[Estrogen therapy effect in arterial tension in postmenopausal women]. / Efecto del tratamiento con estrógenos en la tensión arterial de mujeres posmenopáusicas.

INTRODUCTION: Experimental studies have shown that estrogens prevent deposit of cholesterol in arteries, have effect upon the endothelial function (to prevent contraction of smooth muscle), and enlarge the vascular tone or vasodilatation. OBJECTIVE: To determine changes in arterial pressure before and after use of estrogen-therapy. MATERIAL AND METHODS: A descriptive study was carried out follow-up during 8 weeks in Obstetric and Gynecologic Hospital (No. 3), Instituto Mexicano del Seguro Social. We included 250 postmenopausal women with prescribed estrogen-therapy. Arterial tension was determined before and after therapy; descriptive statistics and student t test (value, p < 0.05) was employed. RESULTS: Menopause was present in a mean of age of 46 +/- 4.2 years (M +/- SD); height was 1.53 +/- 0.6 m; corporal weight, 60.9 +/- 10.2 kg, and hip-waist index was 81.3 +/- 5.4. Mean arterial tension before estrogen-therapy was 90.2 +/- 10.0 mmHg, and after, 85.7 +/- 9.6 mmHg (p < 0.05). CONCLUSIONS: There is evidence of estrogen-therapy vasodilatation and hypotension effects, with clinical changes statistically significative; however is recommendable that such estrogenic therapy must be individualized and attended in slender form. Hormonal therapy (estrogens) has benefits in arterial tension of postmenopausal women.

[Usefulness of establishing diagnosis and severity of the most frequent signs and symptoms in preeclamptic patients]. / Utilidad para establecer diagnóstico y severidad de los síntomas y signos más frecuentes en la paciente preeclámptica.

OBJECTIVE: Our aim was to determine that signs and symptoms are tools in establishing diagnosis and severity of preeclampsia. MATERIALS AND METHODS: Our study design was prolective, comparative, cross-sectional for evaluation of diagnosis. Our sample included 408 patients. The study employed classification criteria of the American College of Obstetricians and Gynecologists. One blinded family physician interrogated and examined each patient. The sample included patients with recent diagnosis and without treatment. Patients with HELLP syndrome, eclampsia, and those in Intensive Care were excluded. Clinical signs evaluated included headache, Phosphenes, acuphenes, tinnitus, vomiting, epigastric pain, right hypochondrium pain, ecchymosis, hematomas,and hyperreactive reflexes. RESULTS: A total of 192 patients without preeclampsia, 63 with mild, and 153 with severe preeclampsia were included. Clinical manifestations were absent in 60, 21 and 8% respectively of patients in each group. Presence of three or more signs or symptoms had sensitivity of 60% (CI95% 53-67), specificity of 84% (CI95% 79-89), and positive likelihood ratio of 3.8 and negative, 0.48. Most usefulness data for diagnosis of preeclampsia are hyperreactive reflexes, phosphenes, acuphenes, right hypochondrium pain, and epigastric pain. CONCLUSIONS: The symptoms and signs taken alone are tools for evaluation of severity but not for detection of preeclampsia. There is necessary to develop new way for it's diagnosis during prenatal care.

Utilidad para establecer diagnóstico y severidad de los síntomas y signos más frecuentes en la paciente preeclámptica / Usefulness of Establishing Diagnosis and Severity of the Most Frequent Signs and Synptoms in Preeclamptic Patients

Objetivo: determinar qué síntomas y signos son más útiles para establecer el diagnóstico y la gravedad de la preeclampsia. Material y métodos: estudio analítico, transversal comparativo prolectivo para evaluar una prueba diagnóstica. Muestreo no probabilístico. Tamaño de muestra 408 pacientes. Se usaron los criterios de clasificación del American College of Obstetricians and Gynecologists. Un médico familiar en forma ciega e independiente interrogó y exploró a cada paciente. Se incluyeron pacientes de reciente diagnóstico y sin tratamiento. Se excluyeron pacientes con síndrome Hellp, eclampsia y de terapia intensiva. Se evaluó: cefalea, acúfenos, fosfenos, tinnitus, vómito, dolor epigástrico, dolor en hipocondrio derecho, disuria, polaquiuria y tenesmo vesical, equimosis, hematomas e hiperreflexia Resultados: 192 pacientes sin preeclampsia, 63 con preeclampsia leve y 153 con preeclampsia severa. Fueron asintomáticas 60, 21 y 8% respectivamente. La presencia de 3 ó más síntomas o signos tiene sensibilidad de 60% (IC95% 53-67) especificidad de 84% (IC95% 79-89) cociente de probabilidad positivo de 3.8 y negativo de 0.48. Para evaluar gravedad son útiles hiperreflexia, fosfenos, acúfenos, dolor en hipocondrio derecho o epigastrio Conclusiones: existe una proporción de pacientes preeclámpticas sin manifestaciones clínicas (29%); los síntomas y signos descritos son útiles para evaluar gravedad pero no para diagnóstico de preeclampsia.

Objective: Our aim was to determine that signs and symptoms are tools in establishing diagnosis and severity of preeclampsia. Materials and Methods: Our study design was prolective, comparative, cross-sectional for evaluation of diagnosis. Our sample included 408 patients. The study employed classification criteria of the American College of Obstetricians and Gynecologists. One blinded family physician interrogatedandexaminedeach patient. The sample included patients with recent diagnosis and without treatment. Patients with HELLP syndrome, eclampsia, and those in Intensive Care were excluded. Clinical signs evaluated included headache, Phosphenes, acuphenes, tinnitus, vomiting, epigastric pain, right hypochondrium pain, ecchymosis, hematomas, and hyperreactive reflexes. Results: A total of 192 patients without preeclampsia, 63 with mild, and 153 with severe preeclampsia were included. Clinical manifestations were absent in 60,21 and 8% respectively of patients in each group. Presence of three or more signs or symptoms had sensitivity of 60% (CL95% 53-67), specificity of 84% (CL95% 79-89), and positive likelihood ratio of 3.8 and negative, 0.48. Most usefulness data for diagnosis of preeclampsia are hyperreactive reflexes, phosphenes, acuphenes, right hypochondrium pain, and epigastric pain. Conclusions: The symptoms and signs taken alone are tools for evaluation of severity but not for detection of preeclampsia. There is necessary to develop new way for it's diagnosis during prenatal care.

[Clinical significance of the laboratory determinations in preeclamptic patients]. / Significado clínico de los resultados de laboratorio en las pacientes preeclámpticas.

OBJECTIVE: To determine the clinical significance and optimal cutting points of laboratory tests more frequently used in patients with pre-eclampsia of recent diagnosis. MATERIALS AND METHODS: We made an analytic cross-sectional study for evaluation of diagnostic test. Non probabilistic sampling. Sample size 400 patients. We used the American College of Obstetricians and Gynecologists criteria as gold standard. Laboratory personnel was blinded to the clinical classification of the patients. RESULTS: We studied 192 patients without pre-eclampsia, 63 with mild and 153 with severe pre-eclampsia. Hematocrits, prothrombin time, partial thromboplastin time, aspartate aminotransferase, alanine aminotransferase and bilirubins did not show significative differences among groups. Platelets counting showed low sensitivity. Lactic dehydrogenase showed 71% sensitivity (65-85 CI95%), specificity 74% (68-80 CI95%) positive likelihood ratio 2.7 and negative 0.4. Uric acid showed sensitivity of 75% (69-81 CI95%) specificity 79% (73-85 CI95%) positive likelihood ratio of 3.5 and negative of 0.3. Seric creatinine with sensitivity of 81% (76-86 CI95%) specificity of 60% (53-67 CI95%) positive likelihood ratio of 2 and negative of 0.3. CONCLUSIONS: Seric uric acid, seric creatinine and lactic dehydrogenase are useful for diagnosis and severity classification of pre-eclampsia. Platelets counting is not useful for diagnosis but is useful for severity classification. In patients with thrombocytopenia prothrombin time is useful for severity classification.