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Progestin only birth control pills appeared on the US market in 1973. As there is no estrogen in these mini pills, they may have fewer dangerous side effects than the combined pills. Some clinics suggest mini pills for women who suffer from estrogen excess side effects. The 3 mini pills available in the U.S. are called Micronor, NOR-QD, and Ovrette. Instructions are presented for patients who are interested in using mini pills. The mini pills most likely work by affecting a women's fertility in several ways: act as a messenger to the woman's ovaries and uterus to prevent the release of an egg; thicken the mucous on the cervix, making it difficult for the sperm to "get through" the cervix and reach the egg; and change the lining of the uterus so that it may not develop properly for the fertilized egg to grow. The mini pills can be 97% effective is used perfectly. The mini pills are only effective for as long as a woman takes them. A woman must take a pill every day to prevent pregnancy. A woman should not use the mini pill if she has or ever has had any of these problems: blood clotting problems in veins; stroke; cancer of the breast or reproductive parts of the body; suspected pregnancy, current pregnancy; and undiagnosed, abnormal genital bleeding. Possible benefits for a woman using mini pills include: an effective method of birth control; a method for nursing mothers since it does not seem to affect the amount of their breast milk; and a possible reduction in premenstrual cramps. Possible risks for a woman using mini pills include: irregular periods; and a less effective method if the patient does not take a pill every day. The danger signals to look for are abdominal pain, chest pain, headaches, eye problems, and severe leg pain. A patient should revisit a clinic in the following situations: has not had a period within 45 days of the last period; severe abdominal pains while taking mini pills; experiences a warning signal; any time one thinks the pills are causing trouble; and once a year for a pap smear, breast examination, and laboratory tests.
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PMID:How to use mini-pills: helpful patient instructions. 1226 79

Guidelines are provided for women who use minipills. Minipills are low dose, progestin only oral contraceptives (OC), which are frequently prescribed for women who 1) experience estrogen related side effects if they take combined OCs; 2) are 35 years of age or older; 3) are 30 years of age or aver and smoke; 4) have a history of headaches, hypertension, or varicose veins; 5) desire immediate postpartum protection; or 6) are lactating. Minipills prevent pregnancy by inhibiting ovulation and implantation and by making the cervical mucus more impervious to sperm penetration. Minipills can be effective if they are used properly. Women who take minipills should be advised to carefully read and follow the instructions provided in the OC packet, initiate pill taking on the 1st day of menstrual bleeding, and take 1 pill every day without and breaks. A backup method should be used during the 1st month and subsequently, during each midcycle phase. If a woman misses 1 pill, she should immediately, upon remembering, take a pill, take her next day's pill at regular time, and use a backup method until menstruation reoccurs. If a woman misses 2 pills, she should immediately, upon remembering, take 2 pills, take 2 pills the following day, and use a backup method until menstruation begins. Women should be advised that many minipill users experience irregular menstural cycles, including amenorrhea and spotting between periods. If menstruation is delayed for 45 days, a pregnancy test is advisable. Women should be advised to immediately seek medical attention if they experience severe chest pain, shortness breath, severe headaches, vision problems, or severe leg pain. Minipill users should let their clinicians know if they experience and changes in mood or sexual drive. These problems can frequently be avoided by switching to another brand of minipills.
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PMID:Instructions for minipill users. 1227 15

Incorrect use of oral contraceptives (OCs) has lowered this method's annual effectiveness from its potential of over 99% to about 92%. In many cases, false information leads to misuse and discontinuation rates as high as 50% in the first year. Counseling about how to take the pill and what to expect in terms of side effects can improve compliance. Acceptors should be informed that side effects such as menstrual irregularities, nausea, headache, and mood changes generally abate within a few months of use. They should further be educated about side effects such as abdominal pain, chest pains, eye problems, and severe leg pain that require immediate medical attention. Medically unnecessary requirements, such as a woman should be having her menstrual period in order to get a prescription, should be eliminated to prevent delays and unwanted pregnancy. In developing countries, the long-term risk of OC use is smaller than that associated with pregnancy. Other noncontraceptive health benefits include reductions in ectopic pregnancies and symptomatic pelvic inflammatory disease.
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PMID:Oral contraceptives are safe, very effective. 1229 90

The acceptability and effectiveness of a progestogen-only oral contraceptive (OC), Ovrette, during lactation were investigated in 200 women recruited from a teaching hospital in Khartoum, Sudan. Ovrette contained 0.075 mg of norgestrel. 69 women (34.5%) had used OCs at some point prior to the index pregnancy. Serious complications (e.g., severe headache, chest pain, leg pain, abdominal pain, blurred vision) were reported by 8 respondents during the 12-month study period. Less serious side effects included dysmenorrhea (49 women), nausea (28 women), dizziness (38 women), vaginal discharge (86 women), headaches (78 women), and breast discomfort (21 women). Overall, 143 women (71.5%) experienced at least 1 side effect. Of the 21 women (10.5%) who discontinued Ovrette use before 12 months, 9 were motivated by menstrual problems and other side effects. The 12-month continuation rate was 89.1%. There were 2 pregnancies, only 1 of which represented method failure. These findings are consistent with previous studies indicating that use of progestin contraceptive agents is associated with more menstrual disturbances and pregnancies than combined OCs. Use of combined OCs is contraindicated during lactation, however.
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PMID:A study of a progestogen only oral contraceptive for lactating women in Khartoum, Sudan. 1229 69

We present the case of a 38-yr-old woman who required an epidural blood patch in the context of acute varicella (chickenpox). The unique risks in this case include the possible triggering of central nervous system complications after the introduction of viremic blood into the epidural or intrathecal space. However, the risk was believed to be acceptable because the patient was receiving antiviral coverage. She enjoyed complete relief of her headache but experienced transient back and leg pain. Leptomeningeal irritation caused by acute varicella infection may put patients at increased risk for pain after epidural blood patch.
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PMID:Epidural blood patch and acute varicella. 1619 66

Dural ectasia, an expansion of the dural sac surrounding the spinal cord, is one of the most common orthopedic manifestations of Marfan syndrome. The purpose of the present study was to characterize the clinical symptoms associated with dural ectasia in patients with Marfan syndrome and to understand the effects of symptomatic dural ectasia on the overall health of affected patients. Twenty-two volunteers aged 9-55 years with Marfan syndrome, and dural ectasia diagnosed by MRI or CT, filled out a "symptoms" questionnaire and completed an SF-36 health survey. Overall, It appears that the symptoms associated with dural ectasia have a marked impact on the overall health of patients with Marfan syndrome. Based on our findings, a "classic" picture of dural ectasia in the Marfan patient may consist of low back pain, headache, proximal leg pain, weakness and numbness above and below the knee, and genital/rectal pain. Symptoms, when present, are typically moderate to severe, occur several times per week (often daily), are commonly exacerbated by upright posture, and are not always relieved by recumbency.
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PMID:Characterization of the symptoms associated with dural ectasia in the Marfan patient. 1569 Apr 2

Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most cases are non-specific, but in about 10% of cases a specific cause is identified. Red flags are typical signs or symptoms that are frequently associated with specific LBP. Yellow flags are prognostic factors associated with a more unfavourable and often chronic disabling course of the disease. LBP has a lifetime prevalence of 60-85%. At any one time, about 15% of adults have LBP. LBP poses an economic burden to society, mainly in terms of the large number of work days lost (indirect costs) and less so by direct treatment costs. A substantial proportion of individuals with chronic LBP has been found to have chronic widespread pain. LBP is often associated with other pain manifestations such as headache, abdominal pain and pain in different locations of the extremities. Widespread pain is associated with a worse prognosis compared to localised LBP. Treatment targets are reduction of pain and better activity/participation, including prevention of disability as well as maintainance of work capacity. The evidence from selected and appraised guidelines, systematic reviews and major clinical studies was classified into four levels, level Ia being the best level with evidence from meta-analysis of randomised controlled trials. Key recommendations (level Ia): fitness programmes and advice to stay active can reduce pain, improve function and can prevent LBP becoming chronic. Simple analgesics, NSAIDs and muscle relaxants can reduce pain and can improve and maintain function. Maintaining physical activity, avoiding rest and manual therapy can reduce pain and maintain and restore function in acute LBP. Behavioural treatment can prevent LBP becoming chronic. Aerobic fitness and endurance training, behavioural treatment and multi-disciplinary treatment programmes can reduce pain and can improve/maintain function in chronic LBP.
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PMID:Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). 1735 May 45

Strongyloidiosis is widely distributed in tropical and subtropical areas but is a rarely reported parasitic infestation in Turkey. Disseminated strongyloidiosis may develop in patients with immunodeficiencies. We report a case of Strongyloides stercoralis infection and Loeffler's syndrome that developed in a patient who had received systemic prednisolone. The patient was a 20 year-old man, born in Hatay, Turkey. The patient presented at our department complaining of abdominal pain and leg pain. After he was admitted for further examination; headache, sore throat and cough developed. The differential-leukocytic count was characterized by 14% eosinophils. When a stool examination was performed, Strongyloides stercoralis larvae were observed. The patient was treated successfully with albendazole. His symptoms improved and Strongyloides stercoralis was not detected in subsequent follow-up examinations thereafter.
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PMID:[Strongyloidiosis and Loeffler's syndrome detected in a patient who used a short term steroid treatment]. 1835 51

Bartonella quintana and Bartonella pediococcus infections are very rare causes of endocarditis. Urban trench fever with relapsing febrile illness, headache, leg pain, and endocarditis has now begun to be a more important cause of disease in socially disadvantaged persons. The diagnosis is difficult because the growth of B. quintana in blood culture takes 20-40 days. B. pediococcus may be an opportunistic pathogen in severely compromised hosts, although it has been described as a harmless bacterium. We describe a patient who developed bioprosthetic valve infection with B. quintana and B. pediococcus after valve replacement.
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PMID:Bartonella quintana and Bartonella pediococcus Infection after Aortic Valve Replacement. 1843 Jun 64

Epidural steroid injection has been used to treat low back pain for many decades. Numerous randomized trials have examined the efficacy of this approach. This review details the findings of older systematic reviews, newer randomized controlled trials, and two recent systematic reviews that examine the effectiveness of this treatment. Collectively, studies in acute radicular pain due to herniated nucleus pulposus have failed to show that epidural steroid injection reduces long-term pain or obviates the need for surgery. Similarly, there is scant evidence that epidural steroids have any beneficial effect in those with acute low back pain without leg pain or in those with chronic low back or leg pain. However, most studies have demonstrated more rapid resolution of leg pain in those who received epidural steroid injections versus those who did not. The role of epidural steroid injections in the management of acute radicular pain due to herniated nucleus pulposus is simply to provide earlier pain relief.
Curr Pain Headache Rep 2009 Feb
PMID:Epidural steroid injections are useful for the treatment of low back pain and radicular symptoms: pro. 1912 69


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