efficacious, as there were no pregnancies in 2326 months of observation. The main side effects were: menstrual disorders in 34.8% of women; soreness in implantation site in 3.6%; headache in 13.4% and nausea, dizziness and vomiting in 11.6%. The most frequent causes for implant retirement were menstrual cycle alterations, and soreness at implantation site, with 7.3 and 3.5 respectively. The continuity rate at one year was 84.3, which was higher to what has been seen at the Institution with other temporal anticonceptive methods, so the implants may be considered as one more alternative in family planning methods.

[Ultrastructure of human endometrium in vitro in various phases of the menstrual cycle]. / La ultraestructura del endometrio humano in vitro en diferentes fases del ciclo menstrual.

Samples of normal human endometrial tissue from eight young women were initiated in tissue culture. Four biopsies were obtained during the first phase of the cycle and four during the secretory phase. The aim of the work was to characterize ultrastructurally the possible changes of the glandular tissue without being dissociated from the stromal component. At eight hours of incubation there was preservation of all cellular components in the tissue from the first phase of the cycle whereas there were minor degenerative changes in the endometrium from the secretory phase but with outstanding preservation of intranuclear canaliculi typical of this phase. After 16 hours minimal changes were seen in proliferative endometrium while severe changes were present in secretory endometrium. The study suggests that whole endometrium in culture can be used to characterize the short time effect of drugs and substances administered during the first phase of the menstrual cycle.

[Oral contraceptives and metabolic changes]. / Anticonceptivos orales y alteraciones metabólicas.

PIP: Sufficient evidence has accumulated to relate oral contraceptives (OCs) to various cardiovascular diseases in which metabolic alterations play a role. Although epidemiological studies have shown OC users to be at greater risk of venous thrombosis than nonusers, blood coagulation studies of OC users have yielded conflicting results due to variations in the methodologies used, the factors studied, the different formulations and doses of OCs, and the duration of use. Moreover, no satisfactory method exists of measuring coagulability in its totality, which is the sum of the effects of individual variations in coagulation factors, fibrinolysis, and platelet function. Numerous studies have shown that OC users have increased levels of several coagulation factors, which are believed to indicate hypercoagulability and increased risk of thrombosis, but the pathogenesis of venous thrombosis is complex. Accompanying changes in the fibrinolytic system can be interpreted as attempts to equilibrate the hypercoagulability induced by OCs. Further, there is no proof that in vitro changes are related to thrombosis in vivo. The alterations appear to be dose-related, produced primarily by estrogens, unrelated to duration of use, and to disappear a few months after termination of OC use. OC users have been shown repeatedly to have elevated levels of glucose and insulin, which are especially pronounced in glucose tolerance tests. The changes vary in intensity according to the dose and progestational components and the existence of other risk factors for diabetes. Deterioration of glucose tolerance appears related to duration of OC use, but serum insulin levels maintain the same initial elevations. The estrogens have been shown to have few effects on carbohydrate metabolism in the lower doses currently used. Norgestrel has the most marked effects on glucose and insulin levels, ethynodiol diacetate has moderate effects, and norethindrone has the least effect. The combination of .15 mg levonorgestrel and 30 mcg ethinyl estradiol has no effect on oral glucose tolerance and little effect on insulin secretion. It is hypothesized that OCs affect carbohydrate metabolism by decreasing the number and affinity of insulin receptors in target tissues. The mechanisms by which OCs produce undesirable effects on the cardiovascular system are not completely understood, but are believed to be related to alterations in lipid metabolism. The majority of laboratory studies have shown that OC users had elevated levels of cholesterol, triglycerides, and the (LDL) fractions, and a diminution of the high density lipoprotein (HDL) fraction, which has antiatherogenic properties. The changes are atherogenic in nature and produce a lipid profile similar to that of men and postmenopausal women, who are at greater risk of thrombotic cardiovascular disease that premenopausal women who are protected by estrogens. .^ieng

[Oral contraceptives and cardiovascular diseases morbidity]. / Anticonceptivos orales y morbilidad de enfermedades cardiovasculares.

PIP: A case control study was conducted in Mexican Institute of Social Security hospitals in the Valley of Mexico to determine the relationship between oral contraceptive (OC) use and nonrheumatic cardiovascular disease in Mexican women. The study involved Mexican women between 20-44 years of age residing in the metropolitan Mexico City area and married or in stable union. 28 women hospitalized with confirmed diagnoses of ischemic heart disease, 22 with cerebrovascular accidents, 70 with pulmonary embolism or venous thrombosis, 33 with hypertensive cardiopathy, and 55 with other nonrheumatic heart diseases comprised the 201 cases. The 606 controls were women hospitalized with noncardiovascular acute illnesses who met the same requirements for inclusion or exclusion as the cases. Over 98% of the women in the study had been pregnant at some time. OC users were younger and better educated than nonusers. 30% of OC users and 26% of nonusers were smokers. The relative risk of nonrheumatic cardiovascular disease was 1.22 for past users of OCs, who included women using OCs until 1 month prior to the interview. The relative risk for women using OCs within 30 days of the interview (current users) was 1.24. The relative risk according to the estrogen dose was 1.79 for users receiving 40 mcg or less, but paradoxically doses of over 40 mcg decreased the risk to .75. The risk was 1.35 after 1 year of use of OCs, .96 from 12-18 months of use, and 1.34 after 48 months of use. The relative risk was .95 for ever users of OCs aged 20-29 years, 1.38 for those aged 30-39, and 1.48 for those 40-44. Among current users the relative risks were 1.19 for those aged 20-29, .84 for those aged 30-39, and 3.83 for those aged 40-44. The relative risks for ever users and current users respectively were 1.65 and 2.01 for ischemic heart disease and cerebral vascular accidents; 1.40 and 1.43 for pulmonary embolism and venous thrombosis; .85 and .71 for hypertensive cardiopathy; and 1.09 and 1.91 for other cardiovascular diseases. Users and nonusers of OCs had the same access to medical services. Observed differences in the ages and educational levels of users and nonusers were not a source of bias because cases and controls were paired by age and education. The results demonstrated that Mexican women in the Valley of Mexico who use OCs have a statistically significant elevated risk of developing nonrheumatic cardiovascular disease. In declining order of risk are cerebral vascular accident, ischemic heart disease, and pulmonary embolism and venous thrombosis. The risk is present from the 1st days of OC use and in use of OCs containing less than 40 mcg of estrogen. The risk increases with the age of users but not with smoking.^ieng

[Cardiovascular diseases and oral contraception. Study of cases and controls]. / Enfermedades cardiovasculares y anticoncepción oral. Estudio de casos y controles.

PIP: Data on 146 Mexican women aged 20-44 years who were residents of the Mexico City metropolitan area, married or in stable union, and who suffered from nonrheumatic cardiovascular disease, and on 387 controls matched for age, parity, and education were used to study the possible association of nonrheumatic cardiovascular diseases and the use of oral contraceptives (OCs). The women were hospitalized at Mexican Institute of Social Security hospitals between 1979 and 1982. 20 cases had ischemic heart disease, 15 had cerebrovascular accidents, 50 had pulmonary embolism or venous thrombosis, 27 had hypertensive cardiopathy, and 41 had other conditions, primarily arrhythmia, cardiomyopathies, and pericarditis. Among OC users and controls respectively, 1.3% and 2.3% had never been pregnant. 35.0% and 18.6% were aged 20-29 years, 50.0% and 49.0% were 30-39, and 15.0% and 32.4% were 40-44. 25.0% of users and 22.8% of nonusers currently smoked. 60.0% of users and 76.5% of nonusers had primary education or less. The relative risk for nonrheumatic cardiovascular disease was 1.00 for 58 women who had never used OCs, 1.49 for 88 ever-users of OCs, and 1.40 for 26 current users. The relative risk for 10 women using pills with an estrogen dose of 40 mcg or less was 1.60, compared to 1.06 for 11 women with an estrogen dose over 40 mcg. The relative risk was 1.60 for 52 patients using OCs for 12 months or less, 1.13 for 22 patients using them for 13-48 months, and 1.87 for 14 patients using them for over 48 months. Relative risk increased by age and was over 3 times as high for women aged 40-44. The relative risk was 1.55 for 13 OC users who had never smoked, .44 for 2 users who had previously smoked, and 1.51 for 11 users who currently smoked. Considering smoking only, relative risk was 1.00 for 80 women who never smoked, 1.61 for 66 who previously smoked, and 1.45 for 47 who currently smoked. The risk was significantly increased in OC users for ischemic heart disease, cerebrovascular accidents, venous thrombosis, and pulmonary thromboembolism.^ieng

Perdida sanguinea mestrual en usuarias de dispositivos intrauterinos Cu 7 y TCu 220C. / Menstrual blood loss in women with Cu 7 and TCu 220C intrauterine devices

Se cuantifico la perdida sanguinea menstrual (PSM) en 101 mujeres a las que se les inserto un dispositivo intrauterino en 41 de tipo Cu 7 y en 60 de tipo TCu 220 C.Previa a la insercion se cuantifico la PSM durante uno a dos ciclos. Ninguna de las mujeres del estudio usaba metodos anticonceptivos hormonales durante seis meses previos, ni DIU's durante tres meses previos.Una vez insertados los DIU's el flujo menstrual se midio en los meses 1, 3, 6, 9 y 12 postinsercion y 1, 2, 3, posretiro. La PSM en el control fue similar en ambos grupos 41.2 +/- 5.1 ml y 39.1 +/- 3.9 respectivamente. Durante los meses de uso del DIU, el grupo de mujeres con Cu 7 no presento cambios significativos en su PSM, mientras que el grupo de TCu 220 C presento incrementos en su PSM hasta de un 64.1 por ciento en el sexto mes de uso con un promedio de 64.2 +/- 8.4 ml. Al retirar los DIU's en ambos grupos la PSM volvio a cifras similares a las del control preinsercion. La hemoglobina venosa no sufrio cambios significativos en ninguno de los dos grupos

[Comparative clinical study of 5 barrier methods]. / Estudio clínico comparativo de cinco métodos de barrera.

PIP: The effectiveness and acceptability of 5 barrier methods of contraception were investigated in 171 males and 407 women. They chose the use of ovules with 0.4 mg phenylmercuric acetate; foaming tablets with mephengol; 60 mg ovules with nonoxynol 9, 5.8%; and polymeric sponges with nonoxynol 9 at different concentrations. Anticonceptive effectiveness was evaluated by the Pearl's Index; the lowest rating (6.0) was for the preservative. In decreasing order came mephengol tablets (33.4), phenylmercuric ovules (33.0), nonoxynol ovules (60.7), and polymeric sponges (52.8-120.0). In general the acceptability was low. Discontinuation of spermaticides was due to unreliability; dissatisfaction was the reason for discontinuation of the preservatives and sponges. There were no important side effects. Some couples using foaming tablets reported a sensation of heat as the tablet was dissolving and 2 users reported a bad vaginal odor. After favorable initial acceptance of these methods, final acceptance was low, possibly due to the association with intercourse and direct manipulation of the genitals. (author's)^ieng

[Application of intrauterine devices preceded by measurement of the endometrial cavity using a Hollister sound]. / Estudio sobre la aplicación de dispositivos intrauterinos previa medición de la cavidad endometrial con la sonda Hollister.

PIP: The frequency of IUD expulsion, pregnancy, and removal was studied in 694 users. Those IUD types examined were the Lippes Loop D, Copper T-device, the 220C, and the T releasing 65 mcg of progesterone. A comparison was done as to the length of the uterine cavity, measured by a Hollister device which tends to be very accurate. Other authors have described certain length limits in the uterine cavity beyond which the number of pregnancies, expulsions, and removals are greater, but this was not confirmed in the present study. The only statistically significant difference was reduced frequency of such events in those women using the Copper T as compared with the Lippes Loop, independent of uterine cavity length. (author's modified)^ieng

Estudio sobre la aplicacion de dispositivos intrauterinos previa medicion de la cavidad endometrial con la sonda Hollister. / Implantation of intrauterine devices with previous measurement of the endometrial cavity using a Hollister catheter

Se efectuo un estudio comparativo entre la frecuencia de los eventos expulsion, embarazo y retiros por razones medicas en 694 usuarias portadoras de dispositivos intrauterinos asa de Lippes D, Tcu 220C y T liberadora de 65 mcg. de progesterona en relacion con la longitud de la cavidad uterina, medida con la sonda de Hollister, la cual permite una medicion mas exacta de esta dimension del utero. A pesar de que otros autores han descrito ciertos limites de longitud de la cavidad uterina, fuera de los cuales las tasas de embarazos, expulsion y retiro son mayores, esto no pudo confirmarse en nuestro estudio. La unica diferencia con significacion estadistica encontrada fue una menor frecuencia de los eventos mencionados en las mujeres portadoras de T, comparadas con el grupo que uso asa de Lippes, independientemente de la longitud de la cavidad uterina