The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis.

In Europe before the advent of the acquired immunodeficiency syndrome (AIDS), fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rarely described and never in young adults. However, rapidly fatal cryptococcal meningitis in young Africans has been known to exist in central Africa for at least 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in this area since 1953, particularly in young patients during the 1950s. It is also known that central African AIDS patients frequently suffer from cryptococcosis, and there is a possibility that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. It appears possible that the central part of the African continent is the area where human immunodeficiency virus originated.

PIP: Rapidly fatal cryptococcal meningitis has existed in central Africa for more than 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in that area since 1953, especially among young patients during the 1950s. People with AIDS in central Africa also often have cryptococcosis, and it is possible that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. Before the advent of AIDS in Europe, fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rare and nonexistent in young adults. The available evidence suggests that HIV may have originated in central Africa, where it had long remained in a specific, but unknown and overlooked habitat. Cryptococcosis infection, cryptococcosis in the Congo River basin, the historical presence of HIV, and HIV in Haiti and among Haitians are discussed.

Impact of Uruguay's introduction of the Haemophilus influenzae type b (Hib) vaccine.

PIP: In August 1994, the National Advisory Commission for Vaccination of Uruguay recommended that the vaccine against Haemophilus influenzae type b (Hib) should be incorporated into the Expanded Program of Immunization vaccination schedule, as follows: 1) newborns should receive the first dose at 2 months, a second and a third dose (to be administered simultaneously with the DPT and the OPV vaccines) at 4 and 6 months, respectively, and a booster between 12 and 15 months; 2) children between the ages of 7 and 11 months should receive 2 doses at intervals of at least 2 months, and a booster between 12 and 15 months (not within 2 months of the date of the last dose); and 3) children 12 months and older should receive 1 dose only. 90,000 doses of vaccine were administered to children less than 1 year old; the cohort numbers approximately 50,000. 130,000 doses were administered to children 1-4 years old. This resulted in a 100% reduction in the number of meningitis cases due to Hib in 1996; 1 reported case was in a non-immunized child. In 1995, 5 cases were reported; only 1 of these was adequately vaccinated with 3 doses of Hib vaccine. During a 1996 epidemiological surveillance study of respiratory infections in children under 5 years old at 2 reference hospitals in Montevideo, no Hib was isolated from 520 reported cases. A histogram plots the number of cases of meningitis due to Hib per month for 1993, 1994, and 1995; the point where vaccination began, August 29, 1994, is marked. Prior to vaccination the number of cases per month cycled, with the highest number occurring during August (7 in 1993, 10 in 1994); after October 1994, the number remained at zero or 1 throughout the year.^ieng

School breakfast and cognition among nutritionally at-risk children in the Peruvian Andes.

PIP: In 1993, in Peru, the Institute of Nutritional Research conducted two studies in Huaraz in the Andean region to evaluate the educational and nutritional impact of the government's School Breakfast Program. The school breakfast included a small cake and a glass of Amilac (similar in taste and color to milk), which provided 30% of each child's energy requirements, 60% of recommended dietary allowances for minerals and vitamins, and 100% of dietary iron needs. A case control study examined the effects of breakfast on cognition among 54 elementary schoolchildren 9-11 years old. It found that the school breakfast did not have a significant effect on the children's performance in the Number Discrimination, Peabody Picture Vocabulary Test, Raven Progressive Matrices, or Reaction Time tests. Children nutritionally at risk who received the placebo had significantly slower short-term memory scanning than their counterparts who received the breakfast. The no-risk placebo group exhibited more rapid discrimination between visual stimuli than the no-risk breakfast group. A field evaluation of the program in 10 rural schools, which were randomly assigned to a treatment or control condition, was conducted. In terms of energy, protein, and iron intake, the children in the case and control conditions were not significantly different. The children tended to be either very stunted or overweight. School attendance increased 0.58 points in the experimental group, while it decreased by 2.92 points in the control group (p 0.05). When both groups received the breakfast, attendance rates increased significantly in both groups (p 0.05). Vocabulary was sensitive to the effects of the breakfast. Specifically, the greater the child's weight, the higher his/her vocabulary test scores (p 0.05). These findings suggest that the brain is sensitive to decreases in the short-term availability of nutrients, and that an overnight and morning fast produces a physiological state accompanied by changes in brain function, especially working memory, particularly among nutritionally at-risk children.^ieng

[Meningitis caused by Haemophilus influenzae type b: its immunological prevention. A necessity?]. / La meningitis por Haemophilus influenzae tipo b (Hib), su prevencion inmunologica. Una necesidad?

PIP: This work argues that the vaccine used to control Haemophilus influenza type b (Hib) in the US should become a routine vaccination for infants in the Dominican Republic as well. Hib was the most common cause of meningitis in children under five years old in the US before the vaccine became available. Mortality from meningitis caused by Hib has declined from 90% before antibiotics became available to between 3 and 5%, but there has been no significant further decline in three decades despite development of powerful new antibiotics. Haemophilus influenza is the principal cause of meningitis at the Robert Reid Cabral Children's Hospital in Santo Domingo, accounting for 50-52% of cases. The great majority of patients are under 15 months old. The case fatality rate is 7% and serious sequelae are not uncommon. The impact of the conjugated vaccine against Hib was demonstrated in the US by an 85-90% decline in secondary infections due to Hib. The vaccine has also been highly effective in Finland, reducing the incidence of meningitis in infants aged 0-4 from a peak of 43/100,000 in the 1970s to 0 in 1991. In the US, the greatest decline in children under age 5 began in 1989, one year before the vaccine was approved for use in this age group. The reason for the timing of the decline is not clear, but transmission from immunized older children may have been reduced. The vaccine, in addition to its efficacy, appears to be associated with few secondary effects. The use of this vaccine despite its high cost in comparison to other routine vaccines is justified in the Dominican Republic.^ieng

Protective efficacy of a serogroup B meningococcal vaccine in Sao Paulo, Brazil.

Serogroup B Neisseria meningitidis is the most common cause of epidemic meningococcal disease in developed countries. Until recently no vaccine has been available for prevention of infection with this organism. In an attempt to control epidemic serogroup B meningococcal disease in greater Sao Paulo, Brazil, during 1989 and 1990, a Cuban-produced outer-membrane-protein-based serogroup B meningococcal vaccine was given to about 2.4 million children aged from 3 months to 6 years. We have done a case-control study to estimate the efficacy of the vaccine in greater Sao Paulo. Microbiologically confirmed cases of serogroup B meningococcal disease were identified through hospital-based surveillance. Controls were matched by neighbourhood and age. Vaccination status was confirmed by inspection of vaccination cards. Between June, 1990, and June, 1991, 112 patients and 409 matched controls with confirmed vaccine status were enrolled. Estimated vaccine efficacy varied by age: 48 months or older = 74% (95% Cl 16 to 92%), 24 to 47 months = 47% (-72 to 84%), and less than 24 months = -37% (< -100 to 73%). Our results suggest that the Cuban-produced vaccine may be effective for prevention of serogroup B meningococcal disease in older children and adults.

PIP: In 1990, researchers compared data on 112 3 month-6 year old children who received a Cuban produced, outer-membrane-protein-based serogroup B meningococcal vaccine (cases) and lived in greater Sao Paulo, Brazil with data on 409 age and neighborhood matched controls to determine the protective efficacy of the vaccine against serogroup B meningococcal disease (Neisseria meningitidis). Health workers began administering the vaccine in 1989 to control an epidemic of serogroup B meningococcal disease in the area. In fact, in mid-1989 and early 1990, the rates of serogroup B meningococcal disease in 1-6 year old children in Sao Paulo were 2.07/100,000 and 2.3/100,000, respectively. Even though only 44% of serogroup B meningococcal isolates corresponded with the vaccine type strain (B:4:P1:15), many isolates had man of the same serotype or subtype antigens as the vaccine type strain. Thus the vaccine was able to protect against some other serogroup B meningococcal strains other than the vaccine type strain. Vaccine efficacy for 4-year old children was 74%, but was much lower for 24-47 month old children (47%) and 24-month old children (-37%). The change in the log odds ratio for vaccination by age was linear and significant (p=.057). The researchers suggested that poor vaccine efficacy among younger children may reflect a need for more boosting to achieve protective levels of immunity. The results showed that the Cuban-produced vaccine could contribute to control of outbreaks of serogroup B meningococcal disease by protecting older children and adults from the disease. Researchers need to conduct additional studies of the vaccine and other possible serogroup B meningococcal vaccines.

HTLV-I associated myelopathy in Salvador (northeastern Brazil).

Recent studies of tropical spastic paraparesis have confirmed the existence of human T-cell leukemia virus type-1 (HTLV-I) in several tropical areas of the world. In order to determine the role of HTLV-I as an etiologic agent of myelopathies in Salvador, we conducted a clinical and serological study in 43 patients with non-traumatic and non-tumoral myelopathies. We found 9 patients with HTLV-I associated myelopathy (HAM) which points to a new endemic area of HAM.

PIP: Human T-lymphotropic virus type one (HTLV-I) exists in several tropical areas of the world and is associated with adult T-cell leukemia/lymphoma and tropical spastic paraparesis. HTLV-I associated myelopathy (HAM) has been described in southern Japan, the US, Colombia, and Central Africa. Several cases have also been identified and described in Brazil. The authors describe the first cases of HAM in Bahia based upon a clinical and serological study in 43 patients with non-traumatic and non-tumoral myelopathies. Sera and CSF of the 43 patients admitted to a general hospital in Salvador over the course of six months with chronic spastic paraparesis were tested for HTLV-I, of whom nine with progressive chronic spastic paraparesis had serum and CSF positive to HTLV-I. These patients were aged 18-56 years. Two were promiscuous and one of them had a blood transfusion eight months before symptoms. They had similar histories with progressive weakness, first in one leg and after in the other which was associated with paresthesias in varying degrees of intensity. None of the patients had sensory level, although all had vegetative disturbances which were characterized by bladder dysfunction, constipation, and impotence in men. These findings suggest the existence of a new area in which HAM is endemic.

Macroepidemiology of the HIVs-AIDS (HAIDS) pandemic. Insufficiently considered zoological and geopolitical aspects.

The human immunodeficiency viruses (HIVs)-acquired immunodeficiency syndrome (AIDS) or HAIDS pandemic originated from lentiviruses of nonhuman primates (thus qualifying as a zoonosis) that moved into humans in Africa. The HAIDS patients eventually die of opportunistic infections, all potentially zoonotic. The HAIDS infection remained parochial, first endemically and then epidemically, until the African urbanization that occurred in each of the countries postindependence. The latter included wars and the massive movement of soldiers (virologically naive) from the American continent to Africa and back. The HAIDS viral ecology coincided with African swine fever (ASF) in the Americas. Haiti became the focal point for both infections. Some infected Haitians also became, together with some infected drug addicts in the United States, a source of contaminated human blood for transfusions and production of plasma derivatives.

PIP: Nonhuman primate lentiviruses are the source of the HIV/AIDS (HAIDS) pandemic among humans. Thus HAIDS constitutes a zoonosis. Opportunistic infections which generally are the immediate cause of death in HAIDS patients tend to be zoonoses. Some of these include tuberculosis, cryptococcosis, cytomegalovirus, toxoplasmosis. Pneumocystis carinii, Listeria monocytogenes, and candidiasis. The HAIDS viral ecology paralleled the intense migration of African swine fever into the Caribbean and the continental Americas. Haitian laborers and prostitutes went to Zaire and later returned. Sexual tourism in Haiti and poor Haitian selling their blood for transfusions and production of plasma derivatives to be marketed to developed countries such as the US and France contributed to the spread of HAIDS from Haiti to developed countries. Thus African swine fever and HAIDS originated in this hemisphere from Haiti after being bought to Haiti from Africa. HAIDS began as an endemic regional disease in Africa then became a regional epidemic disease. After African countries gained independence, urbanization increased in Africa which accounted for the spread of HAIDS in each African country. The US and the USSR played their geopolitical games using and/or resulting in famine, war, and disrupted families on the African continent and elsewhere. Thus husbands from 1 continent were moved to armies and labor camps sometimes on another continent. Prostitution spread tremendously to fulfill women's economic needs and men's sexual needs. HAIDS spread along with these events, e.g. Cuba sent troops to Angola where they were mostly stationed near 2 countries with high HAIDS rates, Zaire and Namibia. These troops often returned to Cuba then returned to Africa. During the 1980s, HAIDS prevalence was 45 times higher among Cuban boat refugees and Marielito Cuban immigrants to the US than that claimed for all of Cuba. In fact, their HAIDS prevalence matched that of Cuba's Caribbean neighbors.

[Evaluation of the potential risk of perinatal exposure to lead in the Valle de Mexico]. / Evaluacion del riesgo potencial de la exposicion perinatal al plomo en el Valle de Mexico.

PIP: Lead exposure even at low levels has adverse effects for the central nervous system (CNS), but pregnant women, neonates, lactating infants, and preschool and school age children are most susceptible to it. In rats anatomical alterations included swelling in the mitochondria of renal duct cells (at 26 mcg/dl); biochemical effects involved marked reduction of cytochrome content in the cerebral cortex (36 mcg/dl); and physiological effects were induced at the level of 30-50 mcg/dl. Central nervous system effects entailed persistent decrease of visual acuity (65 mcg/dl at birth and 7 mcg/dl 90 days later), the increase of the latency of primary and secondary components of evoked visual responses during the prenatal and adult period (65 mcg/dl and 7 mcg/dl on days 21 and 90 after birth, respectively). 30 and even 20 mcg/dl of lead in the blood produced nerve conductivity deficits. A study of 425 children with lead poisoning showed a 39% rate of mental retardation and convulsions impervious to treatment. Lead levels within a range of 10-25 mcg/dl reduced the score on the mental development inventory by 4-8 points. The population of the Valley of Mexico numbers 15-20 million with 50% of Mexico's industry. A who investigation indicated blood levels of an average of 22.5 mcg/dl in a group of school teachers, the highest in 10 major population centers in the world. Blood levels in 405 pregnant women in Mexico City averaged 20.3 mcg/dl, and the sample from the umbilical cord of fetuses showed 13.6 mcg/dl. Another study disclosed blood levels of 16 mcg/dl in mothers and 13 mcg/dl in their offspring. The most probable sources of lead are: leaded gasoline, secondary recapture of lead for making batteries, use of paints, ceramics used for storing and cooking food, lead seal of milk containers, and consumption of food contaminated with lead.^ieng

Opportunistic infections and Kaposi's sarcoma among Haitians: evidence of a new acquired immunodeficiency state.

Twenty Haitian patients, hospitalized from 1 April 1980 to 20 June 1982, had Pneumocystis carinii pneumonia, central nervous system toxoplasmosis, esophageal candidiasis, cryptococcosis, disseminated cytomegalovirus, progressive herpes simplex virus, chronic enteric coccidiosis, or invasive Kaposi's sarcoma. Ten patients died. Opportunistic infections were frequently multiple and were recurrent in three patients. In seven patients disseminated tuberculosis preceded the other infections by 2 to 15 months. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. At least three patients probably acquired the syndrome in Haiti. Lymphadenopathy was common. Seventeen patients tested had anergy, and 18 had lymphopenia. Monoclonal antibody analysis of peripheral-blood T-cell subsets done on 11 patients showed a marked decrease in T-helper cells and an inversion of the normal ratio of T-helper cells to T-suppressor cells. This syndrome among heterosexual Haitians is strikingly similar to the syndrome of immunodeficiency described recently among American homosexuals.

Poliomyelitis: Cuba, 1962-1978.

PIP: Before the Cuban Revolution in 1959, poliomyelitis was endoepidemic, with epidemic peaks every 5-7 years and subsiding peaks in the intervening intervals. 18 mass poliomyelitis vaccination campaigns have been conducted since 1962, and there have been only 6 notified cases. In each case, vaccine administration was preceded by a survey of the level of immunity to polio vriuses and the results of serologhic analyses were used to determine the age of vaccination and the type of vaccine used. Starting with the 9th campaign, trivalent vaccine has been administered in candy form in 2 doess to children 1 month-3 years and a booster is given at 9 years of age to reactivate immunity. Except for the 1st immunization campaign, when 98.6% coverage was achieved, coverage has exceeded 100%. The age group with the lowest prevalence of immunization has consistently been infant under 1 year of age. Serologic surveys indicate that the proportion of resistant individuals rises progressively with age. Resistance tends to level off, however, at 3 years of age, suggesting that once a give level of immunity is attained, it is dufficult to raise it. Protective antibody levels against the 3 polio viruses in persons over 14 years of age is estimated to be about 90%.^ieng

[Clinical analysis and evaluation of various hematologic and metabolic constants with the use of monthly microdoses of parenteral contraceptives]. / Análisis clínico y valoración de algunas constantes hematologicas y metabólicas con el uso de un anticonceptivo parenteral mensual en microdósis.

PIP: 75 women of proven fertility were treated as a contraceptive measure with an injection of 75 mg. of duhydroxyprogesterone acetophenide, and of 5 mg. of estradiol enanthate. Doses were half of what regularly used, and were injected between the 7th and the 9th day of the cycle. Total number of cycles studied was 859. Most important side effects of the treatment was headache in 28.3% of patients, spotting in 15.5%, and emotional instability in 10.5%. Metabolic and hematologic data were unchanged, and vaginal cytology was negative. There were no pregnancies. It must be remembered that, in every contraceptive treatment, lower doses are always preferable when equally effective. (Summary in ENG).^ieng

[Headache and oral contraceptives (author's transl)]. / Cefaleia e contraceptivos orais.

PIP: 175 patients using oral contraceptives (OCs) for periods from 2 months-6 years were studied. A survey was made of the secondary effects of the treatment. Among the total group, 101 of them had not presented headache before the use of contraceptives, and the remaining 75 patients had previously complained of chronic headaches which were considered due to different etiologies. 50 patients from the group without previous headache claimed that OC treatment marked the initiation of the headaches. 25 had vascular headaches and 25 had tension headaches. Among the 75 patients included in the other group as complainers of chronic headache prior to treatment, 30 had a worsening of the symptoms after use of the OCs. The authors compare their results with those referred to in the literature. (author's)^ieng

Three-monthly Depo-Provera in Mexico.

PIP: From 1969 to 1975, 54,650 new acceptors over 30 years of age or with 4 or more children were administered 150 mg Depo-Provera by injection every 90 days. A total of more than 400,000 90-day cycles of clinical observation of the menstrual, metabolic changes, body-weight fluctuations, systemic side effects, and return of fertility were recorded. The rate of pregnancy was .35; the longer the time under treatment, the less abnormal bleeding and greater amenorrhea was noted. Weight gain was between 2-9 kg over 12-36 months. Pregnancy occurred 6-24 months after discontinuation of therapy to achieve pregnancy. Treatment did not affect lactation adversely. There was a continuation rate of 56% during the first 12 months and 54% in the following 18 months. Advantages of use are: 1) can be used on large scale, 2) can be alternative to sterilization, 3) is effective with a minimum of motivation, 4) does not affect lactation, 5) continuity rates are higher than those of oral contraceptives, 6) cost is low, 7) allows use of paramedical personnel, and 8) can be administered postpartum and postabortion.^ieng

[Syndrome of amenorrhea and galactorrhea. Clinical considerations]. / Sindrome de amenorréa y galactorréa. Consideraciones clínicas.

PIP: Of 180 cases of secondary amenorrhea and 20 of primary amenorrhea, 46 patients suffered from the syndrome of amenorrhea and galactorrhea. This showed that this problem is more frequent than the literature indicates. Of the 46 cases, 13% had a pituitary tumor. Such a high percentage was found with several authors so the possibility of a tumor should always be considered. Another 24% of the cases were postpartum and 52.1% were idiopathic. The latter, suffering from primary or secondary sterility were treated with different ovulation induction medication and in 37.2% pregnancy resulted. In general, the treatment of amenorrhea and galactorrhea tries to restore normal ovulation and the menstrual cycle. Possible useful medications are clomiphene, citrate, pergonal, and levo-dopa. Also, recent studies indicate that some alkaloid derivitives of ergot are effective in treating the syndrome. It is important to realize that the syndrome may have physiopathogenic implications that substantiate careful ovulation induction medication.^ieng

[Functional therapeutics: official subject in gynecology. New findings in gynecology. 22nd Brazilian Meeting on Gynecology and Obstetrics]. / 22 Jornada Brasileira de Ginecologia e Obstetricia, tema oficial de ginecologia; Aquisicoes Recents em Ginecologia: Terapeutica Funcional.

PIP: During the past 5 years, after a much longer period of studies and research, new methods of treatment for several gynecological disorders have been employed. Among such new methods the most important are: 1) the use of gonadotropin-releasing hormones as contraceptive agents, to diagnose cases of hypogonadism, or to cure amenorrhea. Gonadotropin-releasing hormones can be administered in several ways, provoke different reactions in different women, and are subject to several contraindications; 2) transphenoidal surgery for hypersecretory hypophysary tumors, or microsurgery of the hypophysis, which allows the identification of tumors smaller than 10mm, and which is used in the treatment of galactorrhea; 3) the use of ergot alkaloids derivates, such as bromocriptine or Lergotrile, to provoke menstruation and ovulation; 4) the clinical use of danazol in the treatment of endometriosis and in induction of ovulation; and 5) the treatment of primary dysmenorrhea by the use of synthetic inhibitors or by the use of prostaglandins.^ieng

[Control of fertility with microdoses of D'norgestrel]. / Control de la fertilidad con microdosis de d'norgestrel.

PIP: 113 multiparous fertile women ranging in age from 20 to 40 with regular menstrual cycles and who had not taken orals for 90 days prior to the trial were given continuous daily doses of 37.5 mcg of D-norgestrel for 4-14 cycles for a total of 1163 cycles of observation. A group of 20 who completed 14 cycles of treatment were given extensive physicals before and after the investigation including endometrial biopsies, vaginal hormone cytology, and blood and liver function tests. None of the patients became pregnant. Side effects were minimal and consisted mainly of headaches and nervousness. The most commonly experienced menstrual irregularities were amenorrhea and short cycles. In 2 cases curettage was done because of continuous bleeding. There was no incidence of thrombosis. There were no important changes in blood count, blood chemistry, urine, or in hepatic function. The biopsies indicated that the drug suppressed ovulation.^ieng

Proceedings: Neurohormonal control of prolactin release.

PIP: Neurohomonal control of prolactin release was studied in pseudopregnant and pregnant rats. Nembutal administered at 1300 hours on Day 3 of pseudopregnancy prevented prolactin release which normally occurred at 1700 hours of the same day. Antiestrogen administered the day before did not prevent prolactin release but ovariectomy did. Estrogen administered immediately after ovariectomy did not restore prolactin secretion; however, progesterone on Day 3 in the ovariectomized-estrogen treated induced an increase in prolactin at 1700 hours. Progesterone was capable of increasing prolactin release the first 5 days of pseudopregnancy but not Days 6-12 when prolactin values were low. A similar effect was seen the first 7 days of pregnancy. Progesterone, but not estrogen, modified prolactin values on Day 9 at 1700 hours. Ovariectomy on Day 19 of pregnancy induced prolactin release within 4 hours and persisted for 58 hours. Progesterone administration immediately after ovariectomy prevented prolactin release for a few hours. These results suggest that the regulation of prolactin release by the central nervous system depends on the circulating estrogen/progesterone ratio, since estrogen facilitated prolactin release when plasma progesterone was low and progesterone induced prolactin release when adequated levels of estrogen existed, but exerted an inhibitory action when estrogen was not present.^ieng

[Secondary effects of ethynodiol diacetate plus mestranol]. / Efectos secundarios del diacetato de etinodiol mas mestranol.

PIP: Medical histories of 436 patients treated with Ovulen after childbirth or an abortion were examined in order to collect a sample of women who had taken the orals for 6-12 cycles. A group of 70 patients was thus formed. The following parameters were investigated: weight variation; blood pressure; nausea and vomiting; varicosities; variation in menstrual flow and length of period; breast-related side effects; jaundice; psychic alteration, i.e., nervousness, anxiety, or depression; changes in libido; headaches; skin changes; and pregnancy. Results are presented both in graph and table form. Weight change was found to tend more to loss than to gain. No statistically significant changes in blood pressure were observed. Nausea and associated symptoms tended to disappear after the 9th cycle. Edema was present in only 6% of all cycles. The most common side effect was varicosities, present in 25% of the sample, but in no instance did thrombosis occur nor was varicosity a cause for discontinuation in any case. Breast-related side effects were more common at the outset. No jaundice was observed. Psychic alterations were not common and were mostly insignificant and tended to occur more frequently at the outset. 12% of the sample had headaches from the beginning of treatment up until the 8th month, after which they began to disappear. Only 1 patient had chloasma and then only during the 1st 2 cycles. There was a marked tendency toward menorrhagia which was thought to be beneficial due to the prevalence of anemia in the group. Changes in libido were minimal and tended to disappear after the 8th cycle. None of the patients became pregnant.^ieng

[Clinical study of a mestranol lynestrenol combination of 1 mg. (preliminary report)]. / Estudio clínico con la combinación de mestranol y linestranol de 1 mg. (reporte preliminar)

PIP: 135 women who had had at least 1 child were treated with 80 mg of mestranol and 1 mg of lynestrenol on a 22 day on, 6 day off basis for a total of 800 cycles of observation. Follow-up was done monthly. Endometrial and cervical biopsies were done and levels of pregnanediol in the urine were tested. Cycles were between 25-31 days with an average of 28. Flow averaged 3 days' duration and was slight in 53.1% of the cycles, normal in 39.3% and heavy in 2.1%. 48.3% of the cycles were characterized by no dysmenorrhea, 35.7% by slight, 11% by moderate, and 1.8% by severe. Incidence of spotting and breakthrough bleeding was slight. Side effects were also slight; nausea was present in 7.6% of the cycles, hypogastric tension in 6.6%, chloasma in 5.9%, and severe headache in 4.3%. Headaches were the only side effect reported with any regularity. No pregnancies occurred. Only 14 patients discontinued. Test results indicated that under medication the amount of pregnanediol diminished, the endometrium modified its ovulatory functions, the cervical mucus lost it ability to crystallize or stretch, and vaginal shedding was slightly modified.^ieng