Metabolic changes during treatment with two different progestogens.

Two triphasic oral contraceptives containing the same amount of ethinyl estradiol in combination with gestodene or levonorgestrel were compared with respect to contraceptive effect, on lipid metabolism and coagulation. Serum concentrations of gestodene, levonorgestrel, ovarian and pituitary hormones, and sex hormone-binding globulin were measured. Thirty-five randomized into two groups receiving either of the preparations. Before treatment and in the third and sixth cycles, blood sample were drawn in the morning while subjects were still in bed to obtain basal conditions. The contraceptive effect and cycle control were good with both preparations, and there were only a few minor side effects. Sex hormone-binding globulin was elevated twofold in the levonorgestrel group and threefold in the gestodene group. The gestodene concentration in serum varied more than the levonorgestrel concentration, but with correction for variations in sex hormone-binding globulin binding, less variability in gestodene and levonorgestrel concentrations were seen. High-density lipoprotein2 cholesterol decreased in the levonorgestrel group but was unchanged in the gestodene group, whereas apolipoprotein A1 increased in the gestodene group but not in the levonorgestrel group. Antithrombin III decreased in the gestodene group but was unchanged in levonorgestrel-treated women. Factor VII increased in both groups but more in the gestodene group. We conclude that gestodene has a positive influence on lipid metabolism, probably because of its lower androgenicity, and a slightly negative influence on coagulation. The latter, however, probably has no clinical relevance.

Clinical and hormonal effects of two contraceptives: correlation to serum concentrations of levonorgestrel and gestodene.

Two triphasic oral contraceptives containing gestodene (GES) (a new progestogen) and levonorgestrel (LNG) were compared with respect to contraceptive effect, cycle control, acceptability and side effects. The serum concentrations of ingested hormones were measured together with ovarian, pituitary, and some adrenal hormones, as well as sex hormone binding globulin (SHBG). The contraceptive effect and cycle control were good with both preparations, and there were only a few minor side effects. SHBG was elevated 2-fold in the LNG group and 3-fold in the GES group. The GES concentration in serum varied more than the LNG concentration, but with correction for variations in SHBG binding, less variability in actual GES and LNG concentrations was seen. Serum levels of FSH, LH, estradiol and progesterone were all depressed with both preparations. The depression was more marked in the GES group, despite lower progestogen ingestion and similar serum concentrations. Equal decreases were found in testosterone, androstenedione and dehydroepiandrosterone sulfate (DHEA-S) with both preparations.

Lipid metabolism and coagulation of two contraceptives: correlation to serum concentrations of levonorgestrel and gestodene.

The effects of two triphasic oral contraceptives containing the same amount of ethinylestradiol (EE) in combination with levonorgestrel (LNG) or gestodene (GES), respectively, on lipid metabolism and coagulation were studied. Serum concentrations of GES and LNG were determined at the same time. Thirty-three healthy women were randomized into two groups receiving either of the preparations. Before treatment and in the 3rd and the 6th cycle, blood samples were drawn in the morning while subjects were still in bed to obtain basal conditions. HDL2-cholesterol decreased in the LNG group but was unchanged in the GES group, whereas apolipoprotein A1 increased in the GES but not in the LNG group. Antithrombin III decreased in the GES group but was unchanged in the LNG-treated women. Factor VII increased in both groups, but more in the GES group. It is concluded that GES has a positive influence on lipid metabolism, and has a slightly negative influence on coagulation but the latter is more likely to be without clinical relevance. The positive influence of GES compared to LNG on lipids is probably due to its lower androgenicity and not to differences in bioavailability.

[Ultrasonic scanning after the legal termination of pregnancy with complications]. / Ultralydundersøgelse efter abortus provocatus legalis med komplikation.

PIP: Incomplete voiding of the uterine cavity following legal induced abortion causes risk of later hemorrhaging and infection. Retained placental tissue must therefore be removed by reevacuation of the uterus. However, since repeated curettage may cause complications in a subsequent pregnancy, this could be avoided unless necessary. It is generally assumed that ultraviolet (UL) can aid in determining if in fact there is any retained placental tissue. The purpose of this study was to ascertain the statistical reliability of UL scanning in finding improperly evacuated uterus cavities in patients having complications following induced abortions, and to see if such screening could eliminate the need for repeated curettage. A group of 60 women was studied who had had abortions performed between weeks 6 and 12 of their pregnancies, and reported having symptoms of complications within a month following their abortions. Such symptoms as hemorrhaging, pain and fever were reported. These women were then monitored. 39 were treated with antibiotics. 48/60 were examined with UL. Of these, it was found that the uterine cavity of 25 (52%) were properly voided. 3 women refused to trust in the UL finding and received repeated curettage, while the remaining 22 accepted the finding and did not repeat the procedure. None of the 25 suffered further complications. That the uterus cavities were empty was further confirmed by microscopic examination of scrapings. UL scanning found suspected placental tissue in the other 23 patients in whom retained placental tissue was suspected. In the subsequent reevacuations, some placental tissue and coagulants were found in 21 patients. Placental tissue with chorionic villi was found among 11 (48%) of the 21. The subsequent absence of complications in the 25 patients shown by UL to have properly voided uterine cavities indicates that false diagnosis is relatively rare. Altogether, 36 patients (75%) were correctly evaluated. The sensitivity of the investigation was found to be 100%, and the specificity 67%. The predictive value of the finding of an "empty uterus" was similarly 100%, and the predictive value of "retained tissue" was 47.8%.^ieng

Granular cell tumor in the perineum. A review and case report.

Granular cell tumor is a lesion which clinically often resembles a fibroma. The tumor is, however, frequently ill-defined, and it may be mistaken for a malignant growth. The granular cell tumor is only rarely located to the perineum. A total of 55 cases have been reported. The diagnosis can be obtained by frozen section microscopy. Recurrence is prevented by excising the whole lesion. The development of malignancy is extremely rare.