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Query: UMLS:C0018681 (headache)
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Changes in blood bicarbonate, phosphate and lipid were followed up on 9 patients as they are dialyzed with an acetate containing dialysate (AC) during 2 years and with a bicarbonate containing dialysate (BC) during 2 more years. The mean (+/- SD) predialysis concentration of blood bicarbonate was 23.11 +/- 1.09 mmol/L on AC period and 26.72 +/- 1.26 mmol/L on BC period. The new bicarbonate concentration steady state was reached with a delay of about 3 months. The mean (+/- SD) predialysis phosphate concentration was lower during BC period (1.73 +/- 0.17 vs 1.95 +/- 1.26 mmol/L). Although the changes were not significant, less aluminium hydroxide (4.8 +/- 0.8 vs 6.0 +/- 1.3 g per day) was necessary to control blood phosphate during BC period. The most striking changes in this long term study was the tolerance of the patients on bicarbonate dialysis, where hypotension episodes and muscles cramps were reduced by 50% and headache, nausea and vomiting disappeared almost completely. Conversely, no significant changes in lipid status with changing dialysate could be found. The results of this long term study provide strong support for promoting bicarbonate containing dialysate for all hemodialyzed patients.
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PMID:[Bicarbonate dialysis: comparative study of its long-term effects]. 666 36

It has been suggested that women over age 40 use methods other than oral contraceptives (OCs) but there is evidence that the benefits of OCs should be weighed against the risks; some researchers have concluded that the existence of other predisposing risk factors is more important than age. Other hormonal methods available to middle aged women are: 1) continuous mini-progestogen OC which obviates the role of estrogens and are suggested for premenopausal women who do not show signs of hypoestrogenism, but pregnancy rate is still relatively high (3.0) for women aged 35 and over; 2) injectable contraceptives are believed to be highly effective but may depress some women; 3) estradiol pellet implants of 6-month intervals; in a group of 144 women aged 35-50 the pregnancy rate was 0.169; and 4) estradiol pellet implants with a 7-10 day course of an oral progestogen such as medroxyprogesterone acetate administered at monthly intervals to induce orderly withdrawal uterine bleeding; most common side effects are hypermenorrhea and mastodynia. The latter method is best suited to premenopausal women who wish to continue the low-dosage estrogen in advancing years, preventing the onset of hot flushes and sweats, minimizing the tendency to osteoporosis and decreasing the severity of menopausal migranoid headaches and mood changes.
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PMID:Contraception for middle aged women. 676 1

A review of the composition, usage, and side effects of hormonal contraceptives is presented. The estrogens ethinyl estradiol, mestranol, ethinyl estradiol sulfonate, and quinestrol, as well as the gestagens chlormadinon acetate, norethindrone acetate, and d-norgestrel, are used in combination, sequential, and depot preparations, mini-pills, and morning-after pills. The failure rate of combination preparations is 1/100 women-years and of sequential preparations is 1-5/100 woman-years. Gestagen-intensive preparations can be used for women showing symptoms of gestagen deficiency (e.g. hypermenorrhea, endometriosis), while estrogen-intensive preparations are indicated for women with e.g. hypomenorrhea, acne, or hirsuitism. Preparations containing chlormadinon acetate are indicated for women with signs of androgen imbalance or for women who sing or use their voices professionally. Control check-ups of patients using hormonal contraceptives should occur every 6 months. Women who still want to bear children should discontinue hormonal contraceptive use for a certain period every 2 years. Hormonal contraceptives can be prescribed to adolescents 2 years after menarche and after one year of regular menstruation. The side effects of hormonal contraceptive use are listed. Subjective side effects such as nausea and headaches are frequently reported. Hormonal contraceptives can cause menstrual irregularities; spottings or break-through bleedings during hormonal contraceptive use indicate a reduced contraceptive effectiveness. Hormonal contraceptive use causes increases in laboratory values, e.g. SGOT, SGPT; lipid metabolism and carbohydrate metabolism are also affected by hormonal contraceptives. Hormonal contraceptives have been shown to cause an increase in blood pressure and affect the circulatory system, liver and gall bladder function, and blood coagulation. Neoplasms may be affected positively or negatively by hormonal contraceptive use. Relative and absolute contraindications for hormonal contraceptive use as well as indications for discontinuing hormonal contraceptive use are listed.
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PMID:[Hormonal contraception--side effects and surgical aspects (author's transl)]. 701 44

Changes in pH and blood gases were studied during hemodialysis with both acetate and bicarbonate dialysates. During acetate dialysis, PaO2 and PaCO2 decreased significantly (P less than 0.05) from 101 +/- 2 to 93 +/- 3 mmHg and from 34.4 +/- 1.0 to 31.8 +/- 0.9 mmHg, respectively, whereas during bicarbonate dialysis neither parameter changed significantly. The final pH was 7.45 +/- 0.01 during acetate dialysis and 7.50 +/- 0.02 during bicarbonate dialysis. Plasma bicarbonate rose immediately and progressively from 18.9 +/- 0.8 to 26.8 +/- 0.9 mmol/L with bicarbonate dialysis, whereas the increase was moderate, from 19.6 +/- 0.6 to 22.3 +/- 0.5 mmol/L, with acetate dialysis. These data indicate that dialysis-induced hypoxemia was prevented and correction of acidosis was more adequate with bicarbonate dialysis. During a two-year period on bicarbonate dialysis, total cholesterol, HDL-cholesterol, and triglycerides did not change significantly when compared to acetate dialysis. The most striking change was the increased tolerance to dialysis with bicarbonate dialysis, which included a 50% reduction in hypotensive episodes and muscle cramps and an almost complete absence of headache, nausea, and vomiting.
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PMID:Effect of bicarbonate-containing dialysate on chronic hemodialysis patients: a comparative study. 716 57

Cyproterone acetate (100 mg daily on the 5th-14th days of the normal cycle) together with ethinyl estradiol (0.05 mg daily on the 5th-25th days) was used for the treatment of hirsutism in 23 women for six months. This treatment caused a significant decrease in the severity of the hirsutism after only three months, the effect being maximal after six months. Sixty per cent of our patients reported being subjectively satisfied with the results. A relapse occurred, however, within three months of the end of the treatment in half the patients. The serum testosterone was significantly decreased after three months of treatment, but the changes in serum testosterone did not follow the changes in the clinical picture of hirsutism, suggesting that one facet in the favorable action of cyproterone acetate is an inhibition of the action of androgen on target cells. Various side effects, such as nausea, headache, loss of libido and depression, were reported very frequently, which undoubtedly limits the large scale use of this treatment, at least with the doses used in this study.
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PMID:Cyproterone acetate in the treatment of hirsutism. 728 7

During standard haemodialysis, cause of calcium and magnesium insoluble salts formation, the bicarbonate as a buffer has been replaced by the more soluble and stable acetate. But the new and more efficient dialytic systems cause an increase of intradyalitic bicarbonate loss and acetate gain the latter, by a direct calcium binding or by calcium displacement from the active sites, has been believed to be responsible for vasodilatation and myocardial contractility depression. Aim of this study is to verify if the bicarbonate dialysis versus acetate dialysis modifies left ventricular performance, investigated by non invasive tools (systolic time index and echocardiography). This work deals with twelve patients undergoing standard haemodialysis (three times a week) since 28 months on the average. Echocardiographic and systolic time index study was performed before and after the acetate dialysis and before and after the tenth bicarbonate dialysis observing the same interdialytic period. The echo has shown improvement concerning the fractional shortening (P less than 0.025) and the cardiac output (P less than 0.05) and only before the tenth bicarbonate dialysis. Systolic time index data have shown reduction of the ratio PEP/LVET (P less than 0.05) and LVET less negative than after acetate only in the end of the tenth bicarbonate dialysis (P less than 0.05). These results seem point out left ventricular performance improvement in accordance with the decrease of clinical intradialytic (nausea, vomiting, and hypotension) and interdialytic troubles (headache, asthenia and washed-out feeling) probably due to the bicarbonate more effective as a buffer in the acid-base and electrolytic balance.
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PMID:[Comparison of acetate and bicarbonate in hemodialytic treatment. Echocardiographic and polycardiographic study of the left ventricle]. 731 88

A 29-year-old woman presenting with persistent headache and oligomenorrhoea was found to have a pituitary adenoma which was treated surgically. Postoperatively she developed diabetes insipidus which resolved on treatment with desmopressin acetate. She represented 11 days post surgery with nausea and vomiting and inappropriate antidiuresis was diagnosed in an infectious diseases unit. On re-admission to our unit cranial diabetes insipidus was confirmed by water deprivation. This case demonstrates the need for careful monitoring of patients after pituitary and suprasellar surgery or head injury.
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PMID:The triple-phase response--problems of water balance after pituitary surgery. 756 42

Six patients with symptomatic leiomyomata uteri and in whom surgical treatment was indicated received, during 3 months, intramuscular leuprolide acetate, 3,75 mg monthly, in order to 1) achieve a reduction of myomata size and 2) recover an anemic patient before surgery. In every patient, amenorrhea was induced since the second month of treatment. A significant decrease of myomas sizes was achieved. The reduction of the volume of the largest myoma in each case, varied between 51% and 77% (x = 60% +/- ES 4,3) LH and estradiol plasma levels diminished significantly and FSH did not changed in response to treatment. Side effects were well tolerated. Hot flashes were present in all patients, headaches in 2 and loss of strength in 2. Surgery was accomplished after 3 months of treatment. Myomectomy was performed in 5 cases and total hysterectomy in 1. Uterine shrinkage and the period of amenorrhea induced by Lupron-depot facilitated hysterectomy and myomectomy techniques and the recovery of one patient with a severe anemia.
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PMID:[Size reduction of uterine myomas with monthly administered leuprolide acetate]. 756 60

Mortality of 70% of all patients with tumors in the head and neck is linked with anorexia and cachexia. Two reasons for cachexia are well known: 1. local disease and local therapy preventing oral nutrition and 2. advanced tumors activating biochemical pathways of proteolysis, lipolysis, and gluconeogenesis. Five groups of substances are now used to treat tumor-induced cachexia: corticosteroids, progestational drugs, cyproheptadine, hydrazine sulfate, and anabolic steroids. Between 1992 and 1993 we treated 38 patients suffering from cachexia due to advanced cancers of the head and neck with 160 mg megestrol acetate per day for four months. The increase in body weight was significant after eight weeks. The mean increase after full therapy was 4.58 +/- 3.19 kg. Treatment of the five women in the series was very successful and all achieved their former body weight. Megestrol acetate therapy was best started after assuring enteral nutrition. Significant adverse events were loss of libido for the men, headache and, rarely, thrombophlebitis. Our first experiences suggest that megestrol acetate treatment is useful in cachectic patients with advanced squamous cell carcinomas of the head and neck.
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PMID:[Value of megestrol acetate in treatment of cachexia in head-neck tumors]. 757 3

In the US, the 90% of women, at risk of pregnancy, who use contraceptives account for 47% of all unplanned pregnancies. Thus, if women using no contraceptives or using user-dependent methods were to switch to long-acting hormonal contraceptives like Norplant or injectables, unplanned pregnancy rates would drop. Norplant was approved for use in the US in 1992. The device consists of six rods that release levonorgestrel over a period of five years to suppress the luteinizing hormone surge responsible for ovulation and thicken cervical mucus to prevent sperm penetration. Norplant is highly effective, results in few metabolic changes in users, and can be used by lactating mothers. Side effects (most prevalent in the first six months) include abnormal bleeding, weight gain, depression, and headaches. Adolescents studied reported overall satisfaction with the method. Difficulties with removal can be minimized if the implants are inserted properly. The injectable use of depot medroxyprogesterone acetate (DMPA) was approved in the US in 1992. Contraceptive plasma levels are reached within 24 hours of the injection and are maintained for 14 weeks. DMPA inhibits ovulation and is highly effective when administered once every three months. DMPA is associated with a longer delay in return to fertility than other methods. The side effects of DMPA are similar to those seen in Norplant users. Concern about changes in bone density are currently being investigated. DMPA users have increased low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels as compared to IUD users. DMPA (unlike Norplant) can be used effectively in women using anticonvulsant medications or antibiotics. It is also safe during lactation. Research into hormonal methods is being concentrated on the development of a two-rod and one-rod Norplant delivery system, on biodegradable delivery systems, and on various injectable formulations, including once-a-month estrogen/progesterone combination methods.
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PMID:New contraceptives in the 1990s. 758 38


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