Prevention and treatment of pregnancy-induced hypertension (preeclampsia) with progestogens.

Available data indicate that progesterone is able to treat pregnancy-induced hypertension (preeclampsia). Dydrogesterone and 17alpha-hydroxyprogesterone caproate might also be used for this purpose. Prevention of hypertensive disorders in preeclampsia also seems possible, but studies are needed to confirm this.

The patterns of expression of an apoptosis-related CK18 neoepitope, the bcl-2 proto-oncogene, and the Ki67 proliferation marker in normal, hyperplastic, and malignant endometrium.

Expression of a neoepitope on cytokeratin 18, recognized by the monoclonal antibody M30, is an early indicator of apoptosis in epithelial cells. The aim of this study was to determine the equilibrium between apoptosis (M30), anti-apoptosis (bcl-2), and proliferation (Ki-67) in different endometrial conditions. Paraffin-embedded samples (n = 107), representing proliferative endometrium (18), secretory endometrium (19), postmenopausal endometrium (15), disordered proliferative endometrium (6), simple hyperplasia (12), complex hyperplasia (8), and endometrial adenocarcinoma (29), were evaluated immunohistochemically. The indirect streptavidin-biotin-horseradish peroxidase technique, with 3-amino-9-ethylcarbazole as the chromogen, was used to visualize the reactions. Proliferative endometrium showed high bcl-2 and Ki-67 expression levels with no M30. In the secretory phase, the balance was tipped in favor of M30 with a decrease of bcl-2 and Ki-67. Postmenopausal endometrium revealed high Ki-67 and bcl-2 expression levels and no M30. In complex hyperplasia, M30, bcl-2, and Ki-67 showed increased expression. In endometrial carcinoma, an increasing reactivity for M30 and Ki-67 was seen as the grade progressed. bcl-2 reacted weakly and only in grade 1 cancer. Immunohistochemistry facilitates the study of the expression of proteins related to cyclic endometrial activity. Interruption of these cyclic events is associated with specific disturbances in the expression patterns of these proteins.

Biochemical and cytochemical changes of alpha-esterases activity in long-term oral contraceptive users.

PIP: The alpha-esterases activity was measured in the serum and vaginal fluid of 39 women who used (OCs) oral contraceptives for long periods of time (12-15 years). The results were compared with the activity of 30 control fertile females who did not take any OCs. The alpha-esterases activity was measured by cytochemical and modified simple reproducible biochemical methods. The biochemical study revealed that serum alpha-esterases activity is not affected either by long-term use of OCs or by different types of cervical infections. On the other hand, the cytochemical and biochemical results show that there is a significant increase in the activity of vaginal alpha-esterases in pill users accompanied with cervicitis. The increase in vaginal alpha-esterases activity may shed light on the possible relationship between the activity of alpha-esterases and malignancy.^ieng

Effect on prolonged use of oral contraceptive pills on the activity of serum and vaginal ribonuclease.

PIP: 39 longterm oral contraceptive (OC) users (12-15 years) and 30 women who have never used OCs were studied to determine the activity of free alkaline ribonuclease (RNase) in vaginal fluid and in serum. All women were of reproductive age. Of the 30 controls, 14 had cervical erosions, and the remainder were clinically healthy. Of the 39 cases, 12 were clinically free of cervicitis or cervical erosion, 21 had some sort of cervicitis, and 6 had trichomonal vaginitis. The group of women using OCs who had cervical infections showed a significant increase in the RNase activities compared with the clinically free pill users (P .025 and .005, respectively). The activity of serum and vaginal free alkaline RNase activity was higher and statistically significant in the controls with cervical erosion compared with clinically free controls (P .001). In addition, OC users with cervicitis showed a significant increase in vaginal RNase activity compared with clinically free pill users (P .001), whereas the difference in mean serum RNase was not significant between these 2 groups. Specifically, OC users with trichomonal vaginitis had significantly higher serum and vaginal RNase activity values than nonpill users who were clinically free or who had trichomonas. The OC users with trichomonas showed only a significant increase in serum free RNase compared with OC users with cervicitis (P .001).^ieng

A clinico-pathological study of Neogynon as a new oral contraceptive steroid.

PIP: Clinical experience, and a pathology study, of 184 women on Neogynon (.25 mg d-norgestrel and .05 mg of 17-ethinyl estradiol, micro 20) was assessed for a total of 3129 cycles. 53 women were nursing babies before use of the pill, and 44 continued to do so throughout pill usage. Endometrial biopsies were taken premenstrually, during the period of full hormonal effect, for 40 cases before and then 6-12 months after initiation of pill usage; biopsies were studied for effect of the combined steroid on the building up of endometrium. The combination pill was 100% effective, with no failures. 23 cases (12.5%) failed to continue through the 18th cycle. 4 cases stopped after the 2nd cycle and 6 more after the 4th; the remaining stopped after the 12th cycle. No change in menstrual pattern was noticed in 136 (73.9%) of the cases; 14 presented with menorrhagia and endometrial biopsy of one of these showed regressive and mixed endometrial changes. 2 cases of intermenstrual spotting were reported. Hypomenorrhea was reported in 16 cases. Side effects were generally effects on the central nervous system: 7 cases of headache and dizziness, 7 cases of mild depression, and 3 cases of sexual anorexia. No gastrointestinal side effects were reported. 44 cases (of 53) continued lactation, and 9 noticed a progressive decrease in the amount of milk produced. 8 cases gained weight and 13 lost, 2 enough to quit using the pills. Hair loss was a noticeable complaint in 5 cases. Endometrial biopsies revealed grades of arrest of endometrial development. 85% showed a resting endometrial pattern, whereas 15% were atrophic. Endometrial response was rather irregular and mainly of the mixed type in 90% of the cases and about 10% were proliferative.^ieng

Progesterone therapy in pre-eclamptic toxaemia.

Progesterone was the principal therapeutic agent used in 40 cases of pre-eclamptic toxaemia. It was also given to 10 normal pregnant women who served as a control group. A significant fall in both the systolic and diastolic blood pressures was observed in 80% of the toxaemic patients. In all cases there was a marked increase in the 24-hour urinary output with an apparent loss of weight. Serum uric acid showed a significant drop and the urea clearance values also improved. The serum sodium showed an apparent decline while the serum potassium did not show any marked variation. The serum uric acid, urea clearance, blood urea, serum sodium and serum potassium remained unchanged in the control group.