Increase in tumour necrosis factor-alpha and a change in the lactate dehydrogenase isoenzyme pattern in plasma of workers exposed to aflatoxin-contaminated feeds

Six types of animal-feed ingredients and swine mixed feeds from factories in northern Thailand were sampled for analysis of mycotoxins. Mycotoxins found in foodstuffs included aflatoxins, fumonisins, ochratoxins, T-2 toxin, vomitoxin and zearalenone. Samples of airborne dust generated while handling animal feed were collected and analysed to assess exposure of workers to aflatoxins. The average aflatoxin level in the control air samples was 0.99 ng/m3. Higher levels of aflatoxins were found in the air samples taken by samplers attached to five workers adding hydrated sodium calcium aluminosilicate to animal feed (group 1; 1.55 ng/m3) and five workers adding glucomannan to animal feed (group 2; 6.25 ng/m3). The exposed workers showed a change in lactate dehydrogenase isoenzyme activity and tumor necrosis factor-levels in plasma. These changes may be associated with inhalation of mycotoxins and other contaminants in foodstuff. Occupational exposure to mycotoxins and mycotoxin adsorbents needs further evaluation in order to set up a proper system for long term surveillance of exposed population.

Shift in FTIR spectrum patterns in methomyl-exposed rat spleen cells

Methomyl is a highly toxic carbamate insecticide which is widely used in many agricultural countries. We have applied the Fourier-transformed infrared (FTIR) spectroscopic method to study the toxicity of methomyl on cytoskeletal protein and the nucleic acid of rat spleen cells. Rats were given methomyl by gavage at 2, 6 and 8 mg/kg in single doses. Colchicine, a microtubule-disrupting agent, was given to rats at 2, 4, and 6 mg/kg in single doses and mitomycin C, an alkylating agent which acts as a DNA-cross-linking agent, was given by an intraperitoneal route to rats at 1 mg/kg. It was shown that the wavenumber of FTIR spectra at amide I and amide II in both methomyl- and colchicine-exposed rats shifted in dose response manner when compared with the control (P < 0.05). The amide I and II shifts in these regions have been proposed to be the result of an alpha-helix protein conformational change. Toxic doses of mitomycin C, a DNA-cross-linking agent, did not result in this pattern. Moreover, all exposed rats showed an increase in the absorbance ratios that were related to the vibrational mode of the phosphodiester group in nucleic acid (P < 0.05).

A randomized trial of oral contraceptive and hormone replacement therapy on bone mineral density and coronary heart disease risk factors in postmenopausal women

OBJECTIVE

To identify the effects of oral contraceptive (OC) and hormone replacement therapy (HRT) on bone mineral density and coronary heart disease risk factors in postmenopausal women.

METHODS

Eighty healthy postmenopausal women were randomly assigned to a cyclic regimen of OC containing 30 microg of ethinyl estradiol and 150 microg of desogestrel or HRT containing 0.625 mg of conjugated equine estrogens 21 days per cycle and 5 mg of medrogestone 10 days per cycle for 12 months. Bone mineral density of lumbar spine and hip, biochemical markers of bone turnover, lipid-lipoprotein profiles, coagulation profiles, fasting plasma glucose, and blood pressure were evaluated.

RESULTS

Both regimens caused significant increase in bone mineral density of lumbar spine, trochanter, intertrochanteric region, total hip, and Ward triangle. Only OC therapy was associated with a significant increase in femoral neck bone mineral density (mean score +/- standard error 2.5% +/- 0.7%, P < .01). Biochemical markers of bone turnover, total cholesterol, and low-density lipoprotein cholesterol decreased significantly in both groups. Posttreatment levels of those bone markers and lipid-lipoprotein were significantly lower after OC therapy than HRT. Fasting plasma glucose and systolic blood pressure decreased significantly in both groups; however, only the OC group showed a significant decrease in diastolic blood pressure.

CONCLUSION

Both OC and HRT increased bone mineral density of lumbar spine and hip, but OC suppressed bone turnover more than HRT. Both methods favorably affected lipid-lipoprotein metabolism, fasting plasma glucose, and blood pressure during the 12 months of treatment.

Experience of Thai women in Bangkok with Norplant-2 implants

A prospective study of the Norplant-2 contraceptive subdermal implant system was conducted in Bangkok, Thailand. The objective of the study was to evaluate the efficacy, adverse effects, and overall acceptability of Norplant-2 implants. A total of 140 women were enrolled in a 3-year clinical trial. The mean age was 29 years. Of all the acceptors, 70% had completed primary school. The continuation rates at years 1, 2, and 3 were, respectively, 94%, 89%, and 83%. No accidental pregnancies occurred throughout the 3 years of use in this study. Personal reasons were the leading cause for termination of Norplant-2 implant use. The 3-year cumulative termination rate for personal reasons was 7.2%. These personal reasons were divorce, husband having vasectomy, and moving away from the study area. The other leading cause for termination was medical reasons; acne, headache, and pain at the implant site were the complaints. The termination rate for medical reasons in year 3 of the study was 4.6%. Prolonged menstrual flow was the other main reason for termination. The 3-year cumulative termination rate for menstrual irregularities was 3.8%. In this study, the cumulative termination for planned pregnancy at the end of the year 3 was only 1.6%. The incidence of difficult removals was 8%. Breakage of the rods on removal was encountered in the majority of these cases. The study findings presented suggest that the Norplant-2 implants are highly effective with high continuation rates. The Norplant-2 system could become another choice of long acting reversible contraception for Thai women.

The use of two estrogen preparations (a combined contraceptive pill versus conjugated estrogen cream) intravaginally to treat urogenital symptoms in postmenopausal Thai women: a comparative study

OBJECTIVE

To determine whether the combined contraceptive pill used intravaginally was as effective as the standard conjugated estrogen cream for the treatment of urogenital symptoms in postmenopausal Thai women.

SUBJECTS AND METHODS

In a randomized clinical trial, 40 postmenopausal women with urogenital symptoms were randomly allocated to two treatment groups for 8 weeks. The first group (n = 20) received a combined contraceptive pill by the vaginal route, one tablet per week at bedtime for 8 weeks. Each tablet contained 250 microg levonorgestrel plus 30 microg ethinyl estradiol. The second group (n = 20) was given 1 gm of an intravaginal conjugated estrogen cream at bedtime, three times in the first week, twice in the second week, and then once a week for the next 6 weeks (1 gram of conjugated estrogen cream contained 0.625 mg conjugated equine estrogens). Subjects were questioned about their urogenital symptoms, and vaginal cytologic smears, vaginal bacterial cultures, and urine cultures were performed before treatment and after 2, 4, and 8 weeks of therapy.

RESULTS

The vaginal pH and the proportion of the fecal type bacteria decreased in both groups, with no statistically significant difference between the groups. The karyopyknotic index and the maturation index were improved during treatment in both groups. An increase in the proportion of lactobacilli were recorded in both groups after therapy, with no significant difference between the two groups. No significant changes were observed in urinary bacteria. The therapy (combined contraceptive pill and estrogen cream) had a marked effect on urogenital symptoms (vaginal dryness, dyspareunia, urinary frequency, and urinary urgency), with impressive improvement comparably in both groups.

CONCLUSIONS

A combined contraceptive tablet administered vaginally once a week can alleviate urogenital symptoms in Thai postmenopausal women as effectively as the vaginal estrogen cream. However, the pills are much less expensive and are easily obtained in developing countries.

Age at menarche in Thai girls

Age at menarche and menstrual symptoms were recorded in a sample of Thai schoolgirls in Bangkok. Using a random sampling proportional to size from this target population, structured questionnaires were offered to a sample of 15998 girls of grades 4-12. Fifty-six per cent of the study population was menarcheal during the time of study. Average mean ages by recalling age at menarche and by probit analysis were 12.51 +/- 1.17 and 12.35 +/- 1.41 years, respectively. The onset of menstruation occurred most frequently in April and October. Abdominal pain was the most common symptom during the menstrual period. Acne, malaise and back pain were other common complaints.

Clinical evaluation of the therapeutic effectiveness of ethinyl oestradiol and oestrone sulphate on prolonged bleeding in women using depot medroxyprogesterone acetate for contraception. World Health Organization, Special Programme of Research, Development and Research Training in Human Reproduction, Task Force on Long-acting Systemic Agents for Fertility Regulation

A placebo-controlled randomized clinical trial was conducted in six centres to compare the effects of a 14 day treatment with either 50 micrograms ethinyl oestradiol daily or 2.5 mg oestrone sulphate daily, on depot medroxyprogesterone acetate (DMPA)-induced prolonged bleeding. Out of 1035 women admitted to the study, 278 requested treatment and were given ethinyl oestradiol (n = 90), oestrone sulphate (n = 91) or placebo (n = 97). Ethinyl oestradiol was successful in stopping the bleeding episode in 93% of cases, compared with oestrone sulphate and placebo which had success rates of 76 and 74% respectively. However, the relative advantage of ethinyl oestradiol was marginal, with an average reduction of 1 bleeding day and 3 spotting days compared with the other two groups. Immediately after treatment, women given ethinyl oestradiol had less bleeding but a more unpredictable pattern than the other two groups. In the long term, there were no differences between the bleeding patterns or the discontinuation rates for any reason in the three groups, and the most important single reason for discontinuation in those groups remained 'menstrual problems'. In summary, the study showed that treatment of DMPA-induced prolonged bleeding with ethinyl oestradiol had a limited short-term effect but no beneficial effect on the acceptability of DMPA as a contraceptive method. Treatment with oestrone sulphate was no different from placebo.

Effectiveness of Norplant implants among Thai women in Bangkok

The purpose of the study was to evaluate the efficacy, acceptability, side effects and continuation rates of the implant system in Thai women. A five-year clinical study of 308 women receiving Norplant-6 implants in Bangkok was conducted. Acceptors' mean age was 29 years, and mean number of children was about two. More than half of the users (63%) finished primary school. The cumulative continuation rates for Norplant implants at first, second, third, fourth and fifth years were, respectively, 98%, 91%, 83%, 78% and 71%. Eight out of a total of eleven pregnancies occurred in the fourth and fifth year of use. The cumulative pregnancy rate was 1.1% for the third year, 2.0% for the fourth year and 4.2% for the fifth year. Desire for future pregnancy was the leading cause for termination of Norplant implants use. The five-year cumulative termination rate for planned pregnancy was 9.2%. Disruption of menstrual rhythm, particularly increased bleeding, was the other main reason for termination; however, the prevalence of menstrual irregularities appeared to diminish with time. The cumulative termination rate for menstrual irregularities in the fifth year of the study was 4.4%. The complaints of "other medical reasons" for removal of Norplant implants were acne, severe headache, and chloasma. The five-year cumulative termination rate for other personal reasons was 7.9%. These personal reasons were husband having vasectomy, husband objection and divorce. It can be seen from this five-year study that Norplant implants are well accepted by Thai women. However, the efficacy in preventing pregnancy was not acceptable during the fourth and fifth year of use in this study, which was different from results of other international studies.

Specifications for new technologies for female sterilization for use in developing countries

The difficulties in providing readily accessible sterilization services for women in rural settings in developing countries are described; they include: problems with personnel; problems with training; anesthesia difficulties; and cost. For a new method of sterilization to be useful in such situations several criteria concerned with overcoming the perceived problems must be met. Any new procedure should be simple, easily learned, capable of being completed with a single visit, and should require only local anesthesia.

The menopausal age and climacteric complaints in Thai women in Bangkok

Age at menopause, associated factors and related clinical symptoms were recorded in a sample of Thai women living in the Bangkok area. Interviews by trained nurses were offered to a sample of 2375 women aged 45-59 years selected at random in 19 of the 54 Bangkok Metropolis Administration health centers. Full reports were obtained from 2354 women. Fifty-six percent of the study population were classified as postmenopausal, i.e. having no vaginal bleeding during the last 12 months, 12% were perimenopausal, i.e. having irregular vaginal bleeding during the last 12 months and 31% were premenopausal, i.e. having regular vaginal bleeding during the last 12 months. The average age at menopause was 49.5 +/- 3.6 years and was not related to body weight, height, age at menarche, level of education, smoking or use of oral contraceptives. However, high parity was significantly correlated to delayed menopause. Clinical symptoms of oestrogen deficiency were reported at a significantly higher rate in the perimenopause group, but the premenopause and postmenopause groups did not differ in their complaints about any symptom, including hot flushes. The most striking effect of menopause was a dramatic loss of sexual desire in 86.9% of postmenopausal women. However, the situation did not induce any specific complaint or any request for medical support.

Maternal risk factors for low birth weight newborn in Thailand

The present study assesses the risk approach for maternal risk factors for LBW newborn in Thailand. This study can be considered as a managerial tool for developing local strategies and is particularly useful in the field of maternal and child health care. A summary of maternal risk factors for LBW newborn as listed in Table 7 and can be used as a health educational tool for pregnant women and as basic data for marital counseling. It can also be used to keep the public informed about the maternal risk factors for LBW newborn which will help Thai women of reproductive age avoid the chance of having such babies.

Itraconazole in the treatment of acute vaginal candidosis

An open non-comparative multicenter study of Itraconazole (Sporal) 400 mg as a single day therapy for vaginal candidosis was carried out at Siriraj Hospital and Chulalongkorn Hospital from 1st November 1988 to 31st August, 1989. Fifty-nine female out patients with vaginal candidosis were included in the study after excluding pregnancy, lactation, mixed vaginal infection and prior antimycotic therapy. Two capsules of 100 mg Itraconazole were given b.i.d. as a single day 400 mg dose. The patients were evaluated at the beginning prior to treatment for physical signs and symptoms, direct microscopic examination, and culture of vaginal fluid. The first and second follow-up were arranged at the end of one week and one month after therapy. The evaluations were the same as in the first visit. The clinical cure rate was 89 and 90 per cent at first and second follow-up respectively. The mycological cure rates were 83.3 and 69.57 per cent at the first and second follow-up respectively. There was one case of Torulopsis glabarta at the second follow-up.

Development and validation of a simple device to estimate birthweight and screen for low birthweight in developing countries

Low birthweight (less than 2500 g) is the major factor associated with the death of infants within the first 4 weeks of life. The mean birthweight of newborn babies of a certain geographic area reflects the quality of maternal and child health care service as well as the degree of socioeconomic development of that particular region. Hence, birthweight is being used increasingly as an indicator for health and socioeconomic planning. However, in a developing country such as Thailand, two-fifths of the babies are delivered at home and are not weighed because scales are not available. To solve this problem in rural areas, a circular nomographic chart was developed with which the birthweight can be computed from a newborn baby's chest and mid-arm circumferences. Preliminary trials comparing these charts with standard baby scales showed a high degree of accuracy with sufficient sensitivity and specificity.

Adverse skin reactions to transdermal oestradiol in tropical climate. A comparative study of skin tolerance after using oestradiol patch and gel in Thai postmenopausal women

A crossover randomized comparison between two different transdermal oestradiol delivery systems has been performed in post-menopausal women of the Bangkok area. Clinical benefits were identical with the use of either a gel, applied once/day on 800 cm2 of skin and which totally evaporated within 3 min, or a patch applied for 3-5 days on 20 cm2 of skin. There was no evidence of pharmacokinetic advantage with the patch, and the day to day intra-individual variations were even greater with patch than with gel. There were no cutaneous side effects with the gel, but unacceptable skin reactions, including itching, vesicular rash and residual pigmentation, were present in 58% of patients during patch use. Therefore a combination, in a small skin area, of adhesive, occlusive effect and high oestradiol concentration does not appear appropriate in hot and humid climate.

A comparative study of the safety, effectiveness and acceptability of two foaming vaginal tablets (nonoxynol-9 versus menfegol) in Thai women

Two foaming vaginal tablets containing nonoxynol-9 (OVT-n) or menfegol (OVT-m) were studied to evaluate safety, effectiveness and acceptability. The study was conducted at the Chulalongkorn University, Institute of Health Research, Bangkok, Thailand. One-hundred-two women randomly assigned to one of the two types of tablets were scheduled for follow-up visits at 1, 3, 6 and 12 months. Although there were differences between the two groups in the gross cumulative 12-month life table rates and 12-month continuation rates, these differences were not statistically significant. Twelve-month discontinuation rates for accidental pregnancy were 31.7 per 100 women for OVT-n group and 25.3 per 100 women for the OVT-m group. Seventeen of the total 22 pregnancies occurred due to use failure. This study indicates that the regular and proper use of OVT-n or OVT-m tablets are comparable and are a safe means of birth control. Although a few product-related (burning) or medical complaints were reported by both groups of tablet users, it seems that the vaginal contraceptive is an acceptable method for fertility control in a suitable population who will use it regularly and properly.

An investigation on the influence of steroidal contraceptives on milk lipid and fatty acids in Hungary and Thailand. WHO Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on oral contraceptives

A double-blind clinical trial to examine the effects of oral and long-acting injectable contraceptive steroids on milk lipid and its fatty acid content has been done in Szeged, Hungary, and Khon-Kaen, Thailand. In Szeged, a combined and a progestin-only pill did not significantly alter total milk lipid. In Khon-Kaen, treatment with the combined pill was followed by a significant increase in the proportion of milk lipid. In the group treated with the long-acting injectable contraceptive, depot-medroxyprogesterone acetate (DMPA), the milk lipid decreased significantly in the first six weeks in comparison with the control group and the individual pretreatment values. A similar but weaker effect was noticed with the progestin-only pill in Khon-Kaen. Few consistently significant differences were found in the shorter chain fatty acids (myristic, lauric and palmitic acids) during treatment. The percentage proportions were increased during the combined pill treatment in Szeged and Khon-Kaen, and reduced in DMPA and progestin-only treatment in Khon-Kaen milks. The possibility that these reflected a response to a milk volume decrease in the combined pill treatment and a reduction in milk lipid synthesis in association with DMPA and the progestin-only pill is discussed. In Khon-Kaen, linoleic acid (which is not synthesized in the body) was increased by comparison with the controls, as a percentage proportion of the fatty acids in the progestin-only and DMPA groups. Calculation of the amounts of linoleic acid per litre of milk revealed that there had been a significant decrease of linoleic, eicosadienoic, dihommo-gamma-linolenic, arachidonic, docosatetraenoic acids in the w6 family and alpha-linolenic acid in the w3 family in the first two post-treatment visits (3 and 4). This reduction in essential fatty acid output follows the reduction in milk volume. In Khon-Kaen, the combined pill group showed a significant decrease compared with the controls, in the proportions of dihommo-gamma-linolenic acid. The difference in response of the mothers in Khon-Kaen and Szeged is discussed in relation to their different nutritional backgrounds.

Effects of hormonal contraceptives on milk volume and infant growth. WHO Special Programme of Research, Development and Research Training in Human Reproduction Task force on oral contraceptives

WHO conducted a three-centre study in Hungary and Thailand to evaluate the effects of hormonal contraception on lactation and infant growth. Women choosing oral contraceptives were randomly assigned to a combined oral contraceptive containing 30 micrograms ethinyl estradiol and 150 micrograms levonorgestrel (N = 86) or a progestin-only preparation containing 75 micrograms dl-norgestrel (N = 85). Identical packaging and treatment schedules allowed double-blind observation. One-hundred-and-eleven women using no contraception or non-hormonal methods acted as controls. In the two Thai centres 59 women using depot-medroxyprogesterone acetate formed an additional comparison group. All subjects were healthy women with normal deliveries, whose infants had normal birth weights and satisfactory growth in the neonatal period. Breast milk volume was determined by pump expression using standardized procedures. Information was obtained on nursing frequency and supplementation, infant growth and morbidity. Pretreatment observations at 6 weeks post-partum were used as a baseline, and subjects were followed-up at 9, 12, 16, 20 and 24 weeks post-partum. Women using combined oral contraceptives had a decline in milk volume within 6 weeks of initiating treatment, whereas no significant decrease was observed in the other treatment groups. After 18 weeks of treatment, combined oral contraceptive users experienced a 41.9% decline in milk volume, compared to 12.0% with progestin-only minipills and 6.1% in the non-hormonal controls. The prevalence of complementary feeding and withdrawals due to inadequate milk supply were comparable in the four treatment groups. However, data were not available on the daily amounts of complementary feeds. There were no significant differences in growth of infants between treatment groups. Thus, women may have compensated for declines in milk volume by more supplementary feeding or by more prolonged and intense suckling episodes. We conclude that 30 micrograms estrogen-containing combined oral contraceptives impair milk secretion, but in the selected healthy group of mothers and children studied with the prevailing level of supplementary feeding, this did not adversely affect infant growth.

A comparative study of Lippes loop and Delta loop intrauterine devices in early postpartum

Two IUDs (Delta loop, Lippes loop D) were randomly inserted in 260 postpartum women within 2-36 hours after delivery by uterine-packing forceps. The Delta loop was designed with the intention of lowering the expulsion rate compared with the standard Lippes loop. The analysis of the data indicated that the expulsion rate of the Delta loop was as high as the Lippes loop D at the one-month follow-up (Delta loop 24.1%, Lippes loop 23.9%). The comparison of other pertinent event rates also showed no significant differences.

A rapid method for the determination of 5 alpha-dihydrotestosterone in Thai males receiving medroxyprogesterone acetate

A rapid method for the determination of DHT (5 alpha-dihydrotestosterone) in serum was established, utilizing potassium permanganate as an oxidising agent to convert the double bond at position 4-5 of testosterone to dihydroxy alcohols. DHT was then extracted with diethyl ether and measured directly using radioimmunoassay technique. The precision of the assay was determined at three levels of DHT added into pooled serum and found to be 4.4-5.1% for between assay percentage coefficient of variation. The sensitivity of the standard curve was found to be 4.2 pg/0.5 ml sample. The accuracy was determined in pooled serum with added standard DHT in the range of 80-800 pg. The percentage recovery of the assay was found to be 92.93-98.35%. The antisera used for DHT assay exhibited no significant cross-reaction with various steroids tested except testosterone which showed a 91.3% cross-reaction. The method was applied to measure the level of DHT in serum of Thai males receiving medroxyprogesterone acetate (MPA) as an oral contraceptive. Twenty-five subjects were divided into 5 groups. Group 1 received an oral placebo with monthly sesame oil injection. Groups 2, 3 and 4 received 5 mg, 10 mg and 20 mg MPA, respectively, with the addition of monthly injection of 250 mg testosterone enanthate (TE). Group 5 received 20 mg MPA daily with the addition of monthly injection of 500 mg TE. Blood specimens were obtained monthly. The first 4 months were used as a control period. After the 4-month period, each subject received treatment as mentioned above for 6 months, then follow-up study was resumed for another 6 months. The results revealed that subjects receiving 20 mg MPA with the addition of 250 mg TE showed a significant decrease of DHT levels (p less than 0.001).

Hormonal changes in normal menstrual cycle of Thai women

The concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), progesterone (P), estradiol (E2), testosterone (T) and cortisol have been measured by radioimmunoassay technique in daily serum samples of 10 Thai women throughout 10 menstrual cycles. The results show that in 10 subjects studied, 9 subjects show the patterns and levels of LH, FSH, E2 and progesterone suggestive of having ovulatory cycles. One subject shows no patterns of these hormones indicative of having ovulatory cycle. Daily serum PRL, T and cortisol concentrations, when determined for each individual subject for the entire cycle, varied among the 9 subjects studied. During the menstrual cycle, changes of hormones were observed in the women studied. There was a significant rise in the concentrations of serum PRL (2 subjects), T (2 subjects) and cortisol (3 subjects) on the day of the LH surge. When the mean levels of PRL, T and cortisol were plotted for 9 subjects in relation to the LH peak, there was no highly significant rise in the concentration of serum PRL, T and cortisol at midcycle.

Post-partum tubal ligation by nurse-midwives and doctors in Thailand

A shortage of doctors limits the provision of post-partum sterilisation services in rural areas of Thailand. To overcome this problem nurse-midwives with theatre experience were trained to perform post-partum tubal ligation by a mini-laparotomy incision under local anaesthesia. The performance of the nurse-midwives was compared with that of doctors in a controlled, randomised clinical trial. Some operative difficulty was encountered by the nurses in 4.9% of cases and by the doctors in 2.0% of cases. This difference is not statistically significant and arose largely because the nurse-midwife cases were more obese. Nurse-midwives required a significantly longer operating-time (18.5 min) than doctors (11.9 min). However, postoperative morbidity was similar in the two groups (7.0% and 6.0%, respectively). These results suggest that trained nurse-midwives with theatre experience can safely provide post-partum sterilisation services. A further field trial is underway.

The effect of injectable norethisterone oenanthate on ovarian hormones in Thai women

The ovarian hormones, progesterone and estradiol, as well as norethisterone concentrations were studied in 15 subjects receiving a single intramuscular injection of norethisterone oenanthate. Three treatment groups were studied. The 5 subjects of group A had no additional treatment, the 5 subjects of group B received ethynylestradiol and the 5 subjects of group C received combined ethynylestradiol and norgestrel orally. Additional treatment was for 5 consecutive days 6 weeks after the injection. Blood samples were obtained weekly for 12 weeks post-treatment. All subjects showed a similar pattern of norethisterone concentrations with a range of 3.5-19.5 ng/ml 1 week after injection, declining to levels of less than 0.02 ng/ml at the end of treatment period. Progesterone concentrations of greater than 4 ng/ml indicated that ovulation had occurred in 2 subjects of group A, 5 subjects of group B and 2 subjects of group C during the study period. Serum estradiol concentrations reached pre-ovulatory levels (greater than 200 pg/ml) in 4,3 and 2 subjects of group A,B and C, respectively, during the treatment period. With the other subjects, serum estradiol showed lesser increases. Among the 15 Thai women in the study, the median time of ovulation was 11 weeks, with the earliest occurring at 6 weeks. Three women receiving NET-OEN and no other treatment had ovulated by 6 weeks. Thai women in this study appear to be more resistant to the antiovulatory effect of NET-OEN as compared to women in other published studies.

The release of prolactin by medroxy-progesterone acetate in human subjects

Medroxyprogesterone acetate an injectable contraceptive when administered to four lactating women at a dose of 150 mg every three months significantly raised prolactin levels over those observed in four control women. Prolactin levels were higher at all times during 4-17 weeks in the drug-treated women, irrespective of whether the samples were collected before or after suckling. It was also observed that while suckling clearly released prolactin in both groups the difference was greater in the women receiving the injection, indicating that the drug enhanced the release of prolactin in response to the suckling stimulus.

A study of the use of intermittent serum luteinizing hormone, progesterone and oestradiol measurements for the detection of ovulation

The value of luteinizing hormone (LH), progesterone (P) and oestradiol (E2) in serum as an index of ovulation and corpus luteum function was studied in blood samples collected at infrequent intervals during the menstrual cycle from 19 healthy Thai women. A serum P level of more than 3 ng/ml was detectable in 70 to 80 per cent samples obtained between days 20 and 25 and a P peak and/or E2 peak (greater than 150 pg/ml) were found at this time in 85 to 94 per cent of the cycles. In not more than 26 per cent of the cycles was an LH peak (greater than 150 ng/ml-LER-907) detected when all results were considered. A significant P and/or E2 peak on day 22 or 23 occurred in more than 78 per cent of 25 to 33 day cycles, whereas, the P and/or E2 peak was detectable in only 50 per cent of the cycles lasting less than 25 or more than 33 days. The postovulatory serum P levels were the ones most consistently raised in patients studied over several consecutive cycles.

The effect of D-norgestrel, 30 micrograms, on the oral glucose tolerance test, including insulin levels, in Thai women

The effect of D-norgestrel, 30 mug, on the oral glucose tolerance test was studied in 49 Thai women. There was a significant elevation of the blood glucose level at 60 minutes during the test in women who had taken D-norgestrel for 6 and 12 months. Insulin levels in the blood were significantly elevated over control levels in both groups of women at 90, 120, 150, and 180 minutes during the test. There was no difference in the results obtained at 6 months and 12 months. There was also no significant difference in the fasting blood glucose or insulin levels in the three groups of women. The results indicate that D-norestrel at a daily dose of 30 mug has an effect on carbohydrate metabolism in Thai women.