Semen quality of workers occupationally exposed to hydrocarbons.

OBJECTIVE: To determine whether occupational exposure of men to hydrocarbons has adverse effects on the quality of their semen. DESIGN: Comparative study. SETTING: The rubber industry in Mexico City. PATIENT(S): Forty-eight workers who were exposed to hydrocarbons for 2-24 years and 42 unexposed workers. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Environmental hydrocarbon concentrations were determined by continuous air monitoring in all areas of the factory. Analyses of semen samples were performed in accordance with World Health Organization criteria. RESULT(S): Hydrocarbon concentrations were as follows: ethylbenzene, 220.7-234 mg/m3; benzene, 31.9-47.8 mg/m3; toluene, 189.7-212.5 mg/m3; and xylene, 47-56.4 mg/m3. The number of subjects with ejaculates that had normal characteristics was greater in the unexposed group (76%) than in the exposed group (17%). More abnormal characteristics were found in the semen of exposed workers than unexposed workers, including alterations in viscosity, liquefaction capacity, sperm count, sperm motility, and the proportion of sperm with normal morphology. Some abnormal characteristics correlated with the number of years of exposure to the hydrocarbons. CONCLUSION(S): Damage to the spermatogenic process resulting from hydrocarbon exposure was demonstrated by an increased rate of abnormalities in the semen of exposed workers compared with unexposed workers. This information may be useful for conducting future analyses of reproductive risks related to exposure to high concentrations of hydrocarbons.

Male fertility of kidney transplant patients with one to ten years of evolution using a conventional immunosuppressive regimen.

The reproductive functions and hormone serum levels of 55 male kidney transplant recipients were assessed. Patients underwent peritoneal dialysis before transplantation and were given immunosuppressive therapy afterward for 1 to 10 years. Spermatobioscopies were performed, and serum urea, creatinine, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and testosterone (T) levels were determined. Average serum urea and creatinine levels were 54.6+/-1.4 and 3+/-1.3 mg/dL, respectively. The average serum hormone levels were 3.2+/-2 mIU/mL (LH), 6.3+/-1.7 mIU/mL (FSH), 11.7+/-1.5 ng/mL (PRL), and 23+/-1.4 pg/mL (T). Libido reduction was reported in 88% of patients within 8 months following transplantation. Normozoospermia was seen in 47.3% of the patients, asthenozoospermia in 18.2% oligozoospermia in 14.5%, while oligoteratozoospermia, asthenoteratozoospermia, oligoasthenozoospermia, oligoasthenoteratozoospermia, and azoospermia were seen in the rest. Twenty-six patients procreated one or more children after transplantation; 36.6% of those children were premature but nonetheless healthy. No association existed between the post-transplant period and urea or creatinine levels. Significant differences were found when LH levels and sperm motility were assessed. Also, statistically significant differences were found when duration of dialysis, FSH levels, sperm counts, morphology, and motility between posttransplant fertile and infertile patients were correlated. In conclusion, there was an adequate recovery of sexual and reproductive functions in most patients subjected to kidney transplantation and conventional immunosuppressants.

[Preventive treatment of primary dysmenorrhea with ibuprofen]. / Tratamiento profiláctico de la dismenorrea primaria con ibuprofén.

An open, prospective study, including 15 young women with primary dysmenorrhea was carried out to asses the prophylactic administration of Ibuprofen for the treatment of severe and disabling primary dysmenorrhea. The study lasted six months, representing a total of 90 cycles, the inclusion criteria were: 1) severe and disabling primary dysmenorrhea, 2) Failure with previous conventional treatments, 3) regular menstrual cycles, 4) without active sexual life, 5) voluntary participation. The treatment schedule included 400 mg of ibuprofen every 8 hours, starting 24 hours before the menstrual cycle during 4 days of menstruation for six consecutive cycles. The intensity of the pain was recorded every eight hours using a linear analogue scale from 0 to 10 where 0 was absence of pain and 10 was severe or disabling pain. Results showed that the mean of initial intensity of the menstrual cramp experienced in the cycle before the treatment (control) was 9.47 +/- 0.5. During the prophylactic treatment the means of initial intensity of the pain were significantly lower, between 7.84 +/- 0.37 and 7.21 +/- 0.52. A statistically significant progressive decrease of pain was recorded during the duration of treatment. After 48 hours of treatment the intensity of the pain was recorded as three (mild). We conclude that the prophylactic administration of ibuprofen is an effective treatment for selected women experiencing severe and disabling primary dysmenorrhea.

[Incidence of dysmenorrhea and associated symptoms in women aged 12-24 years]. / Frecuencia de la dismenorrea y síntomas asociados en mujeres de 12 a 24 años.

A Menstrual Symptom Questionnaire was administered to 1,066 women students from Mexico City. The questionnaire included general data and 12 symptoms related to dysmenorrhea. The mean age of the participants was 18 +/- 3.2 years. The mean age of menarche was 12.3 +/- 1.3 years. The prevalence of dysmenorrhea was 52.1% for the group < 15 years of age, 63.8% for women between 15-19 years, and 52.3% for the group of 20-24 years. The frequency of absenteeism as a result of dysmenorrhea in the group < 15 years was 4.3%, 9.3% for the group 15-19 years and 19.8% for the group 20-24 years. Systemic symptoms accompanying dysmenorrhea were clustered for analysis. The most frequent symptoms associated with dysmenorrhea were nervousness, depression, irritability and sleeplessness. Self-medication was prevalent, the most utilized drugs being antispasmodics.

[Interaction of endogenous opioid peptides with the function of the hypothalamo-hypophyseal-testicular axis]. / Interacción de los péptidos opioides endógenos con la función del eje hipotálamo-hipófisis-testículo.

Since the discovery of endogenous opioid peptides and opioid receptors in the brain, their has been considerable interest in their possible role in a variety of physiological and pharmacological processes. The endogenous opioids and opiate active substances have been clearly implicated in the regulation of male reproductive function. It has been demonstrated that opioid peptides inhibit gonadotropin and TSH secretion and enhance PRL, GH and ACTH. It is believed that opioids elicit their action at the hypothalamic level, most likely by modulating the liberation of hypothalamic releasing or inhibiting factors. In healthy male adults the endogenous opioid peptides (EOP) produce a decrease in serum levels of gonadotropins. Administration of specific opiate antagonists decreases luteinizing hormone (LH) release and increases the frequency and amplitude of the LH pulses. The effects of EOP and specific opiate antagonists are altered in some hypothalamic-hypophysis-testis axis pathologies.

Toxicology of male reproduction in animals and humans.

Environmental contaminants can interfere with the male reproduction function. A review is presented of those pollutants with adverse effects on human reproduction. The possible effects of occupational and environmental exposure to various substances on male reproductive health are evaluated. This analysis considers studies showing damage of men exposed to halogenated hydrocarbons, other organic compounds, heavy metals and some physical agents, and some lifestyles, such as continuous stress, alcohol consumption, cigarette and marijuana smoking, and other addictions. Possible influences of these agents on the neuroendocrine system with the decrease of male fertility during the last decades are also discussed.

[Climacteric. The first level physician's approach to this phase at the Mexican Institute of Social Security]. / Climaterio. Comportamiento del médico de primer nivel del Instituto Mexicano del Seguro Social ante este periodo.

The objective was to know about physician's knowledge, attitude and practice toward climateric syndrome. An observational, descriptive and transversal study was realized in 520 general practitioners and family practice specialists in ten out patients clinics at the Institute of Social Security in Mexico City. A questionnaire of 22 items, which was validated by the Delphi's Technique, was applied to the selected population by one of the researchers (SM). The results were: 5.4% good, 78.9% regular and 15.7% non-acceptable about knowledge; 33.7% good, 44.2% regular and 22.1% non-acceptable for attitude; 5.4% good, 63% regular and 31.6% non-acceptable about medical practice. It was concluded that the knowledge of general practitioners and family practice doctors is reflected in their medical attitude and practice. Therefore we consider essential to train physicians in this specific problem.

[Receptor (ER, PgR) levels as prognostic factors in the endocrine therapy of pre- and post-menopausal patients with stage III infiltrative ductal and lobular cancer of the breast]. / Niveles del grupo de receptores (RE, RPg) como factor pronóstico de la terapia endócrina en pacientes pre y posmenopáusicas con carcinoma mamario ductal y lobulillar infiltrante en etapa clínica III.

Receptors group (ER+, PgR+) in post-menopausal and pre-menopausal patients with ductal and lobular infiltrating mammary cancer clinical stage III and poorly differentiated histological assessment was studied. Levels of (ER+, PgR+) were correlated to endocrine therapy response (Tamoxifen) after 5 years of its administration. Both pre and post-menopausal patients with infiltrating ductal carcinoma, the (RE+, RPg+) tumour content, the mean values were 52 +/- 8, 53 +/- 11 fmol/mg protein and 111 +/- 20, 36 +/- 7 fmol/mg protein, respectively. With regard to lobular carcinoma, the (RE+, RPg+) tumour content, the mean value was 109 +/- 28, 46 +/- 12 fmol/mg protein in pre-menopausal patients, whereas it was 287 +/- 60, 66 +/- 18 fmol/mg protein in post-menopausal patients. The tumour was considered (ER+, PgR+) when specific binding was than 10 fmol/mg protein. In both ductal and lobular carcinoma the mean (ER+) concentrations are significantly different between the post and pre-menopausal patients, while the mean (PgR+) concentrations are significantly different in post-menopausal women. After five years of treatment with tamoxifen, survival analysis of patients with ductal infiltrating and lobular infiltrating carcinoma revealed a very strong correlation between levels of receptor group (ER+, PgR+) and their response to endocrine therapy.

[Chromosomic etiology of male sterility and infertility]. / Etiología cromosómica de la esterilidad e infertilidad masculina.

Recent advances in the knowledge of sexual development have been obtained by studying individuals with dysgenetic gonads and reproductive tract alterations. By using probes Y-ADN in these patients, it was found that a gene of the short arms of Y chromosome, induces testicular differentiation. The way this gene acts is not known, but the observation that there are homologue sequencies in X and Y, suggests the possibility that sexual differentiation depends on genic doses. Other genes like the one that codifies for antigen H-Y, for skeletal maturation, body growth, dental size and spermatogenesis regulation, have been identified in chromosome Y. Findings that have allowed a better understanding of genetic and cytogenetic factor involved in sterility-infertility.

Etiología cromosómica de la esterilidad e infertilidad masculina / Chromosomic etiology of masculine sterility and infertility

Avances recientes en el conociminto del desarorollo sexual se han logrado al estudiar individuos con gónadas disgenéticas y alteraciones del aparato reproductor. Utilizando sondas Y-ADN en estos pacientes se ha encontrado que un gen de los brazos cortos del cromosoma Y, induce la diferenciación testicular. La forma como este gen actúa no se conoce, pero la observación de que existen secuencias homólogas en X y Y sugiere la posibilidad de que la diferenciación sexual depende de dosis génicas. Otros genes como el que codifica para el antígeno H-Y, el de la maduración esquelética, el crecimietno corporal, el tamaño dental y la regulación de la espermatogénesis se han identificado en el cromosoma Y. Hallazgos que han permitido un mejor entendimiento de los factores genéticos y citogénicos involucrados en la esterilidad-infertilidad.

Modificaciones del flujo menstrual con dispositivos intrauterinos de cobre. / Changes in menstrual flow with copper intrauterine devices

Los dispositivos intrauterinos (DIU) tienen como principal inconveniente las modificaciones que producen en el flujo menstrual, siendo estas alteraciones el principal motivo de abandono de este metodo anticonceptivo. En el presente trabajo nosotros encontramos que los cuatro DIU estudiados aumentan la cantidad de flujo menstrual siendo el asa de Lippes y la Tcu 380 los que mas alteracion producen, causando el mayor numero de ciclos por arriba del limite superior normal de 81.6ml.Si bien no se encontro disminucion de la hemoglobina venosa en estas mujeres, si es conveniente mantener a las usuarias de estos DIU en una vigilancia periodica para evitar problemas de anemia