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[Clinical and hematogenic considerations on 2 cases of cerebral venous thrombosis occuring during the use of oral estro-progestational preparations].

The authors illustrate the clinical peculiarities and the laboratory data of thrombotic accidents as complications of oral contraceptives and other estrogen-containing drugs, concerning modern literature. Moreover, they describe two cases of cerebral venous thrombosis verified in Neuropathology Department of Maria Vittoria Hospital-Torino. The problem of prevention of these accidents is debated in the second part of the article.

Adult↗

Prescribing oral contraceptives and the medical record.

Scripts for the oral contraceptive pill are written by general practitioners every day, but how organised are their prescribing habits? The author describes the use of a supplementary insert to medical records to aid the busy general practitioner.

Clinical Protocols↗

Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.

A case-control study of hepatocellular adenoma (HCA), a serious though nonmalignant liver tumor, was conducted by the Center for Disease Control and the Armed Forces Institute of Pathology (AFIP). Interviews with 79 women with HCA and with 220 age- and neighborhood-matched controls were completed. Limited information was obtained on nine additional patients who had died. Women with HCA and hemorrhage have a greater risk of morbidity and death than those with other symptoms. Increasing duration of OC use increases the risk of HCA. Use of OCs with high hormonal potency and age over 30 years may further increase a woman's risk of HCA. Long-term users of OCs have an estimated annual incidence of HCA of 3 to 4 per 100,000.

Adolescent↗

[Contraception and pregnancy in systemic lupus erythematosus].

In 1990 conflicting views are still being held concerning oral contraception and risks associated with pregnancy in women with systemic lupus erythematosus. As regards oral contraceptives, all authors agree that oestrogen-progestin combination pills are harmful, but the best alternative hormonal contraception remains to be determined. Protein-based "micropills" seem to be harmless; cyproterone acetate appears to be without side-effects, and its usefulness in preventing recurrences is being evaluated. As regards pregnancy, it would be wise not to contemplate having a child until 6 months have elapsed since the onset of remission. Blood pressure, platelet count and serum creatinine and uric acid levels must be closely monitored. Two types of antibodies may be present in the mother and are known to be responsible for foetal complications. These are antibodies to phospholipids (antiprothrombinase, anticardiolipin, antibodies responsible for dissociated treponema serology), which expose to spontaneous abortion or intrauterine death, and the antibody to SS-A (or anti-Ro), which exposes to foetal cardiomyopathy and congenital atrioventricular block.

Abortion, Spontaneous↗

The combined oral contraceptive. A practical guide.

Prescribing the combined oral contraceptive pill is a rewarding combination of hands-on clinical medicine, logical therapeutics, prevention, and patient education. Lowest dose with the least side-effects is the overriding principle of prescribing. It is important to spend time teaching patients and partners how to manage their pill-taking and to be responsible for their medication and prevention follow up.

Adult↗

Oral contraceptive absorption and sex hormone binding globulins in obese women: effects of jejunoileal bypass.

Plasma levels of two oral contraceptive gestagens were studied during 24 hour oral challenges in seven morbidly obese women after jejunoileal bypass comparing the results to unoperated normal controls. To study binding and transport of the gestagens, sex hormone binding globulin levels were determined in these patients, in normal-weight controls, and in unoperated morbidly obese patients. The unoperated morbidly obese patients had significantly decreased levels of sex hormone binding globulin, compared to normal-weight controls and to the jejunoileal bypass patients, whose levels were similar to the controls. The jejunoileal bypass patients had a reduced capacity to absorb oral contraceptive gestagens, although the plasma levels were of the same magnitude found in normal subjects using lower doses of gestagens. However, the gestagen to sex hormone binding globulin ratio was lower in jejunoileal bypass patients, implying reduced biologic activity and thus reduced contraceptive efficiency of the gestagen. There were no enzymatic or morphologic signs of liver dysfunction. No correlations were found between plasma gestagen levels and number or volume of stools, fecal fat excretion, or intravenous C-cholic acid load. It is concluded that caution must be exercised in prescribing oral contraceptives to jejunoileal bypass patients.

Administration, Oral↗