[Iatrogenic damage contraception by IUD].
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Biomedical subjects
Publications and source records attributed to E Aguilera.
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A prospective study was made on the duration of lactation in 406 mothers injected postpartum for contraception with medroxyprogesterone acetate (DMPA), 150 or 250-300 mg, IM, at 3- or 6-month intervals. Breast feedings up to 2 per day were recorded, and findings compared with those from 173 nontreated controls. Eighty percent of the DMPA group were nursing successfully at the sixth month and 42% at the 12th month postpartum. These figures are significant and compare favorably with the control group. No advantage was found in the administration of DMPA earlier than the second or third month after delivery. Amenorrhea persisted during lactation. No pathologic breast conditions were observed. The eventual mechanism of DMPA in galactopoiesis has yet to be clarified.
An attempt was made to programme ovulation in women on a predetermined day of the menstrual cycle by treatment used to induce ovulation in anovulatory sterility. At laparotomy for elective sterilization the ovaries were observed to assess the occurrence of ruptured follicles and ovulation. Histological analysis of ovaries and endometrium was performed, and ova were recovered from some women. Several regimens were tested but ovulation seldom occurred as planned. Clomiphene citrate, human chorionic gonadotrophin (HCG), synthetic luteinizing hormone releasing hormone (LH-RH), and ethinyloestradiol were ineffective. Human menopausal gonadotrophin followed by HCG was more effective, but multiple ovulations occurred. When one single injection of a potent long-acting LH-RH analogue was given on day 13 of the cycle to 10 women pretreated with ethinyloestradiol signs of recent ovulation were observed on day 15 in seven and on day 16 in two.
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BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for patients with symptomatic gallstones. The management of choledocholithiasis in these patients remains controversial. Endoscopic retrograde cholangiopancreatography (ERCP) with ductal stone clearance prior to laparoscopic cholecystectomy is one of the options. OBJECTIVE: To evaluate the results of ERCP prior to laparoscopic cholecystectomy in patients with suspected ductal stones. METHODS: We performed a retrospective study from patients who underwent ERCP prior to laparoscopic cholecystectomy in a four years period. RESULTS: ERCP was successful in 86 out of 88 patients (97.7%). Common bile duct (CBD) stones were found in 34 patients (39.5%). Sixty two of 86 patients had symptomatic gallstones with abnormal liver function test and/or ultrasound. CBD stones were found in 25 of the 62 symptomatic patients (40.3%). Twenty four patients had acute biliary pancreatitis. CBD stones were found in nine of these patients (37.5%). All patients with CBD stones underwent stone extraction after endoscopic sphincterotomy (ES). Sixteen other patients underwent ES for suspected obstruction at the ampulla. Stone extraction was successful in 100% of patients. There were six patients with complications (6.9%). Four patients had pancreatitis (4.6%), one patient hemorrhage (1.1%) and one patient cholangitis (1.1%). Analysis using logistic regression model showed that CBD stones on ultrasonography was the only variable significantly associated with choledocholithiasis (P < 0.001). CONCLUSIONS: Preoperative ERCP is useful in the management of CBD stones prior to laparoscopic cholecystectomy.
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A study was made of the oviducts from 110 patients salpingectomized between 1943 and 1976, after endosalpingiosis had been diagnosed. All of the patients were infertile women in whom histopathology performed after surgery revealed diverticula located mainly in the isthmic and interstitial portions of the oviductal wall. By either continuity or invasion, these configurations spread the endosalpingeal epithelium into the peritoneum and/or the ovary. Endosalpingiosis affects the muscular layer of the oviduct, which becomes thickened and rigid, thus accounting for the severe alterations of tubal physiology. The clinical aspects and microscopy of endosalpingiosis are described, and their differences from those of adnexo-peritoneal endometriosis are discussed.
BACKGROUND: Clostridium difficile is the cause of 25-30% of cases of antibiotic-induced diarrhea. Pseudomembranous colitis is the most dramatic manifestation of C. difficile infection. METHODS: We report four cases of pseudomembranous colitis and review the literature. RESULTS: Three of the four patients, were over 80 years old and had other underlying illnesses. Before they developed colitis, all had received cephalosporins (cefuroxime, ceftriaxone, cefalexine) and one of them also clindamycin. All the patients had severe watery bowel movements, with mucus (one patient had also bloody stools), abdominal pain, nausea, vomit and fever. Blood tests disclosed leucocytosis with neutrophilia and increased band neutrophils in all patients. One patient had anasarca and hypo-albuminemia, suggestive of protein losing enteropathy. Sigmoidoscopy showed raised, yellow plaques covering the rectum, sigmoid and descendent colon mucosa. The response to oral metronidazole or vancomycin was good. The response to intravenous metronidazole was good in one patient and poor in another one. Two of our patients had relapses. The response of the relapses to oral metronidazole was good. One patient had two relapses eventually responding to oral metronidazole and Saccharomyces boulardii. CONCLUSIONS: Pseudomem-branous colitis has high morbility in debilitated elderly patients. Relapses are frequent in these patients. If other studies should confirm it, Saccharomyces boulardii could be useful in the prevention and treatment of relapses of this colitis.