[The degree of cognitive disorders and related psychovegative and hemodynamic impairments in patients with essential hypertension].

AIM: to study the specific features of clinical, hemodynamic, and psychovegetative impairments in patients with essential hypertension (EH) in relation to the degree of cognitive disorders (CD). SUBJECTS AND METHODS: Seventy-five patients with EH were examined and, according to the presence and degree of CD were divided into 3 groups: 1) 17 patients without cognitive deficit; 2) 35 patients with mild CD; 3) 23 patients with moderate CD. Risk factors, clinical manifestations, and hemodynamic and autonomic regulation features were assessed. RESULTS: In EH patients without cognitive deficit, blood pressure (BP) corresponded to grade 1; among cerebral disorders, there was a preponderance of early signs of dyscirculatory encephalopathy (DEP) that were accompanied by subclinical anxiety disorders, preserved autonomic adaptation, and symmetrical blood flow in the common carotid artery (CCA) bed. Sympathetic autonomic tone and the occurrence of anxiety-depressive disorders were noted in EH patients with mild CD along with progression of cerebral disorders and impairments in the 24-hour BP profile and hemodynamics in the CCA bed. In patients with EH and moderate CD, the 24-hour BP profile corresponded to grade 2 and the significant cerebral symptoms were associated with the significantly impaired elastotonic properties of the vascular wall in the CCA bed and with the presence of signs of its stenosis, with the increased sympathetic and central effects on cardiac rhythm, and with moderate anxiety-depressive disorders. CONCLUSION: In EH patients, moderate CD is attended by significant BP circadian rhythm disturbances, the functional and structural changes in the vascular wall of the CCA bed, which are combined with autonomic disregulation and anxiety-depressive disorders. The severity of the cardiac-cerebral syndrome in patients with EH should be borne in mind on elaborating individual and preventive programs.

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. I. Contraceptive efficacy and side effects. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

A multicentre clinical trial, including 19 centres in 13 countries, assessed the contraceptive efficacy and clinical acceptability of a Silastic 382 vaginal ring releasing 20 micrograms of levonorgestrel for at least 90 days. A total of 1005 women entered the study and 8176.74 woman-months of experience was gathered. The rate of intrauterine pregnancy at one year of use was 3.6 per 100 women (95% confidence interval 2.2-5.0), and of ectopic pregnancy, 0.2% (one case). The principal reasons for discontinuation were menstrual disturbances (17.2% at one year), vaginal symptoms (6.0%) and repeated expulsion of the ring (7.1%). The pregnancy rate with this 20 micrograms levonorgestrel-releasing vaginal ring compares favourably with that of a low estrogen combination oral contraceptive tested by WHO and is less than half that of a progestogen-only oral contraceptive in a WHO randomized study. It is concluded that the WHO intravaginal ring releasing an average of 20 micrograms of levonorgestrel per 24 hours is an effective method of contraception for at least one year of use.

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. II. Expulsions and removals. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

This paper investigates the relationship between expulsions and removals, and demographic characteristics of 1005 women from 19 centres using a vaginal ring releasing 20 micrograms levonorgestrel per 24 hours. Emphasis is placed on discontinuations of method use due to expulsions, on the number and rate of expulsions, and the time at which the first expulsion occurred. The overall life-table discontinuation rate due to expulsion was 7.1% at one year. Life-table discontinuation rates increased with parity and were highest in Asian and lowest in European women. In respect to the number of expulsions experienced by women (expulsions did not necessarily lead to discontinuation), the women of high parity and those from Asia and Europe have the highest rates. The life-table first expulsion rate is 29% at one year. Such rates are highest in Chinese and Asian women. Following a first expulsion, the second expulsion rate is 45% by the end of the subsequent six months. The majority of first expulsions occur at defaecation (134 or 57% of 234 women), urination (12%) and during menstruation (17%). Rings were removed by 121 (12%) women on 201 occasions and for a variety of reasons. The main medical reasons were vaginal discharge and irritation, bleeding pain and dyspareunia. Others removed the ring during defaecation, intercourse or because the ring came out of place. Women also removed rings for curiosity, to show their husbands and to clean.

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. III. The relationship between pregnancy rate and body weight. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

This paper investigates the relationship between pregnancy rates and body weight of 1005 women using a vaginal ring releasing 20 micrograms levonorgestrel per 24 hours. While the overall pregnancy rate at one year was 3.7%, it was found that women have an increasing risk of pregnancy with increasing body weight. For example, a woman of 40 kg has an estimated pregnancy rate of 1.7% in contrast to 9.8% for a woman of 80 kg weight.

Postcoital contraception with levonorgestrel during the peri-ovulatory phase of the menstrual cycle. Task Force on Post-ovulatory Methods for Fertility Regulation.

The contraceptive efficacy and side effects of postcoital levonorgestrel used repeatedly during the peri-ovulatory period of one cycle was examined in 259 women. All subjects were of proven fertility in their present union and had ovulatory cycles as assessed from pre-treatment BBT charts. The mean number of coital acts during the treatment cycle was 7.5 (SD:2.6) and the mean number of 0.75 mg levonorgestrel tablets taken during the peri-ovulatory period was 4.0 (SD:1.2). Two pregnancies, both considered to be method failures, occurred, giving a failure rate of 0.8% per treated cycle. Although the overall effect of levonorgestrel on menstrual cycle length was small and insignificant, menstrual cycle disturbances were not uncommon. Intermenstrual bleeding or spotting occurred in 8.5% of the treated cycles and 12.5% of the cycles were less than 20 or more than 35 days. Other side effects, mainly nausea, headache and dizziness, were reported by about 20% of the subjects but the apparent incidence of these complaints varied markedly between the nine participating centres from 0% to just over 50%. The data suggest that repeated postcoital use of levonorgestrel is probably not a viable approach to fertility regulation for the majority of women who have regular intercourse and wish to limit the number of their pregnancies.

[Effectiveness of intrauterine contraceptives: the side effects and complications from their use]. / Effektivnost' vnutrimatochnykh kontratseptivov, pobochnye iavleniia i oslozhneniia pri ikh primeneniia.

PIP: A study was done on Russian models of the intrauterine contraceptives (polyethylene umbrellas and loops) used by 772 women (20-39 years old) who were observed for 1-8 years (totalling 8140 menstrual cycles). It was found that in 100 women expulsion of the intrauterine device (IUD) occurred; 20 became pregnant; in 543 women the IUD was withdrawn after 3-5 years of use. The side effects which were noticed at the beginning of usage of the IUD were their expulsion (11.7%) of total, of which 25.0% during the first month). Disturbances of the menstrual cycles were the reasons for withdrawal of the IUD in 133 women (24.5%). This happened mostly after 3-5 years of using the IUD. In these cases inflammation of the endometrium was noted (proved by histological and microbiological analyses). In some women removal of the IUD was done because of pain and in some of them by their own wish. It was shown that the IUD did not negatively effect the ability of women to become pregnant. The conclusion was that a woman using the IUD had to be under a physician's care to prevent complications. The IUD has to be removed if the menstrual cycle is disturbed.^ieng

[Sensitivity of pituitary gonadotropins to luliberin in women using intrauterine contraceptive devices]. / Issledovanie chuvstvitel'nosti gonadotrofov gipofiza k liuliberinu u zhenshchin, pol'zuiushchikhsia vnutrimatochnymi kontratseptivami.

PIP: Despite extensive practical use of IUDs investigations still need to be conducted concerning the reasons for their contraceptive effect. Even though the localized effect on the endometrium which prevent implantation of egg cells is a known cause, possible influence on the hormonal and ovulatory function of the ovaries should not be neglected. IUDs according to various authors either result in decreased ovulation or constant ovulation with a decreased production of ovulatory steroids. No change in the excretion of estrogens and pregnanediols, but increased luteinizing hormone and estrogen as well as prolactin content in the blood are reported. The current study pinpoints the mechanism of the IUD on the hypophysial ovulatory system in women aged 24-35 having used the IUD for 2-3 years. Determination of basal temperature was performed during 2-3 cycles. With 59/60 women, basal temperature was 2-phased and with 1 it was mono-phased. The histological picture of the endometrium was studied for 40 women and it reflected the corresponding phases of the menstrual cycle. Functional reserves of hypophysial gonadotrophs was studied using a test with intravenous injection of 100 micrograms of synthetic luliberin during the cyclic follicular phase for 9 women using the IUD and for 7 healthy women of reproductive age as a control group. The levels of luteinizing and follicle stimulating hormones in the blood serum and also prolactin, estradiol and progesterone in blood samples were determined by radio-immunology at regular intervals. The dynamics of the changes noted for the women in the 2 groups did not differ. The cycles of prolactin and progesterone content in the blood were the same. A slight tendency for decreased levels of estradiol in the blood for women using the IUD was noted, which may be connected with an insignificant stagnation in the growth and maturation of the follicles. The results support the findings that prolonged use of the IUD leaves the hypothalamic-hypophysial-ovulatory system intact.^ieng

[Sensitivity of the pituitary gland to LH-FSH releasing hormone in women after discontinuation of ovidon, an estrogen-progesterone contraceptive agent]. / Chuvstvitel'nost' gipofiza k LG-FSG-rilizing-gormonu u zhenshchin posle otmeny éstrogen-progestagennogo kontratsepnivnogo preparata ovidona.

PIP: Serum luteinizing hormone and follicle stimulating hormone patterns in response to intravenous administration of 100 mcg luteinizing hormone-releasing hormone (LH-RH) during the follicular phase of the cycle were examined in 8 women upon the discontinuation of a combined contraceptive, Ovidon, and in 11 untreated women. The duration of treatment was 9-12 months. Pituitary response to LH-RH was found to be diminished significantly in the treated patients. (author's)^ieng

[The clinico-pharmacological characteristics of anteovin]. / Kliniko-farmakologicheskaia kharakteristika anteovina.

The clinical and laboratory studies carried out on 160 women showed a high contraceptive effect and good tolerance of anteovine. The contraceptive effect of the biphasic drug is determined by its antiovulatory action concurrent with inhibition of the basal periovulatory secretion of gonadotropins and secretion of sex hormones.

PIP: The results of evaluation of the contraceptive activity of the biphasic oral contraceptive anteovin are presented. 1 package of anteovin consists of 11 white tablets containing 0.05 mg of ethinyl estradiol and 0.05 mg of levonorgestrel and 10 pink tablets of 0.05 mg of ethinyl estradiol and 0.125 mg of levonorgestrel. Anteovin was tested according to the conventional 21-day regimen from day 5 of the cycle for 21 days, followed by 1 7-day rest period. Duration of anteovin administration ranged from 1 to 12 cycles. Anteovin was given to 160 women (aged 17 to 40 years old) who had a history of 618 pregnancies (182 ended by term delivery and 436 ended by induced abortion). During anteovin administration none of the women became pregnant. Side effects of anteovin included mild nausea during first several days in 12 women, breast tenderness in 4, and menstruation disorders in 8. The mechanism of contraceptive effect of anteovin was associated with ovulation inhibition. The changes in the basal temperature had a monophasic characteristic. Colpocytological examination showed decrease in the karyopyknotic and eosinophilic indices to 4-30%. All estrogen fractions (estrone, estradiol and estriol) in the urine showed statistically significant decrease on day 14-16 of the cycle (to 15.8 mcg/day, compared with 41.9 mcg/day in controls). The level of pregnanediol in the urine showed a decrease on day 20-23 of the cycle (0.66 mg/day, compared with 2.98 mg/day in controls). After 6 months of anteovin administration, there was a decrease in the basal and periovulation secretion of follicle-stimulating hormone, luteinizing hormone, and estradiol.