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Idiopathic infantile arterial calcification (IIAC) is a rare disease that is characterized by calcification in the media and fibroproliferative changes in the intima of larger arteries, sometimes resulting in reduced vascular elasticity and blood flow. Although the molecular-genetic basis of the disease is unknown, IIAC is presumed to be acquired by an autosomal recessive mode of inheritance and is associated with a reduction in the levels of enzymes responsible for inorganic phosphate balance, resulting in abnormal deposition of calcium into the vessels. We report the case of a female neonate in whom widespread IIAC was initially diagnosed on postnatal sonographic examination. At birth, the infant experienced cardiac failure and hypertension, and arterial pulsation was absent. Routine prenatal sonographic examinations had not revealed any abnormalities, but postnatal gray-scale and color Doppler echocardiographic and sonographic examinations revealed findings consistent with severe IIAC. The cardiac function improved with treatment, but the neonate died of progressive hepatic failure due to reduced flow in calcified and narrowed hepatic arteries. The common carotid arteries were also grossly affected, resulting in cerebral atrophy at the time of birth. Postnatal gray-scale and color Doppler echocardiographic and sonographic examinations allowed noninvasive diagnosis, assessment of severity, and monitoring of progression.

Injectable contraceptives are a valid option in every family planning program. Contraceptives which are administered every 2 or 3 months, containing only progestogen agents (DepoProvera, Noristerat) have proven efficacious and do not show long-term safety problems. They differ from other contraceptives in their long lasting action and by not presenting the contraindications of the estrogens. Their most prominent side-effect is the irregularity of cyclic bleeding. Although bleeding irregularities are not life threatening, many users stop the treatment for that reason. Monthly contraceptives comprising progestogens and estrogens, maintain or improve the high efficacy of the earlier forms and have the added benefit of allowing bleeding to resemble the physiologic one. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal. Other formulations (Cyclofem, Mesigyna) are beginning to be commercialized and their characteristics must still be confirmed through daily use. Indications, contraindications, precautions and warnings for the use of monthly injectable contraceptives are basically identical to those of the combined oral contraceptives, as are the side-effects. Efficacy, though, proves to be superior, which can be correlated to a simpler method of use and less risk of error when using it. Main motivation factors are: efficacy, simplicity in usage, reversibility and confidentiality.

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