Endocrinology: Immunohistochemical sex steroid receptor distribution in endometrium from long-term subdermal levonorgestrel users and during the normal menstrual cycle

The bleeding problems experienced by users of subdermal levonorgestrelimplants (Norplant) remain unexplained. The aim of the presentstudy was to investigate the oestrogen (ER) and progesteronereceptor (PR) distribution in levonorgestrel-treated endometrialbiopsies from 31 subjects recruited in Jakarta, Indonesia, andto compare the sex steroid receptor immunostaining with thatof endometrium from 58 normally cycling women from Melbourne,Australia. Sex steroid receptor immunoreactivity was additionallycompared with days of exposure to subdermal levonorgestrel,serum oestradiol and progesterone levels and days of bleedingduring a 90-day reference period. An immunohistochemical techniquewith an alkaline phosphatase anti-alkaline phosphatase (APAAP)detection system for use in formalin-fixed paraffin wax embeddedendometrial tissue was employed. Significantly greater meanimmunostaining scores of stromal PR were observed in Norplantcompared with control endometrium at all stages across the cycle.No significant correlations were demonstrated between sex steroidreceptor immunostaining and days of exposure to subdermal levonorgestrel,serum oestradiol or progesterone concentrations or days of bleedingduring a 90-day reference period. Whether the elevated stromalPR immunostaining in Norplant-treated endometrium is a consequenceof increased synthesis or reduced turnover of receptor remainsunclear. As yet it is undetermined whether increased PR immunoreactivitycorresponds to an increase in number of functional PR.     

国产长效皮下埋植避孕剂与Norplant多中心临床对比研究

目的 :观察两种国产皮下埋植避孕剂 I型、II型和 Norplant埋植剂的避孕效果、副反应和可接受性。方法 :采用前瞻性、随机分配原则的研究方法 ,在全国 1 0个临床中心开展本专题临床研究。统一研究方法 ,统一科研表格。每年随访一次 ,共随访 5年。结果 :共接收对象 2 999例。国产 型组 1 0 0 1例 , 型组 1 0 0 0例 ,Norplant组 998例。 5年随访率为 99.8%。 5年末 ,国产 型组 ,妊娠 3例 ,粗累积妊娠率 0 .4/1 0 0妇女。国产 型组 ,妊娠 5例 ,粗累积妊娠率 0 .7/1 0 0妇女。Norplant组无妊娠 ,三组间无统计学差异 ( P>0 .0 5 )。三组均无宫外孕发生。 5年末 ,三组共终止 82 2例。继续累积使用率 ,分别为 73.9,68.4和 75 .5 /1 0 0妇女。经 Log- Rankχ2 检验 ,三组无统计学意义 ( P>0 .0 5 )。月经问题是终止的主要原因。随埋植时间延长 ,月经出血模式正常比率明显增加。血红蛋白有上升趋势。 5年内未发生重大健康问题。结论 :国产皮埋剂 I型、II型和 Norplant是高效、长效、安全的节育方法     

长期使用Norplant皮下埋植剂对子宫内膜超微结构影响的研究

目的　探讨Norplant皮下埋植剂长期使用对子宫内膜超微结构的影响。 方法　 1989年 10月至 2 0 0 2年 6月中山大学附属二院对 2 99例使用Norplant埋植剂达 5年以上的妇女 ,观察其子宫内膜的形态学 (光镜与电镜 )变化。结果　长期使用组月经表现较为正常 ,妊娠率为 0 33/10 0妇女年。宫腔镜直视下见子宫内膜变薄 ,77 0 8%子宫内膜覆盖良好 ;光镜下子宫内膜腺体数量减少 ,分布不均匀 ,部分呈萎缩型改变 ,间质蜕膜样改变 ,疏松 ,轻度水肿 ;电镜下腺上皮细胞呈低柱状 ,胞体变小 ,微绒毛脱落 ,稀疏 ,分泌颗粒减少 ,线粒体肿胀 ,外膜消失 ,基质变淡 ,甚至呈空泡状 ,粗面内质网扩张 ,此外 ,间质细胞出现细胞凋亡。结论　长期使用Norplant皮下埋植剂可抑制子宫内膜的发育 ,对子宫内膜是安全的。     

专用固定钳在皮下埋植剂取出术中的临床应用

目的:探讨皮下埋植剂硅胶棒专用固定钳的临床应用效果。方法:采用随机分组方法,将受术妇女分为研究组86例,应用皮下埋植剂硅胶棒专用固定钳;对照组88例,应用小弯纹式血管钳。比较两组手术时间、术中出血量、皮下埋植剂硅胶棒的断裂率和术后疼痛程度。结果:研究组的手术时间、术中出血量、硅胶棒断裂率均较对照组少(P<0.05),且术后疼痛程度也较对照组轻(P<0.05)。结论:临床上应用皮下埋植剂硅胶棒专用固定钳,与小弯纹式血管钳相比,具有安全、简便、省时、出血量少、断裂率低、疼痛轻及组织损伤小等优点,值得临床推广使用。     

皮下埋植避孕185例临床总结

应用LNG皮下埋植剂185例控制生育,无1例妊娠,有效率100％。截至1996年3月30日,使用≥2年、≥1年,不足1年的累积终止使用率分别为0.54、2.16和6.48每百妇女。主要副反应为月经失调,也是终止使用的主要原因;但总失血量不多,对身体健康无明显影响。随着使用时间的延长,副反应逐渐减少,月经失调逐渐好转。埋植剂的放置和取出术容易掌握。185例中无感染和其它合并症。     

Norplant皮下埋植剂使用七年效果

对Norplant皮下埋植剂继续使用7年以上的效果作了多中心研究。3600余妇女使用满6年,2400余妇女使用满7年。第6、第7年的年妊娠率均为0.4/100妇女年。妊娠率随体重增加而增加(P<0.05),随年龄的增长而降低,第6、7年合并计算任何年龄组或体重组其年妊娠平均未超过1/100妇女年。     

Cervical changes associated with progestagen-only contraceptives: a team approach

OBJECTIVES: To report clinical, cytologic and colposcopic findings among women using progestagen-only contraceptives for more than 3 years as compared to nonhormonal contraceptives; and to assess the role of nursing in increasing the women's knowledge about Pap test and risk factors for cervical cancer in a developing country set-up. DESIGN: A prospective cross-sectional comparative study. SETTING: Family-planning clinic of a tertiary care university hospital. SUBJECTS: A total of 325 current users of contraceptive methods for more than 3 years. INTERVENTIONS: Patients were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. While group B comprised 125 patients wearing intrauterine devices. In both groups, the patient was asked about the risk factors and her knowledge about cancer cervix. Clinical and cytologic evaluations of the cervix were done. For each patient, two cervical smears were taken using Ayre's spatula and the endocervical brush. MAIN OUTCOME MEASURES: Clinical, cytologic and histopathologic cervical abnormalities after prolonged use, and the effect of health education or counseling on the patient's knowledge about preinvasive or invasive cervical cancer. RESULTS: Initial naked eye assessment of the cervix revealed statistically significant difference between both groups (p < 0.000). However, cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions (SIL) in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. Women's knowledge was compared in the first and last interviews by the nursing staff involved in health education or counseling. It increased in the counseling group; however, the difference was statistically insignificant. CONCLUSIONS: Prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings. There was a marked lack of women's knowledge as regards Pap test and cervical cancer with some statistically insignificant improvement after interview and counseling. Extended training of the nursing staff on the procedure of Pap smear would help establish screening programs in the developing countries.     

The measurement of endometrial perfusion in norplant users: a pilot study

The use of progestogens without oestrogen is commonly associated with irregular menstrual bleeding. Oestrogens and progestogens are both thought to influence endometrial perfusion; changes in endometrial perfusion may contribute to vascular fragility and breakdown. In this study, endometrial perfusion was measured using laser-Doppler fluxmetry in women in the secretory phase of the menstrual cycle before and 4-6 weeks after insertion of the low-dose long-acting levonorgestrel contraceptive implant system, Norplant. Endometrial perfusion was also measured in women exposed to Norplant for up to 19 months. There was no significant difference between endometrial perfusion in control cycles (27.2 flux units +/- 5.5, SEM) and at 4-6 weeks after Norplant insertion (16.3 flux units +/- 5.0), a time when irregular bleeding and spotting are common. Endometrial perfusion was no different from controls after longer periods of Norplant exposure (35.7 flux units +/- 7.2). No direct relationships between endometrial perfusion and plasma concentrations of ovarian steroid hormones were demonstrated. Short-term endometrial vasomotion was largely abolished during Norplant exposure.     

米非司酮不同服用方法对皮下埋植术后子宫出血影响的观察

目的:探讨米非司酮不同服用方法对皮下埋植避孕术后子宫异常出血的影响。方法:120例行皮下埋植避孕术妇女随机分为3组,每组40例。对照组不服用任何药物;一日组在埋植日和每月月经来潮当日服米非司酮50mg,共服6次;两日组在埋植日和每月月经来潮当日、次日各服米非司酮25mg,共服6次。结果:服用米非司酮期间出血天数和滴血天数较对照组减少(P<0.01),经期延长和长期不规则出血百分率低于对照组(P<0.05),但一日组和两日组间差异无显著意义(P>0.05)。停药后组出血天数较对照组明显减少(P<0.05)、滴血天数差异无显著性意义(P>0.05),一日组和两日组间差异无显著性意义(P>0.05)。结论:皮下埋植术后单次服用米非司酮可以改善术后子宫异常出血。     

WHO 86925 Norplant上市后监测(中国部分)

本课题研究目的是对Norplant皮下埋植剂潜在副作用进行监测,以进一步证实其安全性。对使用Norplant和IUD或绝育术的妇女进行比较随访研究。每半年随访一次,详细记录所有健康情况,共随访5年。随访率达99.9％。结果:Norplant组及对照组IUD和绝育术的5年继续使用率分别为76.25、80.89、98.10/100使用者。Norplant的5年累计妊娠率为0.6/100使用者,远低于IUD的8.11/100使用者,宫外孕发生率为0.46/1000妇女年,低于IUD的1.24/1000妇女年,但宫外孕和妊娠之比在Norplant组为31.6:100,远高于IUD的6.7:100,如发生妊娠,要警惕宫外孕的可能。月经问题是Norplant的主要终止使用原因,但使用5年者,其血红蛋白均值上升,和接收时相比P<0.001,而IUD使用5年者,其血红蛋白均值下降,和接收时相比P<0.01。在观察5年中胆囊炎胆石症、纤维囊性乳腺病在Norplant使用者中的发病率高于对照组,P<0.05～0.001,但未发现重大健康问题。Norplant使用5年是安全的。