Amoxicillin kinetics and ethanol ingestion

The effect of ethyl alcohol ingestion on amoxicillin kinetics was studied. Eight healthy volunteers participated in the study. They received, in three separate occasions, a 500-mg dose of the antibiotic given with water, hydroalcoholic solution or pisco-sour. Blood samples were drawn at appropriate intervals. Amoxicillin was assayed using a microbiological method. Absorption and disposition parameters were calculated by classical pharmacokinetic techniques. There were no statistical significant differences in the rate of elimination of the antibiotic in the three experimental conditions. Ethanol affected significantly the absorption rate constant, lag time and t peak. On the other hand, Cmax and AUC were not significantly modified. Thus, it can be concluded that ethyl alcohol has influence on the rate but not on the extent of absorption.

Early luteal function following danazol therapy for endometriosis

The luteal phase of 20 infertile women with endometriosis who were treated with danazol (600 mg daily for 6 months) was studied by basal body temperature, plasma progesterone (P), oestradiol (E2) and prolactin (PRL) determination, and endometrial biopsy, in any one of the first three cycles after discontinuation of danazol. All endometrial specimens were noted to be fundal samples and were clearly progestational after danazol therapy. Abnormal secretory phases were detected in three patients, as in the pre-danazol control cycles. Moreover, plasma levels of P, E2 and PRL in post-danazol cycles were similar to those found in control cycles and fell within the normal range in all cases except for one patient having hyperprolactinaemia. In conclusion, our study shows that endometrial inadequacy is not the cause of the increased fetal wastage previously reported among proximally conceived pregnancies after danazol therapy for endometriosis.

[Valve replacement using an artificial ball prosthesis manufactured in Mexico]

This report documents our early experience with a cage ball valve manufactured in Mexico. Between May 1985 and March, 1986, 25 consecutive replacements have been performed in 23 patients, 14 underwent aortic valve replacement, 9 received a mitral valve, and 2 received both aortic and mitral valves. Their mean age was 32 years. Most of the patients had rheumatic heart disease. Their functional class prior to operation was as follows: six patients fell into class II, 15 into class III and 2 into class IV. One case died in the operative period. All patients have been followed for a mean period of 5 months. Late mortality has not occurred in any patient. Valve-related complications were not present. The post-operative NYHA functional class was as follows: seventeen (80%) fell into class I and five (20%) fell into class II. The actuarial survival rate 10 months after operation was 96.0%. Our study suggests that the cage ball valve has a good performance, the clinical results justify continuing investigation of this prosthesis.

The significance of luteal phase deficiency on fertility: a diagnostic and therapeutic approach

Luteal phase deficiency, diagnosed by endometrial biopsy, was found in 1 out of 25 control fertile women and in 46 out of 355 infertile patients, a difference that was not significant. It was also found in 19 [corrected] out of 60 patients with early recurrent abortion which was significantly higher than in controls and in infertile patients. Pregnancy outcome was evaluated in treated and untreated groups of patients diagnosed as having luteal phase deficiency. Our data suggest that treatment improved the results of pregnancy in patients with recurrent abortion, but not in infertile patients.

The endometrial biopsy for diagnosis of luteal phase deficiency

We studied endometrial luteal phase in specimens from 660 biopsies done in 300 patients from our infertility clinic. A minimum of two (240 women) or three (60 women) endometrial biopsy specimens from separate cycles were taken regardless of the previous histologic findings in all patients. Statistical analysis of results by the McNemar and the Cochran Q tests for the significance of changes leads us to conclude that a minimum of two, and even three, endometrial biopsy specimens are needed for diagnosis of luteal phase deficiency.

[Effects of several anti-arrhythmia agents on excitability and conduction depressed by digitalis agents]

Digitalis intoxication is characterized by the appearance of most of the types of severe arrhythmias described and also by important disturbances of cardiac excitability and impulse propagation. Most of the antiarrhythmic agents that are used in the treatment of these conditions also depress excitability and impulse propagation. These characteristics are frequently responsible of severe complications. The purpose of this paper is to determine the type of interactions that exist between digitalis and some antiarrhythmic agents, and compare them with the effects of magnesium. The experiments were done in several groups, of dogs anesthetized with pentobarbital and with the chest open. Excitability, conduction time and functional refractory period were determined using the classical methods. The protocol used consisted in the comparison of the actions of toxic doses of digitalis on excitability and conduction times of the atrial and ventricular tissues, under control conditions and in the presence of therapeutic doses of procainamide, lidocaine and magnesium. The results showed that procainamide worsened the depression of excitability and conduction produced by digitalis intoxication, while lidocaine does not add to the digitalis effects and in some cases it produces a partial improvement of these parameters. Magnesium completely reverts the effects on excitability and conduction. These results provide us with rational pharmacological bases for the treatment of digitalis intoxication and suggest that magnesium could be very useful in the management of patients with severe digitalis intoxication.

Endometrial biopsy inadvertently taken in the cycle of conception

Endometrial data, plasma progesterone levels and the outcome of pregnancy were analyzed in 22 infertility patients from whom endometrial biopsies had been inadvertently taken in early pregnancy. We found 22.7% (5 cases) of defective endometria in association with normal plasma progesterone levels (available in four patients). Daily plasma progesterone during the first 21st postovulatory days in the cycle of conception is reported in one of our patients. Fourteen of the 22 women delivered normal infants at term, 1 woman had a hydatidiform mole and 7 women aborted (31.8%). The relevance of endometrial biopsy in the cycle of conception and its influence on the outcome of pregnancy are discussed.

Dehydrogesterone treatment of endometrial luteal phase deficiency after ovulation induced by clomiphene citrate and human chorionic gonadotropin

Twenty infertile patients being treated with clomiphene citrate (CC) and human chorionic gonadotropin (hCG) for induction of ovulation, with a defective endometrial secretory pattern despite normal plasma levels of progesterone, estradiol, and prolactin, were entered into treatment plans on a random basis involving the following: CC-hCG plus dehydrogesterone (group 1), and CC-hCG (group 2). Success rates were similar in both groups (20% and 30%, respectively), based on a corrected endometrial defect during the second treated cycle. It is concluded that progestational agents are of low therapeutic value in endometrial luteal phase deficiency induced by CC.

Dehydrogesterone versus vaginal progesterone in the treatment of the endometrial luteal phase deficiency

Forty-four infertile patients with inadequate luteal phase histologically documented in at least two separate cycles and normal plasma levels of progesterone (P), estradiol (E2), and prolactin (PRL) were entered into treatment plans on a random basis involving at least 3 months of each of the following: P vaginal suppositories, dehydrogesterone, and no treatment. Success rates were similar for P (62.5%) and dehydrogesterone (68.7%), based on a corrected endometrial defect during the fourth treated cycle or when a term pregnancy was achieved. However, these figures are significantly different (P less than 0.001) when compared with 16.6% of the control group. In ten additional infertile patients with normal luteal function as assessed by endometrial histologic study and hormone measurements, a second biopsy was performed in a consecutive cycle under dehydrogesterone administration. In no case was the normal secretory pattern impaired. It is concluded that (1) both P and dehydrogesterone can be used to advantage in the treatment of luteal phase defects, and (2) therapy with dehydrogesterone does not alter the normal pattern of endometrial secretion.

[46 XY gonadal dysgenesis and dysgerminoma (author's transl)]

A patient with gonadal dysgenesis, cariotype 46 XY and female biotype is presented. The histological study confirmed the presence of a dysgerminoma in the left gonad. The features of the cases are discussed.

[Phonomechanocardiography of constrictive pericarditis]

There were studied 19 constrictive pericarditis cases demonstrated by anatomist study. It was evident, at all of them, systemic veiny hypertension's syndrome. "Extinguished" cardiac noises and "quiet" heart only appeared at the 42% of the cases. 73% of patients were found with important incapacity. Lyan's pericardic protodiastolic crack was registered at the 75% of the cases and only at 2 cases (10.9%) it was found reinforcement of pulmonary noise II. It is agree with the haemodynamic discovery of pulmonary pression's light elevation. Characteristically, precordiogrammes showed great "A" wave, and it was agree with telediastolic pression's elevation of the two ventricles obtained by catheterism. Phlebogramme was characteristic of systemic veiny hypertension by impediment of ventricular filled at all the studied cases. Measurement of cardiac cycle's phases showed diminution at PE, Blumberger's intrasystolic quotient, left expulsion fraction (Carrard's method) and ventricular pression's elevation middle velocity (VPEMV). By the contrary Weissler's index was found elevated. Eventhough found ciphers could be considered like bordering normal values, there is a difference statistically significance in relation with the values that were found in sane subjects. These discoveries were interpreted in the base that the patient's heart with constrictive pericarditis acts at the curve's ascendent part of the ventricular function because it has incapacity to utilize Starling's mechanism. Process' chronicity produces myocardic atrophy by "discuss" and, by this, ventricular function's improvement can be no immediate to pericardiectomy. Apexcardiogramme shows the impedement to ventricular filled with its diastolic morphology which is very similar to intracavitary pression's curve ("square root's image"). It is postuled the hypothesis that these sicks do not develop important pulmonary hypertension, because right ventricle's poor diastolic distension impides generation of major expense and systolic pression and, by other side, the impedement to ventricular filled has repercussion over right auricle and systemic veiny territory much more distensible, with the known clinical consequences.

[Corrected transposition of the great arteries without associated abnormalities]

We studied 5 cases of corrected tansposition of big arteries without associated defects. Four of them showed situs solitus with apex to the left, and the fifth one showed dextroversion. In four of the cases the second sound was the only one, strong and to the left of the precordium; in four we found mild sistolic murmur in the third left intercostal space. In all of them, XR plates showed the largest liver lobe to the left, apex to the left in four and to the right in one, being possible to see the ascending aorta to the left in four cases. A patient with complete auriculoventricular block showed cardiomegaly and excavated middle arch. Three of them presented sinusal rithm, one had auriculoventricular block of variable degree and the last had complete auriculoventricular block. In four cases the AQRS showed a deviation to the left, and the other one to the right. In the foreground of the first septal vector was going from right to left. The analysis of the unipolar and thoracic morphologies had alterations in the intraventricular conduction which suggested a right branch block in derivations exploring the ventricle located to the left and potential QS in the right pre-cordials. We found a pattern of sistolic overload of the sistemic ventricle. Through determination made by the His Ecg we found that the alterations in conduction were distal. The electro-mechanic latent period of the ventricle located to the right was shorter than the opposite. The angiographic studio helped to establish the auriculoventricular discordant relations and to identify the ventricles position through their angiographic morphology. In the cases showing point to the left, the ventricle anatomically considered as the left one showed a triangular form and smooth walls, while the ventricle anatomically consider being the right one presented trabeculated walls. In dextroversion the anatomically left ventricle was egg-shaped with smooth walls. All of them presented the aorta above the pulmonar artery.