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A large number of reports have been devoted to the physiologic and toxic effects of methyl chloride, many of which are based on case histories involving occupational exposure. The detrimental actions of methyl chloride on the central and peripheral nervous systems are well established effects. It is a moderately severe narcotic and potentially severe nerve poison. Chronic intoxication is associated with damage to the central nervous system (CNS), kidneys, liver, bone marrow, cardiovascular system, respiratory system, and intestinal tract. The signs and symptoms range from the more severe medical dysfunctions such as cardiac irregularities, respiratory paralysis, nerve degeneration, and severe convulsions to the more subtle clinical observations such as CNS depression, nervousness and emotional instability, insomnia and anorexia, ataxia, blurred vision, light-headedness, nausea, dizziness, narcosis, and disorientation. The behavioral correlates of these and other neurotoxic effects of methyl chloride suggest that a gradual behavioral degradation occurs. Pharmacodynamic studies have shown the compound to be rapidly absorbed by the blood with most authors attributing the toxicity to an enzyme-catalyzed methylation reaction in the body. Despite the fact that several investigators have attempted to correlate such biological responses of methyl chloride with its toxicity, the present knowledge of the problem still lacks a detailed mechanism of action. Until such mechanisms are verified, adequate methods to assess subclinical neurological and behavioral changes must be effectively developed.
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PMID:Behavioral, neurological, and toxic effects of methyl chloride: a review of the literature. 38 67

The objective of this investigation was to identify women's perception on normal and abnormal symptoms of pregnancy, puerperium and breastfeeding; its purpose was to assess the varying educational needs in the geographical area where a reproductive health education program will be implemented. 405 fertile females living in non-residential areas were interviewed in their homes. A predominantly pre-coded questionnaire was used; items related to reproductive health, preventable and susceptible to education were included. Symptomatology perceived incorrectly as normal: a) In pregnancy: Dysuria: 24 percent, genital hemorrhage: 15 per cent, absence of fetal movement: 23 per cent, did not know how to recognize preterm birth symptoms: 70 per cent. b) In puerperium: Increased quantity in lochia rubra: 17 per cent, fever: 22 per cent, fetid lochia: 28 per cent, and c) In breastfeeding: Breasts red and warm: 48 per cent, fever: 30 per cent, nipple fissures: 70 per cent. Symptomatology perceived incorrectly as abnormal: a) In pregnancy: Frequent urination: 17 per cent, morning nausea in the 1st trimester: 9 per cent, emotional instability: 21 per cent, Braxton Hicks contractions: 41 per cent, and b) Postpartum period: Decreased quantity in lochia rubra: 9 per cent, non-fetid lochia alba: 43 per cent, calostrum: 20 per cent. The assessment educational needs showed an inaccurate identification of abnormal and normal obstetric events; its frequency varied. It is essential that a pregnant woman be well informed and educated in order to preserve her own health as well as that of her unborn child. She must be able to recognize warning signs, take action and demand appropriate medical care. Health care personnel and health educators must be responsible for the promoting of maternal and child health during pregnancy.
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PMID:[Perception of common symptomatology during pregnancy, puerperium and lactation]. 188 26

In those subjects genetically susceptible to migraine, biological rhythms or excessive afferent stimulation trigger an episodic neurovascular reaction with focal neurological symptoms, headache and nausea as its most common manifestations. Mood changes and a craving for sweet foods point to a preliminary hypothalamic disturbance. The referral of ice-cream headache and ice-pick pains to the habitual site of migraine headache (even in the intervals between attacks) indicate defective control of trigeminal pathways. Laboratory experiments have demonstrated that projections from the brainstem, releasing monoamines and peptides as transmitter agents, can mimic the vascular changes of migraine. Serotonin released from platelets may sensitize vessels to respond to distension by generating pain-producing afferent discharges. Central depletion of monoamines can accentuate the perception of pain by reducing the efficacy of the endogenous pain control system. The intravenous injection of serotonin relieves migraine headache but produces side-effects. A new drug, sumatriptan, acting on a subtype of serotonin receptors, the 5HT1-like receptor, is undergoing clinical trial for the relief of acute attacks of migraine. Antagonist of the 5HT2 receptor are beneficial in interval therapy for the prevention of migraine. Increased knowledge of physiological mechanisms and neurotransmitters that can mediate the various components of the migraine attack opens the way for improvements in pharmacotherapy.
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PMID:[Physiopathology of migraine]. 196 76

The contraceptive efficacy and menstrual abnormalities of long-acting medroxyprogesterone acetate, injected intramuscularly at doses of 150 mg. every 3 months for 1 year, were studied in 14 women (mean age 33 years, mean parity 4.6). No pregnancies were reported and there were no significant changes in weight or blood pressure. All Papanicolaou smears, taken initially and at 6 and 12 months, were normal and there were no reports of emotional instability, nausea, vomiting, or breast soreness. Results of endometrial biopsies, taken at 6,9, and 12 months are given. The occurrence of spotting and bleeding was erratic (spotting for as long as 20-38 days in a 3-month period), but both tended to decrease as the treatment continued. After cessation of therapy, most patients had 2 or 3 "normal menstrual periods," which biopsy proved to be from a proliferative endometrium. All patients had a secretory endometrium within 12 months after the last injection, or within 9 months after the effects of the last injection had presumably worn off. Disadvantages to MA include fear of injection, irregular bleeding and spotting, and prolonged anovulation after therapy discontinuation. The chief advantage is the infrequent need for injection; patients need to be concerned with birth control only 1 day every 3 months.
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PMID:Contraceptive and endometrial effects of medroxyprogesterone acetate. 577 97

The clinical efficacy of tolfenamic acid and mefenamic acid in the treatment of primary dysmenorrhoea was studied in a prospective, controlled, double-blind, cross-over study comprising 73 patients aged 13-39 with an average body weight of 56 kilos. The patients were randomized to receive either tolfenamic acid (200 mg t.i.d.) or mefenamic acid (500 mg t.i.d.) for 3 days, during 3 consecutive menstrual cycles each, in a sequential design A-B or B-A. At the beginning and at the end of each treatment period, 13 dysmenorrhoeic symptoms were evaluated on a visual analogue scale (lower back pain, interference with daily activities, nausea, vomiting, diarrhoea, headache, dizziness, fatigue, sweating, chills, hot flashes, depressant states, and mood swings). The data were analyzed by using two statistical models. The first one, for the 73 patients, by making paired comparisons regardless of treatment sequence. With respect to the initial values, the results showed that both drugs were statistically significant (P < 0.05) in reducing the intensity of the evaluated symptoms. When comparing both treatments, tolfenamic acid showed a significant difference as to interference with daily activities (P < 0.025) and hot flashes (P < 0.005). In the result analysis with the second model, the groups were divided according to the first assigned treatment and paired comparisons were made. It was observed that the group receiving tolfenamic acid in the last sequence reached a higher level of response and statistical significance was demonstrated in 8 of 13 evaluated symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Tolfenamic acid and mefenamic acid in the treatment of primary dysmenorrhoea. 781 93

Disinfectant surveys from responding members of the American Society of Postanesthesia Nurses were divided into two groups based on whether or not they considered themselves to be exposed to disinfectants in their work environment. Their survey responses were then compared with those obtained previously from members of the Society of Gastroenterology Nurses and Associates, Inc., who were regularly exposed to 2% alkaline glutaraldehyde in the work setting. There were significant differences among the groups in the percentage of respondents who reported having headaches, eye irritations, respiratory problems, shortness of breath, rashes, memory loss, mood swings, and fatigue. These findings support the association of these complaints with 2% alkaline glutaraldehyde exposure. In contrast, there were no significant differences among the groups in the percentage of respondents who reported having asthma, rhinitis, chest pain, nausea, diarrhea, muscle/joint pain, visual disturbances, or dermatitis.
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PMID:Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Endoscopic Disinfectant Survey results compared with control group. 902 1

The side effects of oral contraceptives (OCs) can be minimized by appropriate OC selection. Side effects or perceived side effects that manifest themselves physically--e.g., weight gain, breakthrough bleeding (BTB), nausea, headache, breast tenderness, mood swings, acne, and hirsutism--are the most common causes of premature discontinuation of oral contraception. The relative androgenicity of the progestin component of combination OCs has become an important differential in selecting OC formulations. Several studies have indicated that preparations with less androgenic potential can minimize some of the "physical" side effects and adverse metabolic effects traditionally associated with oral contraception. Acne and hirsutism, common pre-existing conditions that are clearly related to the androgenicity of the progestin component, can be eliminated or improved by use of OCs with low androgenic activity. Many women perceive that OCs cause weight gain; although weight gain is to some extent androgen related, most studies comparing low-androgenic OCs with medium- or high-androgenic preparations have found little or no change in weight regardless of formulation. BTB, which usually subsides within a few months, is related to the dose, potency, and ratio of the estrogen and progestin in the OC formulation. Low-estrogen-dose OCs (< or = 35 micrograms ethinyl estradiol [EE]) containing less androgenic progestins are associated with bleeding patterns as acceptable as older low-estrogen-dose formulations. The same analysis found that smoking cigarettes promotes BTB in women who use OCs. There is no convincing evidence that the use of one progestin or another is less likely to cause or exacerbate headache; however, changing preparations sometimes reduces the incidence. Women with persistent headaches during the pill-free interval may benefit from a longer cycle of OC treatment. Nausea and breast tenderness are primarily estrogen-related effects; if a women experiences persistent nausea, switching to an OC formulation containing 20 micrograms EE may be appropriate as long as the patient is cautioned that BTB is more likely. Mood changes are a common, highly subjective complaint whose relationship to OC use is hard to assess. Concerns about the potentially deleterious effects of combination OCs on lipid/lipoprotein and carbohydrate metabolism have been substantially diminished by new epidemiologic findings relative to cardiovascular disease as well as by the development of low-androgenic progestins. Formulations containing these progestins lower LDL cholesterol and increase HDL cholesterol; they do not affect carbohydrate metabolism as much as older, more androgenic formulations.
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PMID:OC practice guidelines: minimizing side effects. 916 75

This survey of attitudes toward contraception is taken from a document concerning psychological aspects of 233 women seeking pregnancy terminations. 87.12% had utilized a method of contraception at some time, of which 66.5% had used pills, 29.6% had used natural methods, 23.6% had used local methods, and 11.16% had used IUDs. 33.47% of the total sample had refused pills, in 83.65% of cases because of fears for health, and in the remainder because of infrequent intercourse, fears for unborn children, lack of information, belief that women shouldn't be responsible for contraception, or fear of forgetting. 64.38% of the women in the total sample had discontinued use of pills, about 2/3 of them for personal reasons such as nervousness, changes in the relationship, nausea, menstrual changes, frigidity, and depression, which are difficult to evaluate objectively. In most cases of termination of pill use for external reasons, the cause was opposition by the physician. Personality traits of the sample women which could impede responsible fertility control included passivity and inconsistency in 16.47%, dependency in 47.64%, and immaturity and poorly structured personality in 40.34%. Personality disorders among the latter included enjoyment of risk, impulsivity and lack of capacity to anticipate, emotional instability, and significant egocentrism and narcissism. 21.89% had depressive tendencies, 22.75% had sadomasochistic tendencies, and 28.33% had tendencies toward somatization, each of which is often correlated with unconscious choice. The unconscious elements are often more significant than the conscious and apparent motives. More effective contraception and a prevention of abortions might result from making women aware of their unconscious motivations.
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PMID:[Dependable fertility control: hazards and barriers (author's transl)]. 1233 50

Oral contraceptive (OCs) users continue to complain of side effects such as headaches, mood swings, and weight gain, and switch pill formulations. Questionnaires for an annual oral contraceptive survey were mailed to subscribers in the May 1992 issue of Contraceptive Technology Update (CTU) 137 of 1600 surveys mailed were returned for a response rate of 8.5%. 64% of the respondents were nurse practitioners, 19% were physicians, 7% were physician assistants, 5% were registered nurses, and 5% were other types of providers. OC users tend to blame headaches, mood swings, or gaining weight on the pills. The CTU survey found that more than 60% of health care providers would advocate switching to a lower-dose estrogen pill or to a progestin-only pill for headaches and mood swings. For weight gain their first choice of treatment would be counseling about life style changes. 50-60% of American women discontinue OCs in the first year, mainly because of side effects such as breakthrough bleeding, headaches, nausea, weight gain, and acne. 89% of respondents said few women had sever, recurring headaches, but should that occur 66% of respondents would change to a lower-dose estrogen pill. Only 9% of respondents would recommend relaxation exercises and analgesics. 67% of respondents would change the pill formulation before suggesting a life style change when patients complain about mood swings. Ortho Novum 7/7/7 was the pill of choice for 61% of survey respondents, and Triphasil was the 2nd choice by 43%. An international group of physicians recommended that manufacturers, physicians, and OC providers take the lead in providing patients with acceptable counseling concerning correct OC use.
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PMID:Experts debate pill switching to combat noncompliance. Special report: annual pill survey. 1234 22

Family planners responding to an annual oral contraceptives (OC) survey tended to recommend switching pills for complaints of headaches and mood swings and life style changes for the complaint of weight gain. Nearly 3/4 of survey respondents indicated that headaches and mood swings affected less than 5% of their patients. On the other hand, 29% reported that less than 5% of patients complained of weight gain; 27% said 10% complained; 19% said 10-15% complained; 10% said 15 to 20% complained; and 14% said more than 20% of patients complained of weight gain. 57% of the 137 respondents would instruct patients to exercise more and reduce calorie intake, and only 13% would change a patient's pill formulation because of weight gain. Nausea, breast changes, breakthrough bleeding, and compliance issues seem to be more relevant to birth control pills. However, a study indicated that women who discontinue more often do it because more often do it because of weight gain or acne than because of irregular bleeding or amenorrhea. Some women have gained 10-30 lbs using OCs. Researchers in Sweden recorded the secretion of the satiety hormone cholecystokinin during a 24-hour period before and during administration of OCs to 9 women, and found that pills suppressed the serum profiles of cholecystokinin inducing the feeling of hunger. Further studies are needed to evaluate the mechanism of this effect.
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PMID:Lifestyle changes most often suggested for weight complaints. Special report: annual pill survey. 1234 23


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