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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

56 cerebral ischemia patients up to the age of 40 were investigated using a strict clinical and instrumental protocol in order to elicit the relative importance of the various iatrogenic factors involved. In addition to atherosclerosis risk factors (smoking, hypertension, ischemic heart disease, diabetes, dyslipidemia) other possible causes of cerebral ischemia were sought (arteritis, migraine, head injury, oral contraceptives, coagulation disorders, cardiogenic embolism, etc.). 50% of the patients examined had at least two atherosclerosis risk factors and 55% had other causes singly or in association with atherosclerosis.
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PMID:Cerebral ischemia in young adults. 733 59

The following indications must be observed in prescribing ovulation preventatives: 1) use the lowest possible dose of estrogen and gestagen; 2) observe the contraindications at age 30-35 when the risk is very great, and use alternative methods when possible after age 40; 3) check every 6 months to 1 year during the office visit; 4) observe the absolute contraindications (thromboses, embolisms, blood vessel damage, hypertony, hormone-dependent tumors, insulin-dependent diabetes, abnormal genital bleeding); 5) observe the relative contraindications (gynecological age less than 2 years, menstruation less than 1 year, amenorrhea, oligomenorrhea, venous thrombosis of the legs, certain cardiac diseases, acute jaundice, jaundice of pregnancy, certain bilirubin disturbances, depression, migraine headaches, epilepsy, and others); 6) discontinue use of the contraceptive upon appearance of thromboembolisms, hypertony, disturbances of vision, longterm immobilization of the patient (e.g., during an operation), and pregnancy; and 7) the effect of the contraceptive is lessened by longterm use or abuse of analgesics, antibiotics, anticonvulsives, hypnotics, sedatives, and tranquilizers, as well as by others (dihydroergotamine, for example).
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PMID:[Indications for ovulation inhibitors. Recommendations of the Swiss Society for Family Planning]. 740 49

The epidemiology of migraine and non-migrainous headaches (NMH) was investigated in a community survey in a neighbourhood of western Jerusalem in 1969-71. Diagnoses were based on histories taken by physicians. Prevalence rates among persons aged 15 and over were 10.1% for migraine (including classical migraine, 2.1%) and 25.6% for frequent NMH (more than once a month). Both migraine and frequent NMH were more prevalent among women. Migraine showed a peak of prevalence among women aged 35-44. Both migraine and NMH were associated with negative self-appraisals of health, emotional symptoms, reports of unsatisfactory present and past life situations, and a reported tendency to 'try harder' and 'hurry more'. No significant relationships were found with blood pressure, education, region of birth, marital status, number of pregnancies, pregnancy status, oral contraceptives, menopause, cigarette smoking, diabetes, preference for a high or low pressure of activities, or the importance attached to striving for achievement. Headaches accompanied by nausea and visual aura occurred four times as often as might have been explained by a chance concurrence of these features, and the occurrence of these symptoms conformed with a Guttman scale. The findings support the concept of migraine as a specific entity, which should possibly be considered as part of a single continuum of headache and related manifestations.
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PMID:Migraine and non-migrainous headaches. A community survey in Jerusalem. 744 Nov 40

The cranial computerized axial tomography (CAT) findings in groups of patients with epilepsy, migraine, hypertension, and other general medical disorders have been reviewed to assess the frequency and patterns of focal and diffuse brain damage. In addition to demonstrating focal lesions in a proportion of patients with seizures and in patients presenting with a stroke, the CAT scan showed a premature degree of cerebral atrophy in an appreciable proportion of patients with long-standing epilepsy, hypertension and diabetes, and in some patients with migraine, valvular and ischaemic, heart disease, chronic obstructive airways disease, and chronic renal failure. The value of CAT as a means of screening for brain damage in groups of individuals at risk is discussed.
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PMID:Computerized axial tomography in the detection of brain damage. 2. Epilepsy, migraine, and general medical disorders. 746 20

The A 3243 G mutation of the mitochondrial tRNA(Leu) gene was found to segregate with maternally inherited diabetes mellitus, sensorineural deafness, hypertrophic cardiomyopathy, or renal failure in a large pedigree of 35 affected members in four generations. Presenting symptoms almost consistently involved deafness and recurrent attacks of migraine-like headaches, but the clinical course of the disease varied within and across generations. The A 3243 G mutation has been previously reported in association with the mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode syndrome (MELAS) and with diabetes mellitus and deafness. To our knowledge, however, hypertrophic cardiomyopathy is not a common feature in people with the A 3243 G mutation and renal failure has not been hitherto reported in association with this mutation. The present observation gives additional support to the variable clinical expression of mtDNA mutations in humans.
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PMID:Point mutation of the mitochondrial tRNA(Leu) gene (A 3243 G) in maternally inherited hypertrophic cardiomyopathy, diabetes mellitus, renal failure, and sensorineural deafness. 747 62

Recent cohort and case control studies of low-dose combined oral contraceptives (COCs) containing the new generation of progestogens have allowed classification of adverse effects into those which are rare but serious and should be considered risks and those which are more frequent but are less of a threat to health. Low-dose COCs continue to affect coagulation in a complex way, but the risk is less than with the older preparations, and it can be minimized by screening women for a personal or familial history of early or unusual thrombosis and for levels of protein C, S, and antithrombin III. Women with true migraine with focal signs should also avoid using COCs. The relative risk of myocardial infarction (MI) may increase from 4:1 in women with one risk factor (age, smoking, hypertension, hyperlipidemia, and diabetes) to 20:1 with two risk factors and 128:1 with three or more risk factors. In the absence of all risk factors, a recent study indicated that the relative risk of MI with COC use was 1.9 for current and past use. COC use also causes a slight increase in hypertension in most women, especially those who are older or have a family history of hypertension. While the COC can affect carbohydrate and lipid metabolism, the new generation of progestogens has reduced these effects. The COC may accelerate presentation of gallbladder disease in predisposed women. The COC protects against benign breast disease but may increase the risk of breast cancer and cervical cancer slightly. There is a strong link between hepatocellular adenoma and COC use, but the incidence is low. Return to fertility after use has not been a problem. Both estrogenic adverse effects (nausea, dizziness, irritability, weight gain, bloating) and progestogenic adverse effects (vaginal dryness, acne, hirsutism, weight gain, depression, loss of libido) can occur in 50% of women, but these generally disappear after a few months of use. In conclusion, the low-dose, third generation COCs are associated with minimal risks in the absence of other risk factors and have many beneficial effects such as the prevention of ovarian and endometrial cancer; a decrease in pelvic inflammatory disease and ectopic pregnancies; and protection from anemia, primary dysmenorrhea, functional ovarian cysts, and benign breast disease as well as from the morbidity and mortality associated with pregnancy.
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PMID:The combined oral contraceptive. Risks and adverse effects in perspective. 776 40

The endothelium influences local vascular tone by releasing endothelium-derived relaxing factors such as nitric oxide, prostacyclin and a putative hyperpolarizing factor. In isolated ophthalmic arteries and the perfused eye, all endothelial factors importantly contribute to vascular regulation. In larger ophthalmic vessels, this is due to their effects on vascular smooth muscle cells; in smaller vessels, pericytes can be influenced as well. Contracting factors formed include peptide endothelin-1 and cyclooxygenase products, such as thromboxane A2 and prostaglandin H2. In the peripheral circulation endothelial dysfunction occurs under pathological conditions, both in conduit arteries and the microcirculation. An imbalance of endothelium-derived relaxing and contracting factors could be important for the development of vascular ophthalmic complications like hypertension, diabetes, arteriolosclerosis and retinal ischemia. Endothelial dysfunction may also contribute to vasospastic events in retinal migraine and some forms of low tension glaucoma associated with Raynaud phenomenon and migraine.
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PMID:The vascular endothelium as a regulator of the ocular circulation: a new concept in ophthalmology? 780 Dec 20

A set of new guidelines were formulated by an expert group meeting in Sweden organized by the pharmaceutical office during March 31-April 1, 1993. It contains various methods to avoid an undesired pregnancy and also advice about postcoital contraception. Among barrier methods, the condom is the only reversible method for men with a method failure of 2 and user failure of 10. It protects against gonorrhea, chlamydia, condyloma, herpes simplex, HIV, and hepatitis B. The diaphragm can be used with a spermicide and protects to a lesser degree against chlamydia, gonorrhea, and cervical cancer. The female condom is as effective as the condom. Among spermicides, nonoxynol-9 is not only effective against sperms but also against bacteria, viruses, and certain vaginal and cervical cells. The vaginal sponge is impregnated with nonoxynol-9 and is effective up to 24 hours. The copper IUD, with a method failure of less than 1, can cause profuse menstrual bleeding, dysmenorrhea, and endometritis-salpingitis. Hormonal methods include combination pills (2-phase and 3-phase pills) and gestagen methods (high dose with 150 mg of medroxyprogesterone acetate injection every 3 months and low-dose minipills with levonorgestrel, norethisterone, or lynestrol). Mechanisms of action concern combination pills, gestagen methods, minipills, Norplant, and Levonova. Drug cross reaction can reduce effectiveness. Side effects include bleeding and amenorrhea. Risk-benefit determination is based on health effects. Possible risks are associated with breast cancer, cervical cancer, blood pressure increase, venous thromboembolism, and heart infarction. Various phases of the reproductive age include young women, lactating women, and women in the later part of the reproductive age. Special groups include those who have experienced ectopic pregnancy, infections (candida, sexually transmitted diseases: chlamydia trachomatis, HIV infections), obesity, cardiovascular diseases, diabetes mellitus, tumors of the reproductive organs, liver diseases, migraine, epilepsy, surgery, and handicapped women. Postcoital contraception is used only in need, and methods for postcoital contraception include hormonal method and the copper IUD.
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PMID:[Contraception. Recommendations from a group of experts]. 790 65

More than 50 million US women have used oral contraceptives (OCs) in the past 25 years, and the consensus is that the benefits and advantages of OC use outweigh most of the disadvantages. Side effects have been reduced or eliminated by reduced dosage preparations, and effectiveness has been virtually 100%. Despite this widespread use, most US women are misinformed about OCs, perhaps because pediatricians, family physicians, and nurse-practitioners are insufficiently informed. The economic power of the drug manufacturers has been brought to bear on the medical profession to prescribe OCs for virtually every woman of child-bearing age. The drug industry which has been touting the safety of OCs has recently introduced new progestins which are supposed to be "lipid-neutral" and have fewer androgenic effects. Therefore, the potentially harmful effects of the old progestins were deemphasized deliberately. A cautious but advisable approach for physicians to follow in prescribing OCs has 8 points. 1) All sexually active females should be advised that barrier contraception is the best protection (except abstinence) from sexually transmitted diseases, including AIDS. 2) OCs with more than 35 mcg estrogen should be withdrawn from the market. 3) All patients should be encouraged to lead a healthy lifestyle. 4) Barrier methods should be encouraged for patients with such medical conditions as migraine headaches, prominent varicose veins, diabetes, increasing weight gain, hypertension, thyroid dysfunction, and mitral valve prolapse. 5) Switching to a preparation with the new progestins should be considered for some patients who are smokers or have abnormal lipid profiles. 6) It might be advantageous under certain circumstances for a patient to discontinue OC use for a period of time. 7) Women who no longer desire a pregnancy should be encouraged to consider surgical sterilization. 8) Nulliparous women over 30 years old should discontinue OC use to diminish their risk of breast cancer. This last point is controversial, and the editors of this publication invite the readers' comments.
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PMID:A practical guide for prescribing birth control pills. 804 4

This article addresses contraceptive issues for teenagers; women in the perimenopausal, postpartum, and postabortion periods; women with hematological disorders (e.g., acquired hemolytic anemia); women suffering from migraine; women with diabetes; and women with epilepsy. Specifically, it discusses how women's contraceptive needs change as they age. For example, the ideal method for perimenopausal women, who generally do not want to risk pregnancy, is male or female sterilization. The article also informs the reader what methods are most appropriate at the different periods of one's life and for various conditions. For example, since teens tend to be sexually active, the double Dutch method--condom plus combined oral contraceptive (COC) is a good practice for them. The low-dose lipid-friendly COC provides good cycle control for teens. Women with transient cerebral ischemia-related focal membrane, crescendo migraine, and focal migraine occurring for the first time after using COCs and currently use ergotamine therapy should absolutely not use COCs. The article also has tables which are helpful for practitioners. Table 1 lists the criteria for prescribing a medical contraceptive to teens without parental knowledge and consent. Table 2 explains either what contraceptives are or are not safe and effective for women with hemolytic disorders. For example, the IUD is contraindicated for women with immune thrombocytopenia purpura and thrombocythemia. A sidebar provides the reader a clinical focus.
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PMID:Contraceptive dilemmas. 807 39


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