RESUMEN

Partial thromboplastin time, activated with kaolin (TTPA) is a qualitative test used to find defects of some factor of intrinsic via of coagulation or to rule out the presence of some circulating inhibitor. The lupus anticoagulant (LA) is part of a group of several auto-antibody with pathogenic potential in several branches of medicine, mainly rheumatology, hematology and gyneco-obstetrics. In this last area the LA has been associated with different obstetrical repercussions. The purpose of this study was to determine the main obstetrical events associated with patients with circulating anticoagulants identified by TTPA with kaolin. Ninety six patients were included in cases-control study. Group I (n = 48) cases and Group II (n = 48) controls, were selected from the same population and information source. The cases were included when presenting prolongation of more than 4 seconds of TTPA activated with kaolin regarding a control with lack of correction with normal plasma. A registration sheet for data captation, was designed specially for this study. The comparability of both groups was established, as there were no differences (significant) among the variable considered as basal. The group of cases presented with a greater frequency of habitual abortion, neonatal death and thrombotic phenomena. This relationship of autoimmunological pictures with recurrent fetal loss and thromboembolic incidents has been consistently described in literature. To this respect, several immunological abnormalities. Including positive anticardiolipin antibodies and VDRL falsely positive. The incidence, in this country of these entities, is unknown. These observations show the need of a methodologic superation.(ABSTRACT TRUNCATED AT 250 WORDS)

---

PIP: In a retrospective case control study of 96 obstetrical patients 48 cases had partial thromboplastin time (TTPA) with kaolin over 4 seconds compared with the test group. The control group of 48 women with normal TTPA were also studied. Age, socioeconomic status, weight, family and personal illness history were included. Habitual abortion,neonatal death, and hypertension were recorded. The average TTPA value was 53.6 +or- 7.87 seconds for the case group vs 38.8 =or- 4.9 for the controls which was not statistically significant. No statistical significance was found regarding age, start of menarche, nutritional and socioeconomic status, and blood group. The body weight of the case group was higher with 58.5 kg =or- 14.4 kg (a range of 43.4-81.4 kg). There were 7 cases of thrombophlebitis (14.5%) in the lower extremities in the case group and none in the controls. There were 7 cases of habitual abortion in the case group defined as 3 or more miscarriages before 20 weeks of gestation vs 2 cases in controls. There were 4 cases of neonatal deaths associated with premature delivery in the case groups and none in controls. Acute hypertensive disease associated with pregnancy totaled to 8 cases in the 1st group (16.6%) and 4 cases in controls (8.3%). In both groups there were 2 cases of fetal death. In the case group there was 1 case of chromosomopathy and in the control group 1 case of premature expulsion of placenta. The TTPAs test is used mostly for the initial phase of studying patients suspected of having lupus anticoagulant (LA). LA belongs to abnormalities characterized by the presence of antiphospholipid antibodies. It is often used for diagnosing initial stages of autoimmunity which can frequently occur in thrombotic process, fetal loss, intrauterine growth retardation, and increased hypertensive illness in pregnancy.

Asunto(s)

Aborto Habitual/sangre , Mortalidad Infantil , Tiempo de Tromboplastina Parcial , Preeclampsia/sangre , Femenino , Humanos , Lactante , Embarazo

RESUMEN

The Budd-Chiari syndrome is the clinical manifestation of the total or partial obstruction of the hepatic veins and/or inferior vena cava. It is an infrequent cause of portal hypertension. The chronic presentation is the most frequent and is characterized by right upper quadrant pain, hepatomegaly, and ascites of slow onset. We report a case of a 26 year old woman affected by this disorder associated to a recent use of oral contraceptive and a "Lupus Anticoagulant". She subsequently developed deep venous thrombosis and pulmonary embolism. She died almost 6 years after the onset of symptoms.

---

PIP: A 26-year-old woman sought medical care in April 1983 because she had been experiencing pain in the right upper quadrant for 2 months, as well as an enlarged abdomen and postprandial fullness accompanied by nausea and vomiting. She had used oral contraceptives (OCs) for a period of 11 months up to 4 months before the inception of the symptoms. Examination showed normal vital functions but painful hepatomegaly. Hepatic biopsy showed dilatation of the central vein of the lobe; ultrasound of the liver showed hepatomegaly, the dilatation of hepatic veins, and suprahepatic veins; and echos of the inside were suggestive of thrombosis. The Doppler instrument revealed inversion of the hepatic flow towards the spleen and the presence of multiple collateral veins. Venocavography confirmed almost total obstruction of the inferior vena cava in its retrohepatic trajectory. Percutaneous transhepatic splenoportography demonstrated evidence of slow suprahepatic drainage with obstruction of the contrast medium in the area of the cava. The pressure in the suprahepatic vein was 43 cm of H2O. As the illness progressed, profound venous thrombosis of the left lower extremity developed, which was treated with heparin and managed with fenindione for 4 years. 5 years later, multiple pulmonary thromboembolism was confirmed by pulmonary gammagram of perfusion and digital arteriography. She received medical treatment based on low sodium and diuretic diet. Her hepatic function progressively deteriorated with increased ascites and collateral venous network. She died in December 1988.

Asunto(s)

Síndrome de Budd-Chiari/complicaciones , Anticonceptivos Orales/efectos adversos , Inhibidor de Coagulación del Lupus/sangre , Embolia Pulmonar/complicaciones , Tromboflebitis/complicaciones , Adulto , Síndrome de Budd-Chiari/diagnóstico por imagen , Síndrome de Budd-Chiari/etiología , Femenino , Humanos , Portografía , Ultrasonografía , Vena Cava Inferior/diagnóstico por imagen

RESUMEN

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

Asunto(s)

Coagulación Sanguínea/efectos de los fármacos , Anticonceptivos Hormonales Orales/farmacología , Fibrinólisis/efectos de los fármacos , Resistencia a la Insulina/efectos de los fármacos , Metabolismo de los Hidratos de Carbono , Enfermedades Cardiovasculares/inducido químicamente , Anticonceptivos Hormonales Orales/efectos adversos , Estrógenos/farmacología , Femenino , Humanos , Hiperglucemia/inducido químicamente , Metabolismo de los Lípidos , Vigilancia de Productos Comercializados

RESUMEN

The acquired immunodeficiency syndrome has been observed with increasing frequency in children with associated hemophilia, high-risk environmental backgrounds, and blood transfusions. AIDS should be considered in the differential diagnosis of childhood immunodeficiency, and it must be distinguished from congenital disorders. We emphasize the importance of epidemiologic, clinical, and laboratory data in diagnosis and aggressive management of infectious complications. The relationship between human retrovirus infection and AIDS remains to be precisely defined, especially with regard to cofactors that may play a role in the development of severe immunodeficiency following exposure to the agent.

---

PIP: To date, the acquired immunodeficiency syndrome (AIDS) has been identified in over 50 children in the US, including those with associated hemophilia, high-risk environmental factors (Haitian background, parental intravenous drug abuse, or prostitution), and blood transfusions. The evaluation of an infant or young child in whom AIDS is suspected requires exclusion of congenital disorders of immune function. A specific test is not currently available, but inclusion criteria for childhood AIDS have been developed. The diseases accepted as indicative of underlying cellular immunodeficiency children are the same as those used in defining AIDS in adults, with the exclusion of congenital infections such as toxoplasmosis or herpes simplex virus infection in the 1st month of life or cytomegalovirus infection in the 1st 6 months of life. Specific conditions that must be excluded in children are primary immunodeficiency diseases (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome, ataxia-telangiectasia, neutrophil function abnormality) and secondary immuno-deficiency associated with immunosuppressive therapy, lymphoreticular malignancy, or starvation. Almost all young children with AIDS have hepatosplenomegaly, interstitial pneumonitis, and poor growth. The average age of 36 US child AIDS victims studied in detail was 5 months at presentation with findings suggestive of severe immunodeficiency. Mucocutaneous candidiasis was present in 75% of these 36 children, and Pneumocystis carinii and cytomegalovirus were each isolated from 30% of cases. Normal T4:T8 ratios occur in about 15% of pediatric AIDS cases. Laboratory evidence of polyclonal hypergammaglobulinemia generally supports the AIDS diagnosis. Recurrent infection and malnutrition are major problems in the clinical management of child AIDS patients.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/fisiopatología , Síndrome de Inmunodeficiencia Adquirida/terapia , Síndrome de Inmunodeficiencia Adquirida/transmisión , Formación de Anticuerpos , Linfocitos B/inmunología , Niño , Deltaretrovirus/inmunología , Hemofilia A/inmunología , Humanos , Inmunidad Celular , Monocitos/inmunología , Fenómenos Fisiológicos de la Nutrición , Recurrencia , Infecciones por Retroviridae/inmunología , Riesgo , Linfocitos T/inmunología , Reacción a la Transfusión

RESUMEN

PIP: To study the effects of oral contraceptives (OCs) on blood coagulation, and on thrombotic risk, 18 healthy women were observed for a period of 24 months. The study was conducted in 3 stages: 1) measurement of all basal characteristics of the women, 2) 12 months' treatment with OCs containing 1 mg of ethynodiol diacetate and 50 mcg of ethinyl estradiol, and 3) reevaluation of all the basal characteristics measured in phase 1. At the end of the 24th month only 12 patients had completed phase 3. The results of phase 3 hematic tests were not greatly different from those of phase 1; prothrombin time and Normostat were increased in relation to phase 1; factors 7, 10, and 12 showed tendency to an increase, and factors 11 and 9 a decrease. An increase of plasminogen was also noted, together with a slight decrease in antithrombin 3. These changes are not significant enough to justify an increased risk of thrombotic accident in healthy women on OCs; however, obese, diabetic or hyperlipoproteinemic women may have an increased risk, and an alternate contraceptive method would be advisable.^ieng

Asunto(s)

Coagulación Sanguínea , Anticonceptivos Orales , Investigación , Biología , Sangre , Anticoncepción , Servicios de Planificación Familiar , Fisiología

RESUMEN

PIP: The article reports on the case of a 30-year-old woman who had been on OC (oral contraception) for several years, who died in the space of 10 days for thrombosis of the superior longitudinal sinuses and of the uterine vasa, and on the case of a 26-year-old woman, also on OC, who suddenly developed cholestatic jaundice. The relationship between OC and hepatic or/and blood coagulation effects has been amply described in the literature, although the mechanism causing the problems are not yet well known. The authors insist on discontinuation of OC treatment at the first negative symptoms, and on careful examination of the clinical family history of patients before administration of OC.^ieng

Asunto(s)

Colestasis Intrahepática/inducido químicamente , Anticonceptivos Orales/efectos adversos , Tromboembolia/inducido químicamente , Adulto , Femenino , Humanos

RESUMEN

PIP: A study of 51 endometrial samples extracted from 142 IUD users was made; 92 of these users had normal menstrual cycles and 50 had polymenorrhea or hypermenorrhea. 71 samples were extracted during menstrual bleeding and 71 during the intermenstrual period. The IUD and endometrial samples were set down in fibrin plaques and maintained at 37 degrees Celsius for 18 hours. The fibrinolytic activity was evaluated in degrees from 0-4. Bacteriologic and histopathologic analysis was made in 13 of 21 endometrial samples extracted in the intermenstrual period from polymenorrheic women. The results obtained were compared considering the average of degrees and the relative frequency of high and low degrees in each group. The results indicate that in the samples obtained during menstrual bleeding, there was no statistically significant difference between the normal bleeding and the hypermenorrheic or polymenorrheic women, but that there are statistically significant differences when the results obtained with samples extracted during the intermenstrual period are compared. The conclusion is that in 78.79% of the cases of polymenorrheic or hypermenorrheic women studied, there exists an increase in the intrauterine fibrinolytic activity. (author's)^ieng

Asunto(s)

Endometrio/fisiología , Fibrinólisis , Dispositivos Intrauterinos , Trastornos de la Menstruación/etiología , Femenino , Humanos

RESUMEN

PIP: 284 women using 3 types of oral contraceptives were studied for 1 year. The drugs used were: SH-70840, containing 0.050 mg of ethinyl estradiol and 1 mg of ethinyl nortestosterone acetate; SH-70876, containing 0.075 mg of ethinyl estradiol and 1 mg of ethinyl nortestosterone acetate; and SH-70850, containing 0. 050 mg of ethinyl es tradiol and 0.50 mg of norgestrel. The average results were within normal limits. Of the 3 groups, 2 (using SH-70840 and 70876) showed a slight increase in blood coagulation. The tests, conducted with properly selected patients, showed no cases of thrombosis.^ieng

Asunto(s)

Coagulación Sanguínea/efectos de los fármacos , Etinilestradiol/farmacología , Nandrolona/farmacología , Norgestrel/farmacología , Pruebas de Coagulación Sanguínea , Combinación de Medicamentos , Evaluación de Medicamentos , Femenino , Humanos , Nandrolona/análogos & derivados

RESUMEN

PIP: The results of 2 studies on the use of high doses of progestins as postcoitum contraceptives are reported. 1 of the studies was carried out in Peru and involved 4632 women, treated for 41,802 months with single doses of 150, 250, 300, 350, and 400 mcg of D-Norgestrel, administered within 3 hours postcoitum (the doses were administered to 28, 699, 544, 559, and 2801 women, respectively). 165 unwanted pregnancies were reported; their incidence was higher among women treated with the smaller doses. The most important side effects were changes in the duration of the cycle; spotting was present in 10% of the cases and independent of the dose; liver disorders, thromboembolic accidents and breast pains were absent; treatment had to be suspended because of side effects in 5-8% of the cases. The 2nd study was carried out in Chile and involved 136 fertile women for 184 months, treated with 3 different progestins. A total of 5 pregnancies were reported and the treatment was well tolerated by all patients. Generally, it is concluded that these 1st studies suggest that high doses of progestins are effective and well tolerated postcoitum contraceptives, and side effects are less frequent and serious than those produced by estrogen preparations.^ieng

Asunto(s)

Anticonceptivos Orales , Anticonceptivos Poscoito , Estudios de Evaluación como Asunto , Levonorgestrel , Trastornos de la Menstruación , Investigación , Coagulación Sanguínea , Mama , Chile , Anticoncepción , Anticonceptivos , Anticonceptivos Femeninos , Enfermedad , Servicios de Planificación Familiar , Hígado , Perú , Embarazo no Deseado

RESUMEN

PIP: It has been demonstrated that preparations containing estrogens cause metabolic alterations, while such alterations do not occur or are minimal when progestogens alone are administered. Clinical studies were begun using a new polymer that makes possible the release of a constant predetermined amount of progesterone into the uterus for up to one year. The method of intrauterine release of progesterone proved to be very effective in preliminary studies: one case of pregnancy occurred among 263 women observed over 2068 months (.5 effectiveness index). The effectiveness of the method, with the release of a daily dose of 50 mcg, appears to be higher than that of other intrauterine devices and similar to that of combinations of estrogen and progestogens, that are regarded as the most effective method. A great advantage of the new method is that it does not cause systemic effects.^ieng

Asunto(s)

Anticonceptivos , Servicios de Planificación Familiar , Administración Oral , Estrógenos/farmacología , Estudios de Evaluación como Asunto , Femenino , Humanos , Recién Nacido , Menstruación/efectos de los fármacos , Métodos , Embarazo , Progesterona/farmacología

RESUMEN

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

Asunto(s)

Norgestrel/administración & dosificación , Ovulación/efectos de los fármacos , Administración Oral , Adulto , Estudios de Evaluación como Asunto , Femenino , Humanos , Menstruación/efectos de los fármacos , Norgestrel/efectos adversos , Embarazo

RESUMEN

PIP: 2 cases of pregnancy in patients (age 38 and 22) with a Starr-Edwards mitral valve prosthesis implanted some years earlier are described. In both cases a malfunction of the prosthesis was suspected, with a serious and permanent risk for the patient; long-exposure radiology was used on 1 of the patients to study the angle formed by the axis of the valve during systole and diastole. 1 patient was prescribed dipyridamol to inhibit platelet adhesion, because it was suspected that the common anticoagulants had caused a previous premature delivery. In this case, delivery was normal, and mother and child were in satisfactory condition. The other patient received anticoagulants, and pregnancy was terminated by caesarean section in the 38th week, for fear of excessive stress during labor; the results were also satisfactory. Despite the successful results obtained in these 2 cases, pregnancy in patients with such cardiovascular conditions is regarded as highly dangerous and should be avoided.^ieng

Asunto(s)

Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Complicaciones del Trabajo de Parto/prevención & control , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales/prevención & control , Cesárea , Femenino , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , Recién Nacido , Embarazo , Warfarina/uso terapéutico

RESUMEN

PIP: The problems of oral contraception considered are: possible carcinogenesis, thrombophlebitis or thromboembolism, and possible effect on the reproductive or genetic potential of the ova. Estrogen-progestogen combinations produce characteristic effects of estrogen, indicating that the estrogen given exceeds normal endogenous estrogen production. In humans all known carcinogenic agents involve a latent period, many for a decade or more. Both endogenous and exogenous estrogens have been shown to modify the activity of established breast cancer in humans. The effect on the preclinical phases is unknown. Effects of prolonged use of estrogens on breast cancer will require more extensive studies. Endometrial cancer has been reported to undergo regression under intensive progesterone therapy. Other known carcinolytic agents such as X-rays and alkylating substances are known to be carcinogenic under some conditions. One may, therefore, question the advisability of derangement of such endocrinological relationships. Distinctive histological changes in the endometrium after use of estrogen-progestogen mixtures have been described. Such atrophic changes represent drug-induced pathology. Although these changes disappear when therapy is discontinued, the latent effect is unknown. Since the pathogenic period for cancer of the cervix is estimated to be 7-10 years, studies of this possible effect should exceed this time span and be carefully devised so that data can be compared. Data reported so far do not provide a sound statistical basis. Immediate effects on cervical dysplasia have not been shown to be unfavorable. Thrombophlebitis and thromboembolic phenomena have been reported but on the basis of available data no significant increase in risk has been demonstrated. Studies of carcinogenesis in animals are readily reproduced. However, the human population is so heterogenous that the genetic factor is uncertain. The ultimate effect of oral contraceptives on the ova is unknown. So far observations have shown none. Each physician prescribing these drugs should evaluate the risks involved with due regard for the results of alternate methods of contraception available.^ieng

Asunto(s)

Coagulación Sanguínea , Neoplasias de la Mama , Anticonceptivos Orales , Neoplasias Endometriales , Endometrio , Neoplasias , Ovario , Óvulo , Tromboembolia , Tromboflebitis , Neoplasias del Cuello Uterino , Biología , Sangre , Anticoncepción , Anticonceptivos Hormonales Orales , Enfermedad , Embolia , Servicios de Planificación Familiar , Genitales , Genitales Femeninos , Células Germinativas , Fisiología , Sistema Urogenital , Útero , Enfermedades Vasculares