[Size reduction of uterine myomas with monthly administered leuprolide acetate]. / Disminución del tamaño de miomas uterinos con acetato de leuprolide administrado mensualmente.

Six patients with symptomatic leiomyomata uteri and in whom surgical treatment was indicated received, during 3 months, intramuscular leuprolide acetate, 3,75 mg monthly, in order to 1) achieve a reduction of myomata size and 2) recover an anemic patient before surgery. In every patient, amenorrhea was induced since the second month of treatment. A significant decrease of myomas sizes was achieved. The reduction of the volume of the largest myoma in each case, varied between 51% and 77% (x = 60% +/- ES 4,3) LH and estradiol plasma levels diminished significantly and FSH did not changed in response to treatment. Side effects were well tolerated. Hot flashes were present in all patients, headaches in 2 and loss of strength in 2. Surgery was accomplished after 3 months of treatment. Myomectomy was performed in 5 cases and total hysterectomy in 1. Uterine shrinkage and the period of amenorrhea induced by Lupron-depot facilitated hysterectomy and myomectomy techniques and the recovery of one patient with a severe anemia.

A multicentre study of coagulation and haemostatic variables during oral contraception: variations with geographical location and ethnicity. Task Force on Oral Contraceptives--WHO Special Programme of Research, Development and Research Training in Human Reproduction.

A comparative study of the effects of combined oral contraceptives (OC) on coagulation and fibrinolytic variables using standardized laboratory technique and methodology has been performed in Dublin (Ireland), Salvador (Brazil), Santiago (Chile) and Singapore. Of 777 entrants to the study, 622 were randomly allocated to receive one of four different OC formulations. The remainder did not opt for OC. The progestogenic component was levonorgestrel (LNG) in three of the OC formulations and norethisterone acetate (NEA) in the fourth. Results for the three LNG user groups were pooled. The changes in haematological variables observed over 12 months in the LNG and NEA users were examined in relation to the changes seen in the women not on OC. Women in Salvador differed markedly from those in the other three centres, in showing no acceleration of the prothrombin time and no increase in either fibrin plate lysis or plasminogen following the use of OC. After adjusting the findings in OC users for those in non-users, significant differences in response between centres were also detected for activated partial thromboplastin time (accelerated only in Dublin and Santiago), factor VII activity (increased mainly in Salvador and Santiago) and fibrinogen (for which the most marked changes were an increase in Dublin and a decrease in Salvador). This variability between centres in the effects of OC on coagulation and fibrinolysis suggests that OC administration in different populations may not carry equal thrombotic risks.

[Gyneco-obstetrical morbidity in the population of Santiago]. / Estudio de morbilidad ginecoobstétrica en la población de Santiago.

PIP: 1607 women were interviewed about their gyneco-obstetrical health in a survey of 469 randomly selected households in the province of Santiago, Chile. The dependent variables correspond to the frequency of gynecologic or obstetrical morbidity and demand for medical attention in 2 weeks of April, 1987. Independent variables were age, educational status, and health insurance coverage. 125 of the households were headed by uninsured persons. The average woman was 34.4 years old. 43.1% had 8 years or less of education, 42.6% had 9.12 years, and 14.2% had 13 or more years. 21 new cases of acute obstetrical or gynecological disorders were reported, including 15 of vulvovaginitis, 3 abortions, 1 bartholinitis, 1 intrahepatic cholestasis of pregnancy, and 1 urinary tract infection. There were 55 cases of chronic disorders, including 12 benign ovarian lesions, 8 dysmenorrheas, 8 uterine dystropias, 10 cases of menstrual disturbances, 1 of infertility, 4 benign cervical lesions, 5 benign uterine lesions, 2 pelvic inflammations, 2 cervical cancers, 2 breast cancers, and 1 ovarian cancer. Among the 1607 women, 11 had consulted for family planning in the 2 weeks, 25 for pregnancy, 22 for gynecological conditions, and 9 for postpartum care. 58.3% of the women aged 15-49 used a contraceptive method. The proportions of users of oral contraceptives and IUDs respectively were 62.5% and 37.5% for women under 20, 60% and 40% for women 20-29, 27% and 61% for women 30-39, and 15.1% and 60.6% for women 40-49. 28.2% of women over 15 had had a Pap test in the past year. The proportions of different age groups having Pap tests ranged from 2.0% for women under 20 to 46.7% for women aged 30-39. 3 women in the sample households had died in the past year of gyneco-obstetric causes, 1 of complications of childbirth and 2 of cervical cancer.^ieng

Differences in coagulation and haemostatic parameters in normal women of childbearing age from different ethnic groups and geographical locations. Task Force on Oral Contraceptives--WHO Special Programme of Research, Development and Research Training in Human Reproduction.

A comparative study of coagulation and fibrinolytic laboratory parameters was undertaken in four countries (Salvador, Brazil; Singapore; Santiago, Chile and Dublin, Ireland) among apparently healthy women of reproductive age. A continuous external quality control scheme of the laboratory measurements was employed to permit comparison among centres. Significant and consistent differences were found between the four centres. In Dublin, the prothrombin time and activated partial thromboplastin time (APTT) were accelerated, and the specific factor assays showed more activity, whereas the antiprotease levels were higher than in the other centres. In Salvador, a contrasting tendency was found with longer prothrombin times and APTT and lower Factor VII and antiprotease levels. The results from the other two centres were approximately midway between these two extremes. The study has revealed important differences in the coagulation and haemostatic tests between women from widely diverse geographical areas. It is not certain whether these are due to ethnic, nutritional or economic factors but they may be related to the apparent varying incidence of thrombosis in these ethnic groups.

Evaluation of hypercoagulability in septic abortion.

Soluble fibrin monomer complexes (SFMC) were determined in patients with septic abortion (body temperatures of more than 39 degree C and/or chills without apparent signs of endotoxic shock), with infected abortion, with non-infected abortion and with normal pregnancies. Quantitative gel filtration (4% agarose) of beta-alanine precipitated plasma samples yielded the relative (percent of total fibrinogen content) and absolute (mg/100 ml plasma) amount of SFMC. The relative (5.5+/-1.4%, mean+/-SD) and absolute (21.5+/-8.6 mg/100 ml) amount of SFMC was significantly increased in patients with septic abortion compared to patients with normal pregnancies or non-infected abortion (p less than 0.001). Patients with infected abortion (p less than 0.001). Patients with infected abortion already revealed increased levels of SFMC (4.3+/-1.2%, 14.2+/-6.8 mg/100 ml) though their platelet count was still unaltered (infected abortion: 221+/-47 X 10(3) platelets/mm3; septic abortion; 99+/-36 X 10(3) platelets/mm3). The use of heparin in patients with septic abortion resulted in a decrease in SFMC. Chain characterization of SFMC frequently revealed a slight degradation of the alpha-chains probably due to fibrinolytic activity in vivo; gamma-gamma dimers representing intermolecular covalent bindings were not observed. The findings are in agreement with our former assumption that patients with septic abortion have a pronounced state of hypercoagulability.

PIP: The effect of septic abortion on plasma levels of soluble fibrin monomer complexes (SFMC) was studied by quantitative gel filtration (4% agarose) of beta-alanine precipitated plasma samples. Pregnant patients and those with infected or noninfected abortions were also studied. The relative and absolute amounts of SFMC were significantly (p less than .001) increased in cases of septic abortion compared with cases of normal pregnancy or uninfected abortion. Patients with infected abortion showed increased absolute and relative levels of SFMC, though not to the extent of septic abortion cases. However, unlike septic abortion cases, platelet count was not reduced. When heparin was used in septic abortion cases, SFMC decreased. A slight degradation of the alpha-chains of SFMC probably due to in vivo fibrinolytic activity was observed. The findings confirm that patients with septic abortion have a marked degree of hypercoagulability.

[Endotoxic shock in obstetrics]. / Shock endotóxico en obstetrícia

PIP: 28 cases of septic shock which occurred between 1973-74 in a large metropolitan hospital in Santiago, Chile, were analyzed. 25 cases were complications of septic abortion, and 1 was a consequence of an attempted abortion. Average age of patients was 30.9 and average parity 2.9; most patients had experienced abortion before. Average hospitalization time was 10.6 days, and average duration of shock was 10.1 hours. Percentage of mortality was 21.4%. Diagnosis of the cases revealed that all patients had hypotension, that 96.4% had obstetrical infection, that 85.6% had oligonuria and high fever, and that 89.3% had tachycardia. Treatment of patients is carefully described and the importance of the availability of proper laboratory service and equipment is emphasized.^ieng