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

A summary of what is currently known about the negative side effects associated with oral contraceptive usage is presented, and recommendations for prescribing OCs (oral contraceptives) are made. According to the results of several investigations, 2-18% of all women who take OCs develop hypertension. For most of these women the effects are mild; however, for some the increase in blood pressure is marked and results in renal damage. Several studies demonstrate that the risk of peripheral venous thrombosis and pulmonary embolism is enhanced for women who use OCs compared to nonusers. The risk is somewhat reduced for those who take low estrogen OCs. Women aged 30-39, who take OCs, are 3 times more likely to suffer a myocardial infarction than those who do not use OCs. This risk is markedly increased among OC users who either smoke or suffer from hypertension, diabetes, or hypercholesterolemia. OC users have a 9.5 times greater risk of thrombolic stroke and a 2.0 times greater risk of hemorrhagic stroke than nonusers. For women over 27 years of age, OC usage is associated with the development of benign hepatic adenoma. This risk increases markedly with duration of pill use and is greater for women who take pills containing mestranol compared to those who take pills containing ethinyl estradiol. Occasionally cases of pulmonary hypertension, peripheral arterial occlusion, mesenteric vascular insufficiency, Budd-Chiari syndrome, and noninflammatory cholestatic liver injury are reported among OC users. Recommendations are: 1) women with thromboembolic disorders and women over 34 years old, who smoke or who are obese or hypertensive should be advised to consider other forms of contraception; 2) prescriptions should be written for a 6 month supply and renewed only after a follow-up visit; 3) women who experience elevated blood pressure readings should be advised to discontinue usage; 4) serum triglyceride and cholesterol should be checked every 6 months; and 5) consider the use of low dose heparin for OC users who are recovering from trauma or surgery or who are confined to bed for long periods of time.
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PMID:A review: adverse effects of oral contraceptives. 22 69

An 86-year-old man with previous normal renal function was hospitalized because of renal insufficiency. He had a long history of atherosclerotic heart disease, mild hypertension and pulmonary embolism, requiring anticoagulant therapy. In view of the normal-sized kidneys and absence of casts in the urinary sediment, a diagnosis of atheroembolic renal disease was made. The patient's renal function deteriorated, but he refused hemodialysis. Death occurred within a few weeks. At autopsy, severe aortic atherosclerosis was observed and atheroembolic renal disease was confirmed as the cause of renal failure. Occasionally, renal failure can be the sole manifestation of spontaneous atheroembolic disease. This possibility should be considered if the physician is called upon to establish the diagnosis when renal insufficiency develops in atherosclerotic patients.
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PMID:"Spontaneous" atheroembolic disease as a cause of renal failure in the elderly. 46 53

Pulmonary emboli seldom recur, and when recurrence does occur it is not associated with permanent sequelae unless there is progressive pulmonary arterial hypertension. Five patients with clinical and perfusion lung scan evidence of recurrent pulmonary embolism presented with abnormal cardiac rhythms without evidence of progressive pulmonary hypertension. Twenty-four-hour ambulatory electrocardiographic monitoring was valuable in diagnosis and in assessing the effectiveness of treatment. Although palpitation was the main complaint, other symptoms included tiredness, mild exertional dyspnoea, and chest discomfort unrelated to effort. Symptomatic improvement coincided with objective evidence of improvement from repeat lung scans and 24-hour ECG records. Antiarrhythmic agents controlled the arrhythmias but were subsequently withdrawn without the return of symptoms. Four of the five patients continued to take anticoagulants for two years. We believe that these five patients represent a group of patients with recurrent pulmonary emboli and a recognisable clinical picture dominated by arrhythmias unrelated to progressive pulmonary arterial hypertension. Long-term anticoagulant treatment was associated with clinical improvement.
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PMID:Recurrent pulmonary thromboembolism presenting with cardiac arrhythmias. 48 14

In the period 1953 - 1977 there were 223 maternal deaths among 291 800 patients delivered in hospitals under the aegis of the Department of Obstetrics and Gynaecology of the University of Cape Town. A sudden decrease in the maternal mortality rate to below 100/100,000 deliveries occurred in 1956, largely due to the greater use of the obstetric 'flying squad'. Since 1975 maternal mortality rates have been available for the various ethnic groups. For the period 1975 - 1977 the rates were 69/100,000 for Blacks, 40/100,000 for Coloureds and 27/100000 for Whites. Of the deaths, 48% occurred in women aged 21 - 30 years and 29% in those aged 35 years or more. While 28% of deaths were associated with the first pregnancy, grand multiparity (parity 5 or more) accounted for 39%. Nearly half of the patients who died were unbooked. The 7 commonest causes (grouped) of maternal deaths (obstetric as well as non-obstetric) were, in rank order: proteinuric hypertension, haemorrhage, cardiac disease, pulmonary embolism, sepsis, trauma and anaesthetic complications. Proteinuric hypertension is the most important obstetric problem in Cape Town, in terms of numbers of patients, maternal and perinatal deaths, and socio-economic implications for the community. Slightly more than 33% of the infants whose mothers died also succumbed. Major avoidable factors associated with maternal deaths were booking status, grand multiparity, cardiac disease and late or incorrect use of the 'flying squad'.
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PMID:Trends in maternal mortality in Cape Town, 1953-1977. 55 Mar 98

A urinary tract infection with possible septicemia and endocarditis developed in a 36-year-old man. The illness was complicated by pulmonary embolism, thrombocytopenia, hematemesis, hepatic dysfunction, paralytic ileus and accelerated hypertension. The latter finding suggested pheochromocytoma. Treatment with antibiotics and phenoxybenzamine hydrochloride was associated with notable clinical improvement. A chromaffin cell tumor was surgically removed above the lift kidney. Conclusively, a pheochromocytoma may mimic and be present in association with infection.
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PMID:Infection and pheochromocytoma. 57 92

Hospital lethality was studied in myocardial infarction which was 24.9 per cent for the period 1973--1976 with a decreasing tendency during the last two years. The study covers 134 deceased of myocardial infarction at an average age of 70,78, their pathologoanatomical findings in the coronary arteries and localization of the nectrotic zone. In 49,26 per cent the case was that of repeated myocardial infarction, thus raising the lethality in the first 24 hours after hospital admission with 70,9 dead up to the 7th day. The analysis of the lethality causes revealed that according to the relative share they were as follows: acute cardiovascular failure, cardiac rupture, acute rhythm and conductivity disturbances, pulmonary embolism, inflammatory lung diseases, etc. No correlation was found between arterial hypertension, cigarette smoking and diabetes mellitus and the leading lethality cause.
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PMID:[Analysis of hospital mortality in myocardial infarct]. 65 23

Thrombosis of the cranial vena cava in a cow was followed by the formation of aneurysms in the pulmonary arteries. Embolism, pulmonary hypertension and the development of a collateral venous and lymphatic circulation are the suggested causes of these uncommon arterial lesions.
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PMID:Thrombosis of the cranial vena cava in a cow. 91 1

Two hundred eighty patients were admitted to an intensive care stroke unit over a one-year period. Subsequent investigation indicated that only 199 of these patients actually had cerebral ischemic or hemorrhagic lesions, 10 had other cerebrovascular lesions, and the remaining 71 patients had unrelated diseases, predominantly seizures. Detailed analysis of 103 stroke patients revealed an overall incidence of 59% hypertension, and 72% had hypertensive, ischemic or valvular heart disease. Fifty percent of the patients had various cardiac arrhythmias, some of which were responsible for the acute cerebrovascular lesion. Fourteen patients died during the acute phase, 11 from apparently irreversible cerebral selling, mainly due to cerebral hemorrhage. Secondary complications such as pneumonia, pulmonary embolism, pressure sores and urinary infection were almost nonexistent, but beneficial effects on the primary cerebral lesions were more difficult to demonstrate.
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PMID:Intensive care management of stroke patients. 100 32

This study attempts to collect reliable data on maternal deaths, estimate maternal mortality rate for the western state of Nigeria, and identify major causes of maternal deaths in the state. Standardized questionnaires were sent to randomly selected medical institutions (5 specialist hospitals and 25 general/district hospitals) in the state; only 23 institutions (4 specialist and 19 district/general hospitals) completed the questionnaires. The results show that maternal mortality ranged from 0/1000-13.3/1000 total births in 1972 and 0/1000-11.0/1000 total births in 1973; overall maternal mortality rate was 3.8/1000 in 1972 and 4.7/1000 in 1973. Mortality was higher among unbooked patients, accounting for 71.2% and 66.4% of total deaths in 1972 and 1973. Hemorrhage (antepartum and postpartum), obstructed labor (uterus unruptured and ruptured), eclampsia and anemia of pregnancy accounted for over 80% of total deaths. Nonobstetric causes of maternal deaths including poisoning, infective hepatitis, meningitis, encephalitis, bronchial asthma, hypertension, and pulmonary embolism. The major causes of death in this series were preventable. Maternal mortality is associated with age, parity, and past reproductive and medical history. The high maternal death rate in this study is compounded by nonutilization of available medical services by pregnant women most especially for antenatal care, the lack of basic essential life-saving facilities (e.g., for blood transfusion), lack of adequate transportation system, failure of medical/nursing personnel to refer patients early to specialist hospitals, and relative lack of obstetric services both in quality and quantity all over the country. Better coordination and integration of health services are needed, as are nationwide data collection of maternal death statistics, publication of periodical reports, and establishment of standards for overall maternity care.
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PMID:Maternal mortality in Western Nigeria. 108 Dec 90

Left heart diseases, in particular mitral stenosis, are often associated with anatomic and functional alterations of the lung. According to the pulmonary structures involved they could be named chronic secondary intersticial and vascular lung diseases. Congenital heart diseases with pre- or post-tricuspid shunts are also often associated with anatomic and functional alterations of the lung. This condition also constitutes a chronic secondary vascular lung disease (atrial septal defect) or a chronic primary vascular lung disease ( ventricular septal defect, patent ductus arteriosus). Primary lung diseases (interstitial pulmonary fibrosis, pulmonary emphysema, recurrent pulmonary embolism) are often associated with right ventricular hypertrophy with or without dilation, a condition commonly named chronic cor pulmonale. On the whole the interrelationships between heart and lung diseases are as follows: a) anatomic and functional alterations of the lung due to left heart diseases are mediated through pulmonary venous hypertension; b) anatomic and functional alterations of the lung due to congenital heart diseases are mediated through the increased pulmonary blood flow with or without transmission of the systemic blood pressure to the pulmonary vasculature, and c) anatomic and functional alterations of the right ventricle due to primary or secondary lung diseases are mediated through arterial pulmonary hypertension. In summary, the interrelationships between heart and lung diseases are mainly mediated through the pulmonary venous or pulmonary arterial hypertension.
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PMID:Cardiac and pulmonary diseases. A pathophysiologic interelationship. 113 Sep 7


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