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Query: UMLS:C0020473 (hyperlipidemia)
 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Copper IUDs, oral contraceptives, "morning-after' pills and injectables are discussed in general in this review. Small IUDs are less effective, but better tolerated. An exception is the Dalkon shield, which is no longer manufactured because several women died from latent infections when they became pregnant. The Copper T IUD is tolerated much better than the Copper 7, and has only a 3% failure rate. Copper Ts must be replaced every 2 years, however, and are difficult to remove. A beneficial effect of IUDs is cure of uterine adhesions; a subjective side effect if discomfort reported by husbands. Strict contraindications or oral contraceptives are history of cholostatic jaundice of pregnancy, thromboembolism, essential hypertension, tension, diabetes, gynecologic cancer and pregnancy. Relative contraindications are hyperthyroidism, hyperlipidemia, and depression. Depressions occuring soon after starting pills may be due to unconscious rejection; those appearing later may be due to the progestagen itself. The subjective sequelae of pills are more likely in maternal women, women raised to feel guilty for using contraception, women susceptible to believing sensational media reports about pills, and women dominated by their husband's views. Pills are beneficial for essential dysmenorrhea, menstrual irregularity, premenstrual syndrome, depression, frigidity due to fear of pregnancy, uterine hypotrophy, ovarian cyst, certain ovarian dystrophies such as Stein Levinthan syndrome, menopausal symptoms, acne and hirsutism. The morning after pill, 5 mg ethinyl estradiol for 3 consecutive days, is indicated only in exceptional cases such as rape. Injectables are more suitable for those who desire long-term contraception and whose who want no more children. A lower cancer rate has been reported for users of depot progestagens than for women notu sing contraception.
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PMID:[Subjective and objective aspects of modern methods of contraception]. 114 75

Isotretinoin, a retinoid derivative, is in wide use as a treatment for severe acne and other dermatologic conditions. Its effects on serum lipids, most notably the induction of hypertriglyceridemia, have been well documented. We present a case of a young woman with a previous history of gestational hyperlipidemia who developed hypertriglyceridemia and pancreatitis after initiation of isotretinoin therapy. A history of gestational hyperlipidemia may serve as a marker to help identify patients who are at increased risk for developing severe hypertriglyceridemia while receiving isotretinoin. Her case emphasizes the need to consider the possibility of pancreatitis in patients who develop abdominal pain while receiving this drug.
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PMID:Marked hyperlipidemia and pancreatitis associated with isotretinoin therapy. 144 57

The 1st published study of efficacy of a hormonal male contraceptive, by the WHO Special Programme of Research, Development and Research Training in Human Reproduction, employed weekly deep intramuscular injections of testosterone enanthate. 271 fertile married men at 10 centers worldwide participated for 18 months. The goal of this preliminary study was to determine if azoospermia was necessary or sufficient for effective contraception. Azoospermia was produced in 157 men, who then participated in a 12-month trial. There was 1 pregnancy, for a failure rate of 0.8 per 100 person-years, highly effective in comparison with oral contraceptives, IUDs and injectables. There was a 12% annual discontinuation rate reasons cited were acne (4%), behavioral effects such as aggression or increased libido (1%), and other medical reasons (1%), e.g. weight gain, polycythemia, hyperlipidemia or hypertension. Recruitment of study subjects was difficult in developed countries until direct public appeals met with success. Future developments in the male hormonal contraceptive field will require a more acceptable administration route. To develop this, longer-acting injectables or implants utilizing testosterone cybutanate (20AET-1), or other combinations of testosterone with a progestin or a gonadotropin-releasing hormone antagonist are envisioned. The effect of incomplete azoospermia and the fertilizing capacity of remaining sperm is a serious issue for research. Each more crucial is resolution of the social, political and legal problems involved in male hormonal contraceptive research. Probably reform of the US product liability litigation procedures will do more to advance contraceptive development than any other single factor.
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PMID:Bridging the gender gap in contraception: another hurdle cleared. 199 93

The retinoids, a group of compounds consisting of vitamin A and its derivatives, have been the subject of intense investigation over the past 30 years. These molecules have shown beneficial effects in the areas of acne, psoriasis, neoplastic processes and, most recently, reversal of extrinsically aged skin. Additional retinoids are currently under development. Adverse reactions to these drugs include mucocutaneous irritation, hyperlipidemia, and profound teratogenicity. Appropriate patient selection is imperative before beginning therapy with these medications. An overview of retinoid metabolism and the currently available compounds is presented. The newest class of retinoids, the arotinoids, is also discussed.
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PMID:An overview of the retinoids. 265 31

Thirteen patients with severe acne were treated for 16 weeks with 1.0 mg/kg/day isotretinoin. There were significant increases in serum cholesterol (P less than 0.02), triglycerides (P less than 0.02) and apolipoprotein B (P less than 0.02). No changes were found in serum apolipoprotein A-1, non-esterified fatty acids (NEFA), carnitine, lactate, pyruvate, glycerol, alanine, beta-hydroxybutyrate, glucose or insulin. We therefore found no evidence that the hyperlipidaemia of isotretinoin therapy is due to increased fluxes of NEFA from adipose tissue to the liver, although we cannot exclude the possibility that there are changes in the proportion of NEFA being esterified to triglyceride or undergoing beta-oxidation. We suggest that the hyperlipidaemia induced by isotretinoin may be due to an increase in circulating lipoprotein from increased production or impaired catabolism.
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PMID:Isotretinoin and serum lipids: studies on fatty acid, apolipoprotein and intermediary metabolism. 295 78

Apoprotein, lipoprotein and lipid parameters of 36 normolipidemic subjects (23 males, mean age 22.7 +/- 7.6 years; 13 females, mean age 26.2 +/- 9.8 years) receiving oral isotretinoin (mean daily dose 0.73 +/- 0.26 mg/kg body weight) for nodulocystic acne (n = 18), severe acne papulopustulosa (n = 15), gram-negative folliculitis (n = 2) and papulopustular rosacea (n = 1) were monitored before and during isotretinoin therapy at biweekly intervals over a period of 14.6 +/- 5.6 weeks. Pretreatment values of mean plasma triglycerides increased significantly (p less than 0.001) from 81.8 +/- 31.9 mg/dl to 112.4 +/- 38.7 mg/dl (47.4%) during isotretinoin treatment. With respect to the mean percent increase of plasma triglycerides from pretreatment levels, patients were classified as nonresponders (less than 10% triglyceride increase), responders (greater than 10% less than 50% triglyceride increase) and hyperresponders (greater than 50% triglyceride increase), revealing a distribution of 25.0, 36.1 and 38.9%, respectively. Isotretinoin treatment had no influence on the isoelectric focusing pattern of apoprotein E isoforms and C apoproteins. In particular, apoprotein C-II, the cofactor of lipoprotein lipase, was not affected. No correlation between apoprotein E phenotypes (2/3, 3/3, 3/4) and the mean plasma triglyceride increase could be demonstrated. Apoprotein B-48, a marker of chylomicrons and atherogenic chylomicron remnants, could not be detected by SDS-PAGE. On the other hand in 21.0% of patients with preexisting mean lipoprotein Lp(a) levels of 18.1 +/- 12.9 mg/dl a moderate increase of atherogenic Lp(a) to mean levels of 37.0 +/- 22.0 mg/dl was observed. Pretreatment values of very-low-density lipoprotein (VLDL) apoprotein (apo) B (7.5 +/- 2.0 mg/dl), low-density lipoprotein apo B (67.3 +/- 17.5 mg/dl) and total plasma apo B (76.6 +/- 19.0 mg/dl) increased significantly to levels of 10.3 +/- 2.4 mg/dl (p less than 0.001), 75.7 +/- 15.8 mg/dl (p less than 0.10) and 85.9 +/- 17.7 mg/dl (p less than 0.05), respectively. As lipoprotein lipase and hepatic lipase activities have been shown to be unaffected by isotretinoin treatment, our data support the hypothesis that isotretinoin induces hepatic oversecretion of VLDL, a condition resembling type IV hyperlipidemia in diabetics, familial hypertriglyceridemia of familial combined hyperlipidemia.
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PMID:Characterization of apoprotein metabolism and atherogenic lipoproteins during oral isotretinoin treatment. 296 29

Alterations in lipid metabolism have been reported under treatment of various skin disorders with oral retinoids. In 36 patients, mostly psoriatics, under administration of aromatic retinoid (Ro 10-9359) in various dosages serum triglycerides and cholesterol were estimated; in 25 out of 36 patients lipid analysis of the lipoproteins and apoproteins A (HDL) and B (LDL) has been performed. To reveal possible similarities of lipid changes under the two main retinoids we determined the same parameter in 10 patients with conglobate acne treated orally with 13-cis-retinoic acid (isotretinoin/Ro 4-3780 1mg/kg b.w.). Under both drugs serum triglyceride and cholesterol levels were significantly increased. In contrast to the results under the aromatic derivate the HDL- and LDL-cholesterol fractions were changed under isotretinoin. The apoprotein A (HDL) was found significantly increased under aromatic retinoid. Elevated serum lipids mostly occurred in patients having risk factors such as preexisting lipid abnormalities, obesity, diabetes mellitus, heavy smoking, alcohol abuse and hyperlipemia-inducing drugs. Patients to be treated with these drugs should be carefully followed up in order to minimize the risk for atheromatosis.
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PMID:[Changes in serum lipid fractions as a side effect of oral retinoids]. 621 75

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

A retrospective analysis of patients receiving isotretinoin for acne was performed, in order to determine the necessity for routine testing of lipid profiles and liver function tests during therapy. Data were analysed from 209 individuals, 113 (69 males, 44 females) of whom had been treated with 1 mg/kg/day, and 96 (67 males, 29 females) with 0.5 mg/kg/day. There were no significant changes in any of the tests of liver function. There were significant elevations in both plasma cholesterol and triglycerides at 8 and 16 weeks (P < 0.01) for both dose schedules, which were significant in both male and female subjects (P < 0.001). All the individuals with elevated cholesterol (> 6.5 mmol/l) at 16 weeks had elevated cholesterol at the onset of therapy. Triglyceride concentrations were elevated at 8 weeks, but there was no further increase thereafter. It was not possible to predict which subjects would become hypertriglyceridaemic from pretreatment lipid estimations. In conclusion, there appears to be little evidence to support the previously recommended regular biochemical monitoring of liver function and lipid profiles in patients who are treated with isotretinoin for 16 weeks. It would appear prudent to ensure that there is neither liver disease nor hyperlipidaemia prior to the onset of therapy, and to determine the triglyceride response to therapy on one occasion after 4 weeks' treatment. This change in patient management should result in considerable savings both in patient time and in blood collection and analysis.
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PMID:Isotretinoin therapy for acne vulgaris: a re-evaluation of the need for measurements of plasma lipids and liver function tests. 828 55

There is a very small number of patients who suffer from acne even in the sixth and seventh decades of life. These patients have suffered from acne for most of their lives, 30-60 years, and have often received multiple courses of antibiotics over many years. We saw 10 such patients over 4 years. One received oral isotretinoin 1 mg/kg per day, but was unable to tolerate the adverse effects of cheilitis and developed hyperlipidaemia. We subsequently treated nine others with oral isotretinoin, 0.25 mg/kg per day, for 6 months; in six the acne had virtually cleared by 3-4 months while the other three cleared by 6 months. Up to 36 months after therapy these patients have remained clear of acne except for one who relapsed after 11 months. Therefore, as these patients respond well with few side-effects both in the long- and short-term to low-dose isotretinoin, they should be treated with isotretinoin, although at the lower starting dose of 0.25 mg/kg per day compared with younger patients who are treated with 0.5-1 mg/kg per day, and the treatment maintained for 6 months.
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PMID:Acne vulgaris in the elderly: the response to low-dose isotretinoin. 976 56


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