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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

(1) The precise cardiovascular risk of oral contraceptives is poorly known because of a lack of reliable clinical studies and the numerous potential biases in epidemiological studies. (2) The absolute risk of coronary events is very low in women under 35 who are non smokers, have no history of coronary heart disease and have normal blood pressure. In women over 35, smoking over 10 cigarettes a day and arterial hypertension substantially increase the risk of coronary heart disease. (3) The absolute risk of stroke is low in young women who are not hypertensive and do not smoke. It is higher in the case of arterial hypertension. (4) The absolute risk of deep vein thrombosis is increased but remains moderate. Obesity, a family history of deep vein thrombosis, and hereditary clotting disorders are risk factors. (5) The cardiovascular risks linked to oral contraception seem to disappear after cessation. (6) The use of oral contraceptives with very low doses of oestrogen (less than 50 mug ethinylestradiol) reduces the associated risk of stroke. The risk of deep vein thrombosis is probably higher with combined contraceptives containing a third-generation progestagen (desogestrel or gestoden). (7) The coronary and cerebrovascular risks of progestagen-only contraceptives are poorly documented. Low-dose progestagen-only oral contraceptives have little effect on clotting factors or on carbohydrate and lipid metabolism. There may be a risk of deep vein thrombosis, however, with this type of contraceptive. (8) History, physical examination and simple laboratory tests before prescribing or renewing oral contraceptives are sufficient to detect the main contraindications, i.e. arterial hypertension, a history of coronary or cerebrovascular conditions, deep vein thrombosis, hypercholesterolaemia exceeding 3 g/l, hypertriglyceridaemia exceeding 3 g/l, unusually severe headache on a combined oral contraceptive and prolonged immobilisation. However, a combined oral contraceptive can be considered for some women with cardiovascular risk factors such as moderate hypercholesterolaemia or hypertriglyceridaemia, well-controlled insulin-dependent diabetes, uncomplicated cardiac valve disease, migraine not worsened by a combined oral contraceptive, varicose veins or a family history of deep vein thrombosis. (9) Pharmacists should be aware of these risk factors so that they can advise patients to see a doctor if new health problems arise between visits.
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PMID:Cardiovascular risk of oral contraceptives. Low, and mainly in women at risk. 1034 51

Insulin-like growth factor-I (IGF-I) enhances insulin action in normal subjects and in patients with both type 1 and 2 diabetes; however, its administration is associated with significant side effects in a high percentage of patients. The coadministration of IGF binding protein-3 (IGFBP-3, the predominant IGF binding protein in serum) with IGF-I limits IGF-I inducible side effects, but it does not attenuate the ability of IGF-I to enhance protein synthesis and bone accretion; therefore, we determined whether IGF-I/IGFBP-3 would retain biological activity in type 1 DM and limit side effects associated with free IGF-I administration. Twelve patients received recombinant human IGF-I plus IGFBP-3 (2 mg/kg-day) by continuous sc infusion for 2 weeks. Each subject served as his own control; and, during a paired 2-week period, each received a placebo infusion. The order of the treatments was randomized. Subjects were placed on a constant caloric intake but were allowed to adjust insulin doses to maintain appropriate levels of glycemic control. Subjects measured blood glucose four times per day at home and kept a log of their insulin use. Frequent sampling for glucose, insulin, and GH was conducted during four inpatient study periods, one at the beginning and one at the end of each 2-week study interval. During IGF-I/IGFBP-3, insulin doses were reduced by 49%, and mean serum glucose was reduced by 23%. Free insulin levels obtained during frequent sampling in hospital fell 47% on IGF-I/IGFBP-3, compared with control, but showed no change with placebo. Concomitant glucose measurements did not differ in the two treatment groups. There was no change in body weight. Fructosamine levels decreased by 12%, but this was not significant (P < 0.1). Fasting triglyceride was unchanged, but cholesterol declined from 170 +/- 24 to 149 +/- 31 mg/dL (P < 0.05). IGFBP-2 (an IGF-I-dependent responsive variable) rose from 141 +/- 56 to 251 +/- 98 ng/mL (P < 0.01) on IGF-I/IGFBP-3. To analyze the mechanism by which IGF-I/IGFBP-3 might reduce insulin requirements, the change in serum GH was quantified. Mean GH levels were reduced by 72%, from 2.48 to 0.55 ng/mL (P < 0.001). An equal number (40%) of drug- and placebo-treated subjects had minor hypoglycemic episodes at home that required adjustment of insulin doses. No episode was classified as severe. In contrast to previous studies with free IGF-I, there were no cases of edema, headache, jaw pain, retinal edema, or Bell's palsy. No subject withdrew because of drug complications. These findings indicate that IGF-I/IGFBP-3 is biologically active on carbohydrate metabolism, as measured by a decrease in insulin requirements in patients with type 1 diabetes. Further studies will be required to determine the long-term safety and efficacy of this combination in patients with insulin resistance and diabetes.
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PMID:The combination of insulin-like growth factor I and insulin-like growth factor-binding protein-3 reduces insulin requirements in insulin-dependent type 1 diabetes: evidence for in vivo biological activity. 1077 Jan 91

PURPOSE: Collecting daily information on a series of similar, recurring events such as menstrual bleeding, headaches, or insulin levels using paper instruments is subject to problems such as missing or incorrectly recorded data, and retrospective data entry. The authors are developing and evaluating electronic data collection using hand-held personal computers (H/PC) for a variety of health-related applications, including tracking premenstrual syndrome (PMS), fertility awareness, and headaches, to improve accuracy and timeliness of data collection.METHODS: ProCycle is a prototype electronic diary for collection of daily data on menstrual bleeding, medications, and health symptoms. In a 3-month pilot test in 25 regularly cycling women, we compared its performance with a paper calendar regarding missing and incorrect data, data entry lag, data cleaning time, and users' preferences with respect to factors such as remembering to enter data, convenience, and overall preference. Additional programs for PMS, fertility, and headaches are being field tested on subjects from the Boston and New York areas, comparing performance with paper versions.RESULTS: In the pilot test, missing data occurred less frequently with ProCycle than with paper, particularly for any days with missing symptoms (4% vs. 35%, p < 0.05). ProCycle did not permit any data recording mistakes such as circling contradictory responses (e.g., bleeding and no bleeding), compared with incorrect data on 13% of paper calendars. Data entry/cleaning time was 81% lower for ProCycle. 70% of users preferred ProCycle overall, compared with 9% preferring paper (p < 0.01).CONCLUSIONS: Although the initial cost of the H/PC is significantly higher than paper, there are no recurring charges for printing or data entry, and data cleaning is minimal. Electronic instruments on an H/PC provide an efficient, accurate method of data collection, applicable to a number of areas of health-related research involving daily data collection.
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PMID:Electronic versus paper instruments for daily data collection. 1101 66

Pituitary apoplexy has been reported as a very rare complication of combined tests of anterior pituitary function and of TRH or gonadotropin-releasing hormone (GnRH) administration in pituitary tumor. A 34-year-old man with a GH-secreting pituitary macroadenoma and diabetes mellitus received an injection of 400 microg TRH, 100 microg GnRH, and 0.15 U/Kg regular insulin. Twenty minutes later, he complained of a severe headache and vomited. Visual acuity and visual field did not change and his headache was persistent during the next 24 hours of conservative management. Magnetic resonance imaging (MRI) of the sella turcica done the day after the event showed definitive elevation of the optic chiasm and slight enlargement of tumor and focal areas of mixed high signal and low signal intensities in the macroadenoma on noncontrast T1-weighted images. Headache subsided markedly within a day of octreotide therapy. Transsphenoidal removal of the pituitary tumor was performed 9 days after the hormone study. Ischemic necrosis and hemorrhage were confirmed in the acidophilic adenoma with positive immunostaining for GH. Postoperative course was uneventful and his serum insulin-like growth factor-1 (IGF-1) level and blood glucose levels were normalized. Three months after the surgery the dynamic test was repeated without adverse effects. To our knowledge, this is a very rare case of apoplexy of GH-secreting pituitary adenoma after a combined stimulation test of anterior pituitary function.
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PMID:Apoplexy of pituitary macroadenoma after combined test of anterior pituitary function. 1103 77

A 29-year-old man developed acute visual impairment, cough, and headache. Both eyes showed serous retinal detachment in the posterior fundus. Fluorescein angiography showed subretinal pooling of fluorescein in the late phase. A diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made based on clinical features. Treatment with systemic corticosteroids resulted in improvement of uveitis and both eyes showed "sunset glow" fundus 11 months later. Insulin-dependent diabetes mellitus (IDDM) developed 13 months later (3 months after systemic corticosteroid therapy). Despite treatment with insulin, glycemic control was poor. Human leukocyte antigen (HLA) typing showed HLADR9 and DQB 1*0303 related to IDDM. We postulated that treatment with corticosteroids precipitated IDDM, a yet unknown common autoimmune mechanism might have caused IDDM and VKH, or both conditions occurred coincidentally.
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PMID:A case of insulin dependent diabetes mellitus following systemic treatment for Vogt-Koyanagi-Harada syndrome. 1109 27

A 67-year-old woman with diabetes mellitus was hospitalized due to a throbbing headache. She appeared neurologically normal, except for meningeal irritation. The cerebrospinal fluid pressure was high. There was increased fluid protein without an increased cell count. Brain CT scan showed no abnormality, however, brain magnetic resonance angiography (MRA) showed complete right transverse sinus stasis and partial left transverse sinus stasis, indicating bilateral transverse sinus thrombosis. At this time thrombin anti-thrombin III complex (TAT) and prothrombin fragment F1+2 (PTF1+2) indicating hypercoagulation had increased. Urokinase, followed by aspirin and ticlopidine hydrochloride were administered. After diet therapy and transient insulin administration, her blood glucose levels improved. By the 22nd day, the headache had disappeared. Subsequently, brain MRA showed left transverse sinus blood flow recovery and complete right transverse sinus stasis, while carotid angiography showed recovered left transverse sinus but right transverse sinus defect. TAT and PTF1+2 levels improved concomitantly with better blood glucose control. We diagnosed this case as left transverse sinus thrombosis because of the hypercoagulable state resulting from diabetes mellitus accompanied by right transverse sinus aplasia.
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PMID:Diabetes mellitus with left transverse sinus thrombosis and right transverse sinus aplasia. 1113 80

The action of growth hormone (GH) via its receptor involves many organ systems and metabolic pathways. These diverse actions are reviewed in this paper in the context that they may represent unwanted side-effects of GH therapy for growth promotion. The monitoring of GH therapy in large multicentre international databases has demonstrated a low frequency of adverse events. Tumour recurrence or new malignancy are not increased. Headaches, especially in the first few months of therapy, require close evaluation as benign intracranial hypertension is found infrequently, especially in children with GH deficiency and chronic renal failure (CRF). Children at risk for slipped capital femoral epiphysis and scoliosis require close monitoring during therapy. Decreased insulin sensitivity that is dose-dependent is observed during GH therapy. Glucose homeostasis, however, is not affected, but a recent report of increased incidence of Type 2 diabetes mellitus in children undergoing GH therapy requires prospective surveillance.
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PMID:Safety issues in children and adolescents during growth hormone therapy--a review. 1173 34

Rosiglitazone is a potent insulin-sensitizing oral hypoglycemic agent of the thiazolidinedione class that works through activation of the peroxisome proliferator-activated receptor-gamma (PPAR-gamma) nuclear receptor and improves glycemic control in patients with non-insulin-dependent diabetes mellitus. The potential for a drug-drug interaction with oral digoxin was investigated. Subjects received both of the study regimens in a random sequence: digoxin 0.375 mg plus matching placebo for rosiglitazone orally each morning for 14 days or digoxin 0.375 mg plus 8 mg rosiglitazone orally each morning for 14 days. There was a 14-day washout period between sessions. Blood and urine were collected over 24 hours beginning on the morning of day 14 for measurement of digoxin concentrations. An equivalence statistical approach was used, with rosiglitazone considered to have no effect on the pharmacokinetics of digoxin if the 90% confidence interval (CI) for the ratio of digoxin plus rosiglitazone relative to digoxin plus placebo was completely contained within the range (0.80, 1.25) for the primary end points, AUC(0-24), and C24. Digoxin AUC(0-24) and C24 values were similar for digoxin 0.375 mg plus matching placebo (18.5 ng.h/mL and 0.579 ng/mL, respectively) and digoxin 0.375 mg plus rosiglitazone (19.1 ng.h/mL and 0.594 ng/mL, respectively). Point estimates were 1.05 (90% CI: 1.01, 1.10) for AUC(0-24) and 1.04 (90% CI: 0.98, 1.11) for C24. Oral and renal clearance were also similar between regimens. Digoxin alone or in combination with rosiglitazone was safe and well tolerated. The most common adverse experience was headache. Coadministration of digoxin with rosiglitazone had no significant effect on the safety or steady-state pharmacokinetics of digoxin.
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PMID:Rosiglitazone does not affect the steady-state pharmacokinetics of digoxin. 1118 75

Repaglinide, a carbamoylmethyl benzoic acid derivative, is the first of a new class of oral antidiabetic agents designed to normalise postprandial glucose excursions in patients with type 2 diabetes mellitus. Like the sulphonylureas, repaglinide reduces blood glucose by stimulating insulin release from pancreatic beta-cells, but differs from these and other antidiabetic agents in its structure, binding profile, duration of action and mode of excretion. In clinical trials of up to 1-year's duration, repaglinide maintained or improved glycaemic control in patients with type 2 diabetes mellitus. In comparative, 1-year, double-blind, randomised trials (n = 256 to 544), patients receiving repaglinide (0.5 to 4mg before 3 daily meals) achieved similar glycaemic control to that in patients receiving glibenclamide (glyburide) < or = 15 mg/day and greater control than patients receiving glipizide < or = 15 mg/day. Changes from baseline in glycosylated haemoglobin and fasting blood glucose levels were similar between patients receiving repaglinide and glibenclamide in all studies; however, repaglinide was slightly better than glibenclamide in reducing postprandial blood glucose in I short term study (n = 192). Patients can vary their meal timetable with repaglinide: the glucose-lowering efficacy of repaglinide was similar for patients consuming 2, 3 or 4 meals a day. Repaglinide showed additive effects when used in combination with other oral antidiabetic agents including metformin, troglitazone, rosiglitazone and pioglitazone, and intermediate-acting insulin (NPH) given at bedtime. In 1-year trials, the most common adverse events reported in repaglinide recipients (n = 1,228) were hypoglycaemia (16%), upper respiratory tract infection (10%), rhinitis (7%), bronchitis (6%) and headache (9%). The overall incidence of hypoglycaemia was similar to that recorded in patients receiving glibenclamide, glipizide or gliclazide (n = 597) [18%]; however, the incidence of serious hypoglycaemia appears to be slightly higher in sulphonylurea recipients. Unlike glibenclamide, the risk of hypoglycaemia in patients receiving repaglinide was not increased when a meal was missed in 1 trial. In conclusion, repaglinide is a useful addition to the other currently available treatments for type 2 diabetes mellitus. Preprandial repaglinide has displayed antihyperglycaemic efficacy at least equal to that of various sulphonylureas and is associated with a reduced risk of serious hypoglycaemia. It is well tolerated in a wide range of patients, including the elderly, even if a meal is missed. Furthermore, glycaemic control is improved when repaglinide is used in combination with metformin. Thus, repaglinide should be considered for use in any patient with type 2 diabetes mellitus whose blood glucose cannot be controlled by diet or exercise alone, or as an adjunct in patients whose glucose levels are inadequately controlled on metformin alone.
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PMID:Repaglinide: a review of its therapeutic use in type 2 diabetes mellitus. 1157 98

A 63-year-old man, who presented with visual field loss due to pituitary tumor, received an intravenous bolus injection of thyrotropin and gonadotropin releasing hormones and insulin as a preoperative evaluation. He complained of severe headache and nausea 2 hours after injection. Emergent CT scan showed no evidence of intratumoral hemorrhage. The next day, his visual field became null. MR images revealed heterogeneous mixed intensity lesions. Under diagnosis of pituitary apoplexy, he underwent transsphenoidal tumor removal 30 hours after onset. Intraoperative and pathological findings showed tumor hemorrhage and adjacent necrotic change. Fourteen cases with sufficient clinical detail in the literature are reviewed: All of the cases had macroadenoma with suprasellar extension. Testing agents were gonadotropin and thyrotropin releasing hormones in 92.9% and 85.7% of cases, respectively. Headache was an initial symptom and started within two hours in all cases but one. Half of the cases showed no change on CT scan. However, tumor hemorrhage was evidenced in 92.9% of cases with or without necrosis due to ischemic change, intraoperatively or pathologically. It is speculated that pituitary apoplexy often starts with infarction possibly due to vasoactive effect of testing agents and later develops into hemorrhage. Therefore, it is necessary to observe patients closely at least a few hours after endocrine stimulation test, and MR imaging may make an earlier diagnosis for the pituitary apoplexy since CT scan often shows no density change in the pituitary adenoma.
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PMID:Infarction followed by hemorrhage in pituitary adenoma due to endocrine stimulation test. 1160 73


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