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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Certain physiological and pathological conditions in women require choice of a contraceptive method that will not aggravate the condition or exacerbate known side effects. IUDs and oral contraceptives (OCs) are not appropriate for the immediate postpartum. Low dose progestins appear best suited and can be started on the 5th day after delivery. IUDs and high dose discontinuous progestins are the best choices for the menopausal period, but contraindications to them must be respected. Contraception with a dominant progestational climate is required in case of benign breast disease. Low dose progestins may cause luteal insufficiency and low dose combined OCs may allow endogenous estradiol secretion poorly balanced by the progestin. All progestin-dominant formulations and discontinuous 19-norsteroids may be used. 19-norsteroids appear suitable for women with breast cancer because of their antiestrogenic activity. High dose progestins are advisable for women with precancerous or cancerous endometrial pathology. Estrogens should be avoided in such cases. Cervical cancer has never been proven to be hormonodependent, and at present the use of hormonal contraception in cervical dysplasia is not contraindicated except after pelvic radiation for invasive cancer. Use of the IUD has the same indications as for the general population after lesions have been treated. In cases of hyperlipidemia, low doses of continuously administered 19-norsteroids cause a decline of high density lipoprotein (HDL) cholesterol but are considered to be without longterm metabolic effects. The new progestin desogestrel does not diminish HDL cholesterol. Many cases of hyperlipidemia and hypercholesterolemia contraindicate OCs at the usual dose and require mechanical contraception, although low dose progestins may be considered. Derivatives of 17-hydroxyprogesterone are without effects on lipid metabolism but are less reliable. No contraceptive method is fully satisfactory for diabetics. Hormonal contraception is risky because of possible metabolic and vascular effects. Low dose progestins have the fewest side effects but are often poorly tolerated. IUDs are often used for diabetics despite possible increased risks of infection and failure. Hypertensive women should not use combined OCs or high-dose 19-norsteroids, but low dose progestins carry no risk of hypertension. Women at vascular risk are advised to use IUDs if no specific contraindications are found. Otherwise low-dose progestins are an acceptable choice. Low dose progestins are often the only possibility for cardiac patients. Nonhypertensive women with renal insufficiency can use OCs under careful supervision if there are no contraindications. Combined OCs are contraindicated when there is any disturbance of hepatic function, but low dose progestins or mechanical means are acceptable. Chronic use of certain drugs which act as enzymatic inductors is incompatible with hormonal contraception.
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PMID:[Contraception at risk]. 365 96

We consider a study of MZ and DZ twin pairs ascertained because one or both twins have a disease. Genotypes at a major locus are known and putative environmental risk factors have been measured for all individuals. The power of the study to estimate the effect on liability of the measured and residual genetic and environmental effects (Gm, Gr, Em, Er) and all two-way interactions between them (except Gr X Er) is estimated by simulation. If liabilities can be indexed on a continuous scale (eg, blood pressure as an index of liability to hypertension), then a study of 600 MZ and 600 DZ pairs would have sufficient power to detect quite subtle interaction effects, even if ascertainment is greatly biased toward MZ twins. If liabilities cannot be measured and only affection status is known, then the power of the study would be much lower, although not impracticably so. There appears to be no advantage in augmenting the twins with a sample of control individuals who have been drawn at random from the population regardless of disease status, at least for the case we have considered in which the disease threshold on the liability scale is assumed to be known without error. The argument is developed in terms of the utility of the design for research into breast cancer.
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PMID:Prospects for detecting genotype X environment interactions in twins with breast cancer. 367 76

Adolescents constitute a particular group of patients because of their young age and incomplete or erroneous knowledge of contraception and reproduction. The physical condition of a young girl and the medical history of her close relatives must be assessed in the contraception consultation. In the absence of obvious contraindications such as hypertension, diabetes, hypercholesterolemia or renal insufficiency, oral contraceptives (OCs) are most often indicated, whether or not the menstrual cycle is well established. It has been demonstrated that the hypothalamus resumes its previous activity when OC use is discontinued. Standard-dosed combined OCs are usually recommended, because low-dose formulations do not always sufficiently block the hypothalamus and may induce a state of relative hyperestrogenism. Girls with benign breast disease or whose mothers have histories of breast cancer may benefit from the antigonadotropic properties of a 19-nortestosterone derivative progestin administered from the 8th to the 25th cycle days. Some 19-nortestosterone derivatives can cause seborrhea, acne, or hair loss. Sequential OCs may be indicated at this age for temporary use in exceptional cases. Low-dose progestins are not completely effective and cause worrisome menstrual problems. In cases of renal insufficiency, lupus, or hypertension, derivatives of 17-OH progesterone can be used. Cyproterone acetate is indicated for adolescents with hirsutism. Barrier methods are not used by adolescents as often as the less reliable but simpler ovules or jellies. The diaphragm with jelly or the condom correctly used are the most reliable, but they have a bad reputation. Information campaigns have successfully promoted use in some countries. IUDs are strongly contraindicated for all young girls because of increased risks of infection and sexually transmitted diseases. In extreme necessity they may be used for mentally ill adolescents unable to use any other method.
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PMID:[Contraceptive methods for adolescents]. 385 20

The relationship of clinically defined menstrual categories and an independent measure of hormonal stimulation, maturation index of vaginal smear cytology, was studied. Analysis of 596 smears obtained at the time of breast cancer diagnosis revealed a statistically significant association between menstrual status and maturation index. However, within each menstrual group varying levels of maturation were noted. Estrogenic effect in the absence of exogenous hormone administration was found in 11% of patients following bilateral oophorectomy and among 24% of women whose natural menopause occurred 20 years or longer prior to diagnosis. Endogenous estrogen production appears to continue for many years among some women. Clinical factors such as obesity, diabetes and/or hypertension may stimulate high squamous maturation in some patients. Others of the same age and with similar clinical histories were found to have atrophic smears. The differences in maturation index may be due to individual variations in: endogenous hormone levels; sensitivity of the vaginal mucosa to similar hormonal stimuli; use of certain medications; or unidentified exogenous factors. The maturation index was found to be significantly associated with the following prognostic factors: weight relative to height, tumor size and estrogen receptor content of the primary tumor. These findings indicate that vaginal smear cytology may define specific subsets within menstrual categories which may be relevant to therapy and prognosis in breast cancer.
Breast Cancer Res Treat 1985
PMID:Association of vaginal smear cytology with menstrual status in breast cancer. 402 97

Although reserpine has an important role in treating patients with hypertension, its appeal was sharply reduced a decade ago when an alleged relationship to breast cancer was reported in case-control studies. Since the relationship was not confirmed in subsequent research and analyses, the original association is now regarded as erroneous. Since patients with cardiovascular disease were rejected as possible controls in the original reserpine-breast cancer case-control study, we suspected that the false association may have been produced by a phenomenon called exclusion bias. This bias can arise in case-control studies if patients with a particularly high (or low) rate of prior exposure to the alleged etiologic agent are excluded from the selection of either cases or controls, but not from both. To test that suspicion, we recapitulated the original study, in another medical setting. The cases were 257 women with breast cancer; and the controls were 257 hospitalized women matched according to date of admission, age, and race. The overall data showed no association between reserpine and breast cancer (odds ratio [OR] = 1.1), but when we excluded 101 women with cardiovascular disease from the control group, the OR rose to 2.5. The results suggest that exclusion bias played an important role in creating the false association between reserpine and breast cancer.
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PMID:Exclusion bias and the false relationship of reserpine and breast cancer. 403 48

Over a period of 13 years, 353 cases of metastases in the brain, spinal canal or peripheral nerves were treated in 14,350 inpatients. In 79.6% of the cases, the metastases were localized intracranially, in 14.7% spinally, in 2.6% peripherally and in 3.1% in several of these sites. Solitary tumors predominated (65.7%). Of 420 intracranial metastases, 336 were located supratentorially (80%) with a slight preponderance on the left side (54.5%), 15% cerebellar, and 5% in the brainstem. Of the spinal metastases, 80% were located in the thoracic spinal cord. Almost 60% of the cases also displayed metastases outside the nervous system, mainly in the skeletal system and the lungs. The most frequent primary tumor was bronchial carcinoma (26,6%) followed by breast cancer (19.5%) and unknown primary tumor (17.6%), which was also not found on autopsy in 0.8%. Rare primary tumors were parotid and pancreatic carcinomas, testicular and bladder tumors. There are correlations between the primary tumor and the location of the metastases in the nervous system in general and in the brain in particular. The latency between diagnosis of the primary tumor and that of the metastasis was 1-3 years. In one out of three cases, the metastasis in the nervous system was the first sign of the tumor condition. In six cases, the metastasis was removed before the primary tumor and two possible kinds of primary tumors were found in seven cases. Compared to intracranial hypertension focal deficit manifestations including focal convulsions occurred twice as frequently in cerebral metastases. Spinal metastases led to CSF blockade in 20%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Metastases to the nervous system]. 405 15

Norinyl 1+50 oral contraceptive pills contain 1 mg of the progestin, norethindrone, and .05 mg (or 50 mcg) of the estrogen, mestranol. These pills can either be taken in 21-day or 28-day therapy cycles. This dosage is low but effective. Oral contraception is supposed to prevent pregnancy by suppressing ovulation and by causing changes in the endometrium and cervical mucus. Contraindications are: 1) a history of thrombosis or cerebral disorders, 2) liver dysfunction, 3) suspected breast cancer, 4) suspected estrogen-dependent neoplasia, and 5) undiagnosed abnormal genital bleeding. Close surveillance of women taking oral contraceptives is recommended. The areas to be closely examined periodically are listed. Adverse reactions and warning signs are enumerated. A warning is issued of increased risk of the following conditions due to oral contraceptive therapy: 1) thrombotic disorders, 2) neuroocular lesions, and 3) fluid retention and hypertension.
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PMID:Avoidance of dual publication. Statement by the Council of Biology Editors. 468 30

120 women with carcinoma of the breast were matched in a matched pairs analysis to 120 women as a control group. The estrogen use patterns for these women were determined after the matching and the relative risk (RR) of developing breast cancer during estrogen use was determined. The RR of developing breast cancer was increased significantly among patients who used conjugated estrogens. The RR did not increase as the length of estrogen use increased. Estradiol use caused a non-significant increase in the RR of developing breast cancer. Nulligravidity, hypertension, and obesity did not increase the RR of developing breast cancer during estrogen use.
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PMID:[Estrogen therapy in carcinoma of the breast (author's transl)]. 624 9

4 kinds of progestin only oral contraceptives (OCs) and numerous combined OCs containing ethinyl estradiol (EE) or occasionally mestranol and either norgestrel or norethindrone are currently available in Australia. All progestins except norgestrel are effective in vivo after metabolism to norethindrone. Mestranol is effective in the human after demethylation to EE. The main side effects of OCs, including menstrual disturbances and changes in weight and mood, are primarily of nuisance value. Menstrual blood loss with OCs is almost invariably less than during spontaneous menses, but breakthrough bleeding and midcycle spotting may cause concern in patients. Amenorrhea and weight gain are rare with low dose pills. Approximately 6 in 1000 women remain anovulatory for 12 months or more after discontinuing OCs, but it is not yet know whether the amenorrhea is related to pill use and it is usually corrected by induction of ovulation. Cardiovascular side effects including venous thrombosis and pulmonary embolism are seen less frequently with new lower dose pills. The effects of OCs on the cardiovascular system are complex and depend on the interaction of estrogen and progestin. Amounts of estrogen and progestin should be the lowest possible to prevent ovulation, and routine monitoring should be provided for all women using pills. Older high dose formulations altered lipid metabolism in the direction of greater risk of coronary heart disease. Although research suggests the lowest dose triphasic pills have no significant effect, not enough large studies have been done with matched controls. Any effects on carbohydrate metabolism of the low dose pills are apparently minor and of little clinical significance. Insulin dependent diabetics with adequate supervision may safely use low dose pills. Combined OCs reduce the incidence of endometrial and ovarian malignancy. No relationship between OCs and the risk of breast cancer has been demonstrated except possibly in women under 35 when the cancer developed. The risk of intraepithelial neoplasia may be increased in women taking OCs for more than 8 years. Data on drug interactions are inconclusive, but women on rifampicin should use some other method. Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation. Progestin only OCs have a higher rate of failure and irregular bleeding than combined pills and their main use is for breastfeeding women and those with contraindications to estrogen. The pill of 1st choice should be a triphasic low-dose formulation.
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PMID:Oral contraceptives. 650 52

With a view of the prevention as well as treatment of cancer and other diseases, it is important to quantify health positively and on an individual basis by chronobiologic methods. These include the assessment of the characteristics of certain circadian, circannual and other endocrine rhythms and trends, for the recognition of risk (prior to the occurrence of a given disease) by an alteration of the same rhythm characteristics and even by a time-specified single sample. With this aim in mind, a small number of selected (rather than randomly picked) women of 3 age groups was extensively sampled for 12 plasma hormones around the clock and the calendar, in 2 geographic locations. Such data revealed correlations of the familial risk of developing breast cancer with the circannual amplitudes of circulating prolactin and TSH. The risk of several other conditions was also correlated with hormonal rhythm characteristics; for example, the risk of developing diseases associated with a high blood pressure was correlated with the circannual amplitude of plasma aldosterone. The mapping of circannual characteristics, however, is time-consuming and costly and may not be warranted as a first step, for example when a physician is not in a position to wait for a year to make a diagnosis. With the possibility in mind that sampling requirements may be reduced to one or at most two samples, a chronobiologic pattern discrimination analysis was undertaken on the original data from young adults. The results are presented to indicate the method and to suggest the singling-out of certain variables for further testing on a larger, properly stratified and randomized sample, rather than as definitive results. Different classifiers and different corresponding reference values from variables that undergo circadian and circannual rhythms may perhaps withstand the test (and, with Vergil, the tooth) of time. If so, reference values that are time-specified may well prove to be a sine qua non in the assessment of certain neuroendocrine aspects of developing certain diseases, including breast cancer.
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PMID:Toward chronobiologic pattern discrimination of the risk of developing breast cancer and other diseases. 676 84


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