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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

As opposed to acute or subacute orificial localizations, suppurative parietal endocarditis is a very rare entity (5 cases in 3,900 autopsies). More readily localized in the left heart and being generators of systemic emboli, they remain latent until anatomically verified. Two circumstances promote their occurrence : the focal point caused by the mural thrombus of a recent myocardial infarction ; septicemic infections with pulmonary localization and neighbouring thrombophlebitis within the context of intense depression of immunity.
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PMID:[Suppurative parietal endocarditides]. 97 Aug

Adjuvant tamoxifen therapy is associated with modest improvement in disease-free and overall survival in women with invasive axillary node-negative breast cancer. The preponderance of data supporting these general conclusions are from trials in postmenopausal women; in premenopausal women data appear convincing regarding disease-free, but not overall, survival. Firm conclusions regarding magnitude of benefit related to presence of different prognostic factors cannot be drawn at present. In postmenopausal women tamoxifen appears to alter favorably some risk factors for cardiovascular diseases and osteoporosis, which are the most common causes of mortality or morbidity in older American women. Adjuvant tamoxifen is associated with a significantly reduced risk of second primary breast cancer. Major serious risks of tamoxifen therapy include depression, and possibly thrombophlebitis and uterine endometrial cancer. Symptomatic vasomotor and gynecological side effects are frequent. Decision making with women should include assessment of these multisystem benefits and risks.
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PMID:Tamoxifen in axillary node--negative breast cancer: multisystem benefits and risks. 142 94

In endoscopic monitoring and treatment of gastrointestinal disease, it is important that patients will accept repeated examination. They are less likely to do so if the procedure is remembered as distressing or uncomfortable, as is likely when it is performed under topical anaesthesia alone. The aim of conscious sedation is a lightly sedated patient, who is awake, cooperative on demand, amnesic, and free from anxiety and fear. Various drugs in low doses can be used to meet these criteria. Among these are phenothiazines, butyrophenones, barbiturate and non-barbiturate hypnotics, benzodiazepines, and the hypno-analgesic, ketamine. As benzodiazepines offer both sedative and profound amnesic and anxiolytic effects, these drugs are used for conscious sedation worldwide. Diazepam has been the 'gold standard' of sedation, but the more modern benzodiazepines, particularly midazolam, are now more commonly used. In general, benzodiazepines demonstrate a broad therapeutic range. In accordance with dose, however, sedative drugs may induce side-effects, such as drowsiness, lowering of blood pressure, and respiratory depression. In addition, some may induce more wide-ranging side-effects, such as histamine liberation and anaphylactic reactions, thrombophlebitis, and pain on injection. They may have severe drug interactions when used in combination with local anaesthetics, hypnotics and opioids. In older patients, lower doses are necessary for sedation. Sedative drugs should be administered slowly, to avoid haemodynamic and respiratory side-effects.
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PMID:Pharmacology of drugs for conscious sedation. 198 Nov 3

There are many drugs marketed for the purpose of altering vascular blood flow in various regions, especially of the central nervous system and in peripheral arterial insufficiency. More than 50 different methods are described for the treatment of sudden deafness. Considerations of the therapy of sudden deafness are influenced by the fact that the cause of the disease is unknown. The dysfunction of the hair-cells of the organ of CORTI is thought to be caused by a deficit of oxygen due to disorders of micro-circulation in the inner ear. The infusion of vaso-active drugs in the early state of disease can lead to a remarkable improvement of hearing whereas the prospect of improvement without treatment remains uncertain. Nevertheless it may be difficult to distinguish the beneficial effects of vasodilator agents from spontaneous improvement. Naftidrofuryl oxalate (dusodril) has been in use for many years and proved its therapeutic value in many studies. It is regarded as non-toxic and is used extensively in Europe. Side effects are only reported rarely, and include decrease of cerebral blood flow, abdominal distension, diarrhoea, oesophageal ulceration, epileptic seizures, aphasia, disturbances of consciousness, hypotension, hypertensive crisis, vertigo and dizziness, depression of cardiac conduction, thrombophlebitis, and allergy. This case report of allergic reaction in a young female patient demonstrates that the intravenous application of this drug may lead to severe complications.
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PMID:[Allergic reaction in therapy with naftidrofuryl (Dusodril). A case report]. 361 Jun 82

This article discusses some of the issues raised by development of a new low-dose oral contraceptive (OC) now available in the US after 12 years of clinical use around the world. The principle of using as little of a therapeutic agent as possible to achieve the desired results is the rationale for low-dose OCs. It is very difficult to show a correlation of ambiguous side effects such as depression and mood changes and the dosage level. Some controversy accompanies efforts to reduce grave adverse reactions to OCs, primarily cardiovascular, by lowering the dose: doubts about the underlying epidemiological data result from the probable process of self-selection among women choosing OCs and changing prescription practices by physicians as well as the steady decline in frequency of serious cardiovascular problems, both of which create a shifting baseline. Thrombophlebitis has an even more ambiguous correlation: epidemiologists using clinical and hospital diagnostic records were apparently unaware of the considerable evidence which began to appear in the late 1950s on the unreliability of the clinical diagnosis of deep vein thrombosis. Mechanisms that may be involved in initiating cardiovascular accidents must be considered in the effort to demonstrate the beneficial effects of dosage reduction in a nonepidemiological manner. Little support remains for the notion that coagulation factor changes are important in the genesis of cardiovascular problems attributed to OCs, and the Framingham study, which is attempting to relate information on lipid factors predisposing to myocardial infarction to use of OCs, has not had a single myocardial infarction in a premenopausal woman. The role of lipoproteins among older OC users who smoke cannot however be dismissed and possible risk factors should be minimized even in the absence of detailed information. Other issues discussed are the apparent difference between metabolic transformation of the inactive isomer removed from norgestrel and the metabolism of the active compound, the near impossibility of detecting very small differences in contraceptive effectiveness, the importance of cycle control in determining acceptance of an OC, and the question of whether important beneficial side effects will persist as dosages are lowered.
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PMID:Advances in oral contraception. An international review of levonorgestrel and ethinyl estradiol. 640

Oral contrceptives (OCs), usd by over 30% of reproductive aged women in Belgium, are by far the most widely used contraceptive in that country. The various types of OCs include monophasic, biphasic, and triphasic combinations of an estrogen and a progestin, sequentials containing estrogen only for 7-14 days followed by a progestin through the 21st day; macrodose or microdose progestin only formulations, 3-month injectable progestins, and the morning after pill. Side effects of OCs are mainly due to metabolic effects on coagulation factors, the renin-angiotensin system, glucose tolerance, or the lipid profile. Users of OCs face increased risks of cholelithiases, thrombophlebitis, thromboembolism, cerebrovascular accidents, myocardial infarcts (among smokers over 35 years of age), and hepatic adenomas. The most troubling secondary effect is the excess cardiovascular morbidity and mortality show by contraceptive users, not just those who are obese, hypertensive, or who have histories of vascular pathology, but also those over 40 years of age and smokers. Lenght of use of OCs does not increase vascular risks. Epidemiologic studies demonstrate that vascular risks are reduced in lower dose formulations. Absolute contraindications to OC use include serious cardiovascular problems, severe hepatic pathology, estrogen-dependent tumors, pregnancy and undiagnosed gynecologic problems, and significant hyperlipidemia. Relative contraindications include severe headaches, cholelithiase, previous cholestasis of pregnancy, severe renal disease, fibromyomas, benign breast disease, age over 40 years, smoking, surgery anticipated within 4 weeks, infectious mononucleosis, falciform anemia, and immediate postpartum and lactation. Epilepsy, diabetes, depression, and varicose veins are not strictly speaking contraindications but require additonal surveillance. Lower dose formulations should be prescribed if possible. OC users should be followed up every 6-12 months. Among other steroidal contraceptive methods, sequential OCs and high dose progestin-only formulations are used for short-term treatment of specific conditions. Progestin-only minipills are used when an OC is desired but estrogens are contraindicated. Injectable progestins should be reserved for patients who for cultural or medical reasons can use no other type of contraceptive. Morning-after pills should not be considered a regular form of contraception. If OCs are used in adolescents, a low dose pill is indicated. Low dose OCs may be indicated for diabetics because of the danger of infection with IUDs and the lesser efficacy of barrier methods. If OCs are used in epileptics, they should be regular dosed because of the danger of drug interactions. Only low-dose formulations and progestin-only minipills should be used by women over 40.
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PMID:[The choice of oral contraception in 1984: general indications and specific cases]. 672 93

Results are presented of an evaluation of the contraceptive efficacy, cycle control, and tolerance of a low dose triphasic pill, Trigynon, used by 353 reproductive-aged women for a total of 1668 cycles. 20 physicians in different Belgian centers recruited and followed the women. Average weight of the patients was 56.8 kg, average age was 24.8 years, average parity was 1.07, and 1/3 smoked. None had any medical condition contraindicating the use of the preparation. 156 of the women had never used contraception, 163 had used combined pills, 4 had used injectables, 6 had used progestin-only minipills, 21 had used IUDs, and 22 had used other methods. 2.5% of the patients forgot to take at least 1 pill in a typical cycle. No pregnancies were imputed to forgetting, but 3 pregnancies occurred during the study: 1 already established but not recognized at the start of treatment, 1 in a woman taking antituberculosis drugs, and 1 in a patient suffering an attack of dysentery. Almost 90% of patients had regular cycles of 28 days with treatment, compared to only 57.5% before treatment. The duration and quantity of bleeding were significantly decreased. Compared to the last pretreatment cycle, the 3rd and 6th cycles with Trigynon showed a decrease in percentage of patients complaining of dysmenorrhea, nervousness, headaches, breast tenderness, nausea, vomiting, decreased libido, depression, thrombophlebitis, and edema. The percentage complaining of acne and vertigo increased slightly at 3 months and then declined to below pretreatment levels. Average weight was almost unchanged. It appears that Trigynon offers reliable protection, excellent cycle control and few side effects, and would be an appropriate contraceptive choice for most women except those with benign breast disease or hyperestrogenism.
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PMID:[Clinical evaluation of 1,668 cycles of triphasic oral contraception (Trigynon). Multicentric Belgian study]. 681 54

Five cases with recurrent pulmonary embolism (RPE), all having severe chronic cor pulmonale due to marked pulmonary hypertension, were reported. None of them had a history of thrombophlebitis of the legs. Dyspnea was the common symptom and signs of pulmonary hypertension were usual. Focal oligemia, cardiomegaly and plump pulmonary arteries on chest X-ray films, right axis deviation, clockwise rotation, ST-segment depression and T-wave inversion on electrocardiograms, and dilatations of the pulmonary arterial trunk, the right ventricle and the right atrium, and the posterior displacement of a small, compressed left ventricle on echocardiograms were the common findings. Gas exchange abnormalities were severe and they were considered the characteristic findings of this disease. Multiple perfusion defects were observed by a lung scan in all cases. Marked pulmonary hypertension with low cardiac output was the usual feature of RPE. Actual cutoffs or filling defects were demonstrated on a pulmonary angiogram. Deep vein of the legs were all intact and no thrombi were found. Pulmonary embolectomy was performed on one case. The importance of early diagnosis and early treatment of acute pulmonary embolism was emphasized for preventing the progress of this debilitating disease.
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PMID:Recurrent pulmonary embolism. 685 11

It is stimulating to ascertain the comparative risk to the woman of hormonal contraceptives of the various kinds used today: combination preparations, which rely on blocking the secretion of gonadotropic hormones by the hypothesis; sequential preparations, which rearrange the physiological relationships of the menstrual cycle; gestagen preparations (minipills), which heighten the viscosity of the cervical mucus; longterm injectable preparations, which initially block ovulation and then act on the cervical mucus; postcoital preparations, which act by inducing abortion of the fertilized egg. Of these the most reliable are the fixed combinations, while sequential preparations are somewhat less so. The minipills are the least reliable. Interaction with other medications can reduce the reliability of these preparations; for instance, women on contraceptives have become pregnant after taking antiepileptic medications containing phenobarbitol and hydantoin. As far as risk is concerned, we must distinguish between those that merely harm the woman and those that pose a threat to life. Some of the former are: bleeding between cycles, failure of menses to appear after cessation of contraception, depression, breast-pains, hypertension, thrombophlebitis, and reduced libido. Hormonal contraceptives also have a series of beneficial effects, especially in women who ordinarily have menstrual difficulties. Among the more serious side effects are: risk of teratogenicity, carcinogenicity, liver problems, thromboses, and infarctions. To reduce the risks of these various side effects, the physician should observe carefully the contraindications: these are both absolute (cerebrovascular and retinal problems, thrombo-embolisms, hepatic disease, diabetes, porphyria, and sickle-cell anemia and relative (migraines, cardiac pains, hyperlipemia, epilepsy, and multiple sclerosis).
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PMID:[Safety and risks of hormonal contraceptives]. 712 52

This paper analyses the pattern of use of and the response to electroconvulsive therapy (ECT) in an Indian rural teaching general hospital between 1977 and 1980. ECT was used in 503 cases (14.3 per cent of 3,517). Three-quarters of the patients to whom it was given were schizophrenic, one-fifth depressed and 6 per cent suffering from post-partum psychosis. Though the treatment gave the best results in depression it was also effective in many schizophrenics and post-partum psychotics. The commonest side effect was memory impairment. Following unmodified ECT severe confusion and excitement were frequent, while thrombophlebitis, bronchospasm, prolonged apnoea and peripheral circulatory collapse occurred only with the modified technique. The usefulness of ECT in developing countries like India is highlighted.
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PMID:Electroconvulsive therapy in a rural teaching general hospital in India. 733 65


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