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I report the case of a woman with systemic lupus erythematosus who had pulmonary hypertension unassociated with chronic interstitial lung disease or pulmonary emboli. She had started taking the contraceptive pill seven months previously.
An increased risk of developing genital actinomycosis has been found with long-term use of IUDs. In this study a group of women who had used their IUDs for 60 +/- 6 months was compared with a group having worn their IUDs for 36 +/- 6 months. None of the women examined had symptoms of genital infection. No significant differences could be found in colonization frequency of A. israelii on the IUDs or in humoral antibody response to the bacterium.
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Deep venous thrombosis and pulmonary embolism are frequent complications of surgery. A careful evaluation of both the thromboembolic and the haemorrhagic risks depends on the type of intervention and associated individual risk factors. Such an evaluation should allow allocating the patient to an appropriate prevention which consists of mechanical and/or pharmacological means.
Optimal efficacy has been achieved in both oral contraception and postmenopausal replacement therapy. The current challenge is to minimize the side effects and metabolic impact of the administered hormones in both oral contraceptives and hormone replacement agents. When the dose of estrogen in oral contraceptives was reduced the risk of thromboembolism decreased, but the androgenic side effects of the progestin became increasingly apparent. The addition of progestins to hormone replacement therapy reduces the risk of endometrial cancer associated with unopposed estrogen, but their androgenicity offsets the favorable effects of estrogen on lipid metabolism. Androgens not only cause troublesome clinical side effects but also induce changes in blood levels of lipoproteins that have been associated with an increased risk of atherogenesis and coronary heart disease, as well as alterations in glucose and insulin levels. Both the side effects and the adverse effects on lipoprotein and glucose metabolism can be reduced by the use of less androgenic progestins.
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We have studied 286 cases of sudden death due to massive pulmonary embolism. In 155 women and 131 men, we made a statistical analysis of the average age, the presence of thrombosis, varices, atherosclerosis, and other complications, and also dietary considerations. We present a detailed observation of a thirty-two year old woman, who died following massive pulmonary embolism, the source of which was thrombosis of the ovarian and pelvic veins. We learned that this woman, who did not smoke, and whose liver was slightly affected, had, for three years, been taking an uninterrupted course of the contraceptive pill Non-Ovlon.
We describe the case of a woman with McCune-Albright syndrome who had a pathological bone fracture while being treated with an oral contraceptive. In this syndrome the bone lesions contain estrogen and progesterone receptors. The possibility of progression of the bone lesions during pregnancy is well-known. We judge the use of oral contraceptives to be dangerous in this syndrome; the affected women must be orientated towards alternative contraceptive methods.
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Following a recent case, the authors review the literature of hepatic nodular hyperplasia. The incidence of this condition increases regularly with the consumption of oestrogens. They attempt to define the methods of detection for patients at highest risk. Without exaggerating the incidence of this complication of oral contraceptives, the authors believe that it will become increasingly more common than the vascular complications which, although frequently discussed, are relatively rare.
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We report a case of intrahepatic biliary cystadenoma in a young woman who had no prior history of liver disease and who had taken oral contraceptives for one year. A 27-year-old woman was admitted to our hospital with a firm epigastric mass. At laparotomy, a large cystic mass was resected from the left hepatic lobe, and diagnosed as biliary cystadenoma. In the tumor tissue, the estrogen receptor content was 14.0 fmol/mg cytosol protein, which was much higher than the 3.0 fmol/mg cytosol protein in the surrounding liver tissue. This is the first case of biliary cystadenoma in which the estrogen receptor content was increased.
The primary aim of the haemostatic mechanism is to protect the vascular system and to keep it intact after injury in order to secure the function of tissues and organs. A second aim is to provide a matrix in wound healing and tissue repair. The regulation of this physiological mechanism is effected by a dynamic haemostatic balance comprising interactions between endothelial cells, thrombocytes, coagulation, and fibrinolysis. This balance determines the amount of fibrin layed down at a site of injury thereby influencing the progress of the reparative processes. Clinical experience has, as described, shown that the concept of a dynamic haemostatic balance, and the increase in knowledge about the mechanisms involved in its regulation, can be applied with success in the elucidation and treatment of cases of impaired haemostasis, or when during a disease instances of thrombosis or embolism arise, which otherwise would have been difficult to explain or to subject to rational treatment. The results obtained and the experiences gained have therefore substantiated the existence of such a balance. Disturbances in the regulation of the balance may cause the formation and deposition of too little fibrin at a site of injury resulting in impaired haemostasis, ultimately manifesting itself as a haemorrhagic disorder. Or, an enhanced formation or delayed resolution of fibrin may cause thrombosis. Therefore, in the acute clinical cases the balance may adequately be described as a thrombohaemorrhagic balance. These observations have in particular underscored the role of an impaired fibrinolysis or decreased inhibition of coagulation in the pathogenesis of thromboembolic disease. They suggest the existence of an antithrombotic potential, which might be reduced due to a decreased inhibition of coagulation and/or a decreased fibrinolysis. The major stages in the mechanisms of blood coagulation and fibrin resolution are now well elucidated. This has increased our understanding of the interplay between the activating and regulating factors by which the organism keeps the formation of fibrin under control. Effects of disturbances in the balance are illustrated by description of cases of haemorrhagic disorders or thrombosis, and the pathophysiological aspects are surveyed. The regulation of coagulation and fibrinolysis follows in both systems the same pattern. The active enzymes (thrombin and plasmin, respectively) are formed by activation of circulating proenzymes, and inhibitors (circulating or localized) exert their modifying influences at various stages of the total process.(ABSTRACT TRUNCATED AT 400 WORDS)
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