Gene/Protein Disease Symptom Drug Enzyme Compound
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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Norplant System consists of 6 capsules each containing 36 mg of crystal line levonorgestrel (LNG), for a total dose of 216 mg LNG. The capsules are inserted subdermally in the mid-upper arm, and LNG diffuses continuously through the capsule walls for 5 years. In the United States the Norplant System was approved in December 1990. The initial rate of hormone delivery is about 85 mcg/day, then decreases over the next 9 months to 5 mcg/day, and over the ensuing 9 months to 35 mcg/day. Thereafter, the diffusion rate levels off for the next 3.5 years, averaging around 30-35 mcg/day. Removal results in a drop in the plasma concentration of levonorgestrel to below contraceptive levels within 24 hours and below the detectable limit of .1 pg/ml at 96 hours. Preliminarily data from 402 users over 5 years show improvements of Norplant produced better efficacy in all weight classes and a lowered cumulative rate of 1.1 pregnancies of 100 users. The pregnancy rate for the first year of use is 02., better than for oral contraceptives. Side effects include headache, nervousness, nausea, dizziness, dermatitis, acne, change of appetite, breast tenderness, minimal weight gain, some change in hair distribution, and adnexal enlargement. Adverse reactions include breast discharge, possible cervicitis, musculoskeletal pain, abdominal discomfort, leukorrhea, and vaginitis. More than the usual number of bleeding days occurred in slightly more than one fourth of the patients, prolonged bleeding in 27.6% spotting in 17.1% and amenorrhea in 9.4% of patients. Hyperlipidemic users should be observed for possible low-density lipoprotein elevations. The cumulative discontinuation rate for pregnancy was 3.9 per 100 users; for bleeding irregularities the rate was 25.1 per 100 users, and for other medical results it was about 22.4 per 100 users. Personal reasons for discontinuation accounted for 38.7 per 100 users, equivalent to a cumulative continuation rate of about 30 per 100 users over the 5-year duration.
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PMID:The NORPLANT system of contraception. 168 4

This literature review compares the merits and disadvantages of the levonorgestrel-releasing IUD made by Leiras Pharmaceuticals, Turkey, Finland (LNG-IUD-20), with the Nova-T, Copper-T (TCu) and 220C, and Copper-T-38-Ag (TCu-380Ag). This IUD releases 20 mcg levonorgestrel daily from a Silastic sleeve on the vertical shaft containing 52 mg. The plasma level stabilized after a month at about 0.2 ng/ml, about half as high as that seen with Norplant implants. It is identical in size to the Nova-T. The Cu-T IUDs differ with respect to copper wire or sleeves, or silver-cored wire. The chief studies reviewed here were 2 multi-center trails primarily in European countries, and a 2 large multi-center trials in India. Cumulative pregnancy rates were 0.0 to 0.6 per 100 users for the LNG IUD, compared to slightly higher failures for inert or copper IUDs. While removal rates for bleeding, pain and pelvic inflammatory disease were lower for the LNG-IUD-20, removals for oligomenorrhea, amenorrhea and hormonal side effects were higher than for the other IUDS. In the Indian trials, removals for amenorrhea and irregular bleeding were much higher than rates reported in the European studies, resulting in significantly lower continuation rates overall. The results pointed to district benefits for the LNG-IUD-20, such as lower blood loss and anemia, relief of dysmenorrhea and menorrhagia, as well as possible lower risks of ectopic pregnancy in case of failure, less PID (pelvic inflammatory disease), and the claim by the maker that strictly correct placement is not necessary. Disadvantages of the LNG-IUD-20 are more difficult insertion due to the wider diameter; oligomenorrhea, amenorrhea and irregular bleeding; hormonal side effects such as acne, weight gain, nausea, headache and breast tension; and potential risk of functional ovarian cysts. The LNG-IUD-20 is considered comparable to copper IUDs in effectiveness, safety, longevity, and return to fertility after removal. Users should be counseled that the oligomenorrhea or amenorrhea is neither a medical problem or indicative of infertility, is common for the 1st 2 months, is reversible on removal, may signal an improved hemoglobin profile, relief of dysmenorrhea, and may be preferred to heavy bleeding from other IUDS. The program implications of this IUD are potential lower incidence of ectopic pregnancy and PID. The effect of its use on breast feeding, cost-effectiveness compared to Norplant, in-country manufacture, and cultural acceptance need to be determined in specific locales.
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PMID:An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs. 177 15

From September 1982 to June 1987, all members (N = 513) of the Group Health Cooperative of Puget Sound, Seattle, Wash, who were prescribed isotretinoin for acne were observed throughout the first 4- to 5-month course of therapy for effectiveness and adverse effects. The highest rates of use were among male subjects aged 15 to 24 years. Excluding 47 subjects whose prescriptions were stopped because of noncompliance or who left the care of Group Health Cooperative physicians, 39 (8.4%) of the remaining 466 discontinued taking the drug because of the following adverse effects: mucous/skin/musculoskeletal effects (17); elevated triglyceride levels (eight); headaches (five); increased liver enzyme levels (three); amenorrhea (two); and other (four). One subject, excluded from the 466 because of noncompliance, became pregnant while using medication from a previous prescription and had a therapeutic abortion; she was not under the care of a physician at the time of pregnancy. Most subjects (97%) developed a mucocutaneous symptom, and 42% developed musculoskeletal symptoms. Moderate elevations in liver enzyme levels developed in six (1.8%) of 341 subjects with normal baseline values. Of 389 subjects with normal baseline triglyceride values (less than 2.25 mmol/L), nine (2.3%) developed moderate elevations (4.5 to 9.0 mmol/L), and one (0.3%) developed a severe elevation (greater than or equal to 9.0 mmol/L). Of 24 subjects with elevated baseline triglyceride levels, three (12.5%) developed moderate elevations. Of an additional 53 subjects whose baseline serum triglyceride levels were not determined, two developed elevations during therapy, one up to 13.4 mmol/L. Subjects who were overweight or had elevated baseline serum triglyceride values had an increased risk of developing elevations in triglyceride levels during therapy (odds ratio, 6.0; 95% confidence interval, 1.6 to 22.0; and odds ratio, 4.35; 95% confidence interval, 0.9 to 20.2, respectively). Acne was improved for at least 94.0% of subjects.
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PMID:An observational study of isotretinoin recipients treated for acne in a health maintenance organization. 182 96

Sustained released progestin-containing subdermal implants, the first new contraceptives to be released in 30 years, have the advantages of being easy to use, completely reversible, highly effective, and free of some of the health risks associated with combined oral contraceptives. The Norplant implant system, consisting of 6 levonorgestrel-filled silastic capsules, is being used by more than 500,000 women around the world and was approved for use in the US in late-1990. Because Norplant does not contain estrogen, it can be used safely by women with elevated blood pressure or a history of thromboembolic disease. Clinical trials have revealed first-year continuation rates of 76-90% compared with 50% for the pill. The most common reasons for requesting removal of Norplant are menstrual irregularity (prolonged menstrual bleeding, spotting between periods, or amenorrhea), headache, and weight gain. Plasma levonorgestrel concentrations are below contraceptive levels within 48 hours of removal, and most women resume normal ovulatory cycles during the first month after method discontinuation. Studies of carbohydrate metabolism, liver function, blood coagulation, immunoglobulin levels, serum cortisol levels, and blood chemistries have failed to reveal significant alterations in Norplant acceptors. Although some studies have recorded reductions in cholesterol, and triglyceride levels, lipoprotein levels return to pretreatment values by the end of the first year of use. Biodegradable implants that eliminate the need for surgical removal and implants that provide contraceptive protection for only 1-2 years could further increase the affordability and acceptability of this method. Under development are the Capronor and norethindrone/cholesterol pellet systems, both of which are shorter term and biodegradable.
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PMID:Subdermal progestin implant contraception. 190 16

Two cases of TSH-secreting pituitary adenoma were reported. Endocrinological and immunohistochemical features of these cases were described and problems in diagnosis and treatment of the rare disease are discussed. [case 1] A 28 year-old woman suffered from hyperthyroidism with a relatively high value of serum TSH (T3; 350 ng/dl, T4; 10.0 micrograms/dl, TSH; 24.5 microU/ml). She was treated with antithyroid drug and then underwent subtotal thyroidectomy. Although the levels of serum T3 and T4 were lowered to within normal range, the level of serum TSH still remained high. One month later, she developed frontal headache, amenorrhea and bitemporal hemianopsia. A CT scan showed an enhanced mass in the sellar and suprasellar region. Preoperative endocrinological studies showed elevated values of TSH (47 microU/ml) and its alpha-subunit (9.0 ng/ml). The levels of both T3 (190 ng/dl) and T4 (10.0 micrograms/dl) were near the upper normal limit. Serum TSH was suppressed by administration of exogenous T3, but did not respond to exogenous TRH, l-Dopa nor bromocriptine. Under the diagnosis of TSH-secreting pituitary adenoma, the patient was operated on by craniotomy and received local radiation therapy (50 Gy). In 1990, 12 years after the treatment, she is well and endocrinologically normal. Immunohistochemical study revealed that most tumor cells were positive for TSH. [case 2] A 28 year-old woman visited our hospital for examination of hyperthyroidism. Serum level of TSH was detectable (4.5 microU/ml). A CT scan performed at that time disclosed no pituitary tumor. Thyroid function was normalized by antithyroid drug, but the level of TSH was still high and progressively increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of TSH-secreting pituitary adenoma; endocrinological, diagnostic and therapeutic approach to the disease]. 194

The role of intracranial pressure in the development and maintenance of the primary empty sella has been pointed out in the literature previously. The hormonal changes and clinical features have been evaluated in a 30 year-old female patient examined for a convexity meningioma and a 20 year-old patient examined for chronic hydrocephalus caused by cured meningitis. Histories and investigations revealed an empty sella turcica associated with primary amenorrhoea and delayed puberty. The removal of the convexity meningioma resulted in loss of amenorrhoea and a rise in plasma gonadotrophins. The establishment of a ventriculo-peritoneal shunt did not bring about any changes in hormonal values and clinical features except the subjective headache disappeared. The importance of consideration of intracranial causes in patients who have delayed puberty or absence of menstrual history is briefly emphasized in light of the literature. Our data also demonstrated a correlation between an increase in intracranial pressure and a deficiency of hormonal secretion by the hypophysis.
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PMID:Relationship between chronic raised intracranial pressure and empty sella presenting hormonal disturbances. 197 9

From August 1988-June 1989, 983 physicians participated in a phase IV trial by following 7759 women using the monophasic oral contraceptive (OC), Demulen 1/35 (1 mg ethynodiol diacetate and 35 ug ethinyl estradiol) to evaluate its efficacy and safety. The total number of cycles for the study stood at 21,440. In addition, the total woman-years stood at 1787. Only 6382 patients could be evaluated for safety. 4.4% of the patients had adverse reactions to the OC, but only 1.7% of all patients stopped taking it. The leading side effects included nausea (67 cases), headache (45), amenorrhea (42), emotional changes (30), breast pain (19), dysmenorrhea (12), and 11 cases of weight gain, abdominal/pelvic pain, and bloating. Of the 280 reported adverse reactions, only 87 (31%) were considered severe. The leading serious adverse reactions were depression (10) and hypertension (6). Only 5412 patients could be used to determine efficacy. The physicians initially reported 121 (2.2%) pregnancies during the study. The researchers learned that 33 of the 84 returned 2nd questionnaires (response rate, 70%) reported that the women conceived after enrollment but before taking the OC. 36 conceived while taking it, but 8 did not take it daily. Noncompliance may have contributed to pregnancy for the remaining 28 cases. Therefore the 36 confirmed pregnancies made for a failure rate of .7%. 85.7% of the pregnancies happened in the 1st 3 months of taking the OC. Either patient noncompliance or true medication failure accounted for treatment failure. Therefore it is important for physicians to instruct patients on how to take OCs correctly.
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PMID:Efficacy and safety of ethynodiol diacetate, 1 mg, with ethinyl estradiol, 35 micrograms, with an emphasis on contraceptive efficacy. A phase IV trial. 204 81

An 18-year old patient bearing a subcutaneous Norplant implant in the left upper arm for 2 years visited a gynecological clinic. The implant rods were removed under local anesthesia because of the increasing pigmentation of the skin, and she switched to oral contraceptive use. Norplant contains a total of 216 mg of levonorgestrel (LNG) in 6 silastic rods, each 3.4 cm long. Norplant-2 consists of 3 rods with a length of 4.4 cm providing a total of 140 mg of LNG. It has been in use since 1974 in Chile, and subsequently in Brazil, Indonesia, Thailand, Africa, and to a lesser extent in Scandinavia. It works via the continuous release of 30-50 mcg doses of progesterone daily that induces cervical mucous changes whereby sperm penetration is thwarted; nidation does not occur, and ovulation is also often inhibited. The Pearl-Index reaches .1-1.1 in the first 5 years of use. The most important side effects are menstruation changes (oligo- and amenorrhea), weight gain, and headache. The continuation rate is similar to that of the IUD: 95% through the 1st year of use, and 75% through 3 years reported from Chile and China. Reversibility is a major advantage: 50% of women become pregnant within 3 months after removal, 86% within 1 year, and 93% within 2 years. In the Netherlands sits acceptance is clearly distinct from prevalence in Chile and China, and it has only a minor role in applicability when other contraceptives fail.
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PMID:[Norplant in The Netherlands]. 210 35

Clinical trials in Europe have found that a single oral dose of RU-486, followed by prostaglandin administration, effectively and safely terminates early pregnancy in about 95% of women. In a multicenter study carried out in France, 1 600-mg dose of RU-486, followed 36-48 hours later by intramuscular sulprostone or intravaginal gemeprost, induced complete abortion in 96% of 2000 women with up to 49 days of amenorrhea. In a British multicenter study, the combination of RU-486 and intravaginal gemeprost induced abortion in 95% of 600 women with up to 63 days of amenorrhea. RU-486 is not effective in aborting ectopic pregnancies. Bleeding usually starts 1-2 days after treatment and lasts for 1-2 weeks. About 1% of patients have required curettage since the amount of blood loss exceeds that in a normal menstrual period. The other side effects recorded with any frequency--abdominal cramping, nausea, vomiting, diarrhea, and headache--are all transitory and mild. Only 1 case of myocardial infarction has been reported in the more than 20,000 RU-486 acceptors studied. Endometritis and salpingitis are extremely rare complications. There have been no maternal deaths, and no fetal abnormalities have been observed in women who took RU-486 alone early in pregnancy and failed to abort.
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PMID:Mifepristone (RU 486). 224 20

Altogether 45 patients (41 women and 4 men) with benign intracranial hypertension (BIH) were observed. BIH developed in 22 women in the gestation period, in 4 during a menopause, in 2 in the presence of hypothyroidism, in 2 due to respiratory infection, in 2 due to a slight cerebrocranial injury, and in one patient with associated galactorrhea-amenorrhea. The cause of BIH in 12 patients remained unclear. Most of the women were obese (33 of 41). The clinical picture of BIH consisted of headaches, congested optic discs, and elevated pressure of cerebrospinal fluid. In most cases prognosis turned out favorable. In the residual period, 1 patient had amaurosis, 25 presented with mild headache, 19 completely recovered. Three women had recurrent BIH.
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PMID:[Benign intracranial hypertension syndrome]. 229 Mar 26


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