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

From August 1988-June 1989, 983 physicians participated in a phase IV trial by following 7759 women using the monophasic oral contraceptive (OC), Demulen 1/35 (1 mg ethynodiol diacetate and 35 ug ethinyl estradiol) to evaluate its efficacy and safety. The total number of cycles for the study stood at 21,440. In addition, the total woman-years stood at 1787. Only 6382 patients could be evaluated for safety. 4.4% of the patients had adverse reactions to the OC, but only 1.7% of all patients stopped taking it. The leading side effects included nausea (67 cases), headache (45), amenorrhea (42), emotional changes (30), breast pain (19), dysmenorrhea (12), and 11 cases of weight gain, abdominal/pelvic pain, and bloating. Of the 280 reported adverse reactions, only 87 (31%) were considered severe. The leading serious adverse reactions were depression (10) and hypertension (6). Only 5412 patients could be used to determine efficacy. The physicians initially reported 121 (2.2%) pregnancies during the study. The researchers learned that 33 of the 84 returned 2nd questionnaires (response rate, 70%) reported that the women conceived after enrollment but before taking the OC. 36 conceived while taking it, but 8 did not take it daily. Noncompliance may have contributed to pregnancy for the remaining 28 cases. Therefore the 36 confirmed pregnancies made for a failure rate of .7%. 85.7% of the pregnancies happened in the 1st 3 months of taking the OC. Either patient noncompliance or true medication failure accounted for treatment failure. Therefore it is important for physicians to instruct patients on how to take OCs correctly.
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PMID:Efficacy and safety of ethynodiol diacetate, 1 mg, with ethinyl estradiol, 35 micrograms, with an emphasis on contraceptive efficacy. A phase IV trial. 204 81

490 women who used Stediril (.5 mg norgestrel and .05 mg ethinyl estradiol, combined) for a total of 5600 cycles or 466 woman-years over a 3 year period are presented. They all took the pills primairly for contraception; most were 20-30 years old, and took Stediril 3-6 months. Some other indications were 119 cases of menstrual irregularity, 15 of spaniomenorrhea, 14 of premenstrual syndrome and 3 of acne, all relieved. 46 of 50 cases of menorrhagia, 83 of 89 of dysmenorrhea and 32 of 34 with pelvic pain were relieved. Withdrawal bleeding was usually less than before and tended to diminish with time. There were 46 women with nausea, 3 of whom stopped Stediril. Migraines sometimes a ppeared, sometimes disappeared, but often occurred regularly on the first day between pill cycles. 52 women complained of breast congestion for the first time. Weight rose in 2301, fell in 98 and stayed constant in 134 after 3 months: weight was easily controlled with diet and appetite supressant drugs. No hypertension was observed. There were 19 single cycles of amenorrhea, several cases of persistant amenorrhea and 4 cases of amenorrhea after stopping. 2-3% of cycles were marked by metrorrhagia; 63 women had spotting, 8 had significant metrorrhagia; 7 had metrorrhagia followed by withdrawal bleeding in that cycle. 1 woman had a thromboembolism of the left leg after 2 pill cycles during which she gained 3 kg. There was 1 pregnancy due to irregular pill use.
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PMID:[Clinical study of an estro-progestative association in low doses. Experience of 3 years (490 patients-5600 cycles)]. 426 90

An integrated health and family planning program, operated by the University of Ife Teaching Hospital, was assessed to determine the impact of the integrated approach on family planning service utilization among the predominantly Yoruba residents of the city. In Nigeria, family planning services are generally delivered in clinics which have little or no connection with medical facilities, and service utilization is low. In 1979 the hospital decided to include family planning as part of the routine medical services provided at its 8 clinics located within a 25 kilometer radius of the hospital. Staff members at the clinics were trained in family planning. Trained female fieldworkers conducted motivational activities to encourage the women in the community to use the family planning services of the clinic. The program provided women with an opportunity to obtain contraceptives in a familiar setting and as part of their routine medical care. Neither parental nor spousal consent was required. Yoruba men tend to oppose family planning. Data for the study was obtained from the records of the program's 1495 new acceptors served by the program during its first 2 years of operation. 50.6% of the acceptors were 25-34 years of age, and another 31.7% were between 35-44 years of age. Very few teenagers utilized the services. 96% of the wome were married and they had an average of 4.4 living children. 56% were Catholic, 25% were Protestant, and 16% were Muslim. 37% were illiterate, and another 42.5% could barely read or write. Most were wives of government workers or service men. 88% had never used a modern contraceptive, and 94.5% were not using a method at the time of their first clinic visit. 68.4% of the acceptors were referred to the clinic by the fieldworkers or other health personnel. Only 11.2% sought the services on their own. 85% of the acceptors choose oral contraceptives (OCs), 13% had IUDs inserted, 0.3% were sterilized, and the remaining 2% chose other methods. The low sterilization rate probably reflected the fact that spousal consent was required for sterilization. Side effects reported by the OC users included asthma (9.6%), headaches (5.2%), phlebitis (3.5%), jaundice (1.7%), chest pain (1.5%), depression (1.5%), scanty menses (0.8%), and high blood pressure (0.4%). Among IUD users, 10.8% had intermenstrual bleeding, 18.4% reported pelvic pain, and another 6.8% reported a variety of other problems. 42.1% of the acceptors wanted no more children, and the remainder wanted to avoid the hardships associated with traditional methods of spacing. Correlation analysis revealed that the total number of living children was negatively related to maternal education and that women with sons wanted significantly fewer additional children than women with fewer or no sons. 51% of the acceptors were continuing contraceptive use at the time of the study. The study confirmed the feasibility of an integrated approach. The findings should be of use to government officials who want to improve service utilization in the national family planning program.
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PMID:Integrated family planning services: a Nigerian experience. 651 Mar 20

102 patients using Trinordiol, a triphasic oral contraceptive (OC) containing ethinyl estradiol and d-norgestrel, were followed for 932 cycles in a study of secondary effects. Follow-up visits were scheduled after 1,3, and 6 months and every 6 months thereafter. 26 patients discontinued use of the pills during the study after using them for a total of 159 cycles. 5 discontinued because of abdominal pain, 1 for breast tenderness, and 1 because of headaches or migraines. 7 discontinued because of metrorrhagia, 4 for weight gain, 3 for amenorrhea, 2 for nausea and vomiting, and 1 each for nervousness, water retention, acne, desire for pregnancy, leaving the country, hypertension, and unknown motivation. the average age of patients was 23.6 years, with a range from 14-48. 76% were aged 15-29 years. 52.9% were nulliparas. 58.8% were Belgian, 21.6% were from Mediterranean Europe, 10.8% were Moroccan, and 7.9% were from black Africa. Only 1 patient, a 37 year old, developed hypertension. 15 patients gained more than 2 kg and 17 lost more than 2 kg. 15.8% complained of spotting during the 1st cycle compared to 3.1% during the 6th cycle, 5.2% during cycle 7-12, and 9.1% during cycle 13-30. Among 35 patients who did not discontinue treatment, 7 complained of amenorrhea and 1 of scanty menstrual bleeding, 14 of pain including 7 cases of pelvic pain, 2 of dysmenorrhea, 3 of breast tenderness, and 2 of headaches, 15 of leukorrhea, 3 of nausea, 2 of dizziness, and 1 each of fatigue, acne, galactorrhea, and cutaneous pruritus. 1 case of myoma at the level of the uterine cornu was identified after 24 cycles of treatment. In all, 61 patients had some complaint, while 41 were totally satisfied. No patient became pregnant during the study.
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PMID:[Clinical study of the secondary effects associated with taking a triphasic anti-ovulatory contraceptive]. 670 4

This article, arguing that consumers have a right to be informed about the dangers of health care measures, discusses the health risks of oral contraceptives (OCs) and IUDs. In a brief review of the history of contraceptive development and use, it is stated that the 1st OC was tested on only 132 women in Puerto Rico before being approved for commercial use. OCs, which inhibit ovulation, sperm penetration, and implantation of the egg, represent the surest and most convenient contraceptive yet developed. Despite their advantages, pills may cause various secondary effects such as spotting, water retention, irritability, nervousness, nausea, vaginitis, migraine headaches, hypertension, and others, whose alleviation is responsible for large additional profits to the pharmaceutical industry. Although results are difficult to interpret and the passage of time may not have been sufficient, disquieting indications of a possible carcinogenic effect of OCs have been noted. The pill has been implicated in an elevated incidence of thromboembolism and is known to influence the metabolism of some substances, and the list of contraindications for pill use is long. Women wishing to use pills should consult a conscientious physician who will take a complete medical history, perform a thorough physical, and furnish complete information on the risks of pill use. IUD mode of action is incompletely understood. Fewer than 2/3 of women accepting IUDS are able to tolerate them for more than 1 year, from 7 to 20% of IUDs are spontaneously expelled, and from 3-35% are removed at the request of the client for pelvic pain and bleeding. Another 4-15% are removed each year for other medical reasons. IUD related mortality is less than that related to OCs, but a series of secondary effects and contraindications are associated with their use. If a woman chooses to use an IUD despite everything, she should choose a physician experienced in IUD insertion who is not experimenting with a new type of device. The preference for powerful contraceptives has caused women to excuse men from sharing in the responsibility for birth control, among other deleterious effects.
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PMID:[Contraception: yes, but at what cost?]. 675 25

A 32-year-old woman was bedridden for a year because of chronic pain and headaches. She had insomnia, depression, suicidal thoughts and a severe chemical allergy. She had been on steroid therapy for two years and became Cushingoid with striae in the arm pits, groins and abdomen. However, she had no hypertension, nor the buffalo fat and hirsutism. She was very edematous, with a weight gain from 112 to 180 lbs. The fluid retention did not conform to the syndrome of inappropriate antidiuretic hormone. Studies revealed abnormal scalp EEG discharges and high-voltage seizure discharges in the posterior thalamus. Electrothalamic stimulation suppressed the thalamic discharges and relieved the patient's pelvic pain and headaches. After one month of several thalamic stimulations per day, she was able to get out of bed and ambulate. In addition, the patient no longer was edematous and was tolerating perfumes and floor detergents. Steroids were progressively reduced without complications of withdrawal. She went from a completely steroid dependent state to independent during the first 1-1/2 yrs of thalamic stimulation. With continued thalamic stimulation she has done well for 8-1/2 yrs, weighs 112 lbs, keeps house and drives a car. It's speculated the illness is a chronic pain multiple syndrome predominantly due to mesothalamic discharges and body infirmities. The mesothalamic discharge implicated neural networks, which represent biologic systems, i.e. pain, sleep, fluid retention, etc. Therapeutic stimulation attenuates the discharges and the neural networks return to their normal set points of homeostasis.
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PMID:Mesothalamic discharge in a chronic pain, allergy and fluid retention syndrome (case report). 766 2

Caudal block with a local anesthetic through the hiatus sacralis has been performed in patients with chronic low back pain, lower limb pain, anal pain, and pelvic pain due to spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, postherpetic neuralgia, peripheral vascular disease, complex regional pain syndrome and so on. We prepar- ed an information and consent sheet on caudal block in The University of Tokyo Hospital. In the information sheet, we included disease, purpose, methods, outcome, accidental complications of caudal block, other treatments, progress on unperformed case, questions and answers, influence of rejection, and doctor's name. We experienced some cases of boring pain, deterioration of low back pain and lower limb pain, headache, nausea, hypertension, hypotension, and tachycardia as accidental complications of caudal block. In describing some accidental complications, we included boring pain, high intracranial pressure, dural puncture, nerve injury, infection, hemorrhage, embolism, allergy, and heart, lung, brain, liver, and kidney failures. Further, we could refer to the accidental complications of epidural block. However, the rate of each accidental complication has not been known in detail. We should survey the outcome and accidental complication of caudal block prospectively in multiple facilities and provide the patients with useful information.
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PMID:[Information and consent sheet of caudal block in the University of Tokyo Hospital]. 1678 90

The incidence of uterine fibroid tumors increases as women grow older, and they may occur in more than 30 percent of women 40 to 60 years of age. Risk factors include nulliparity, obesity, family history, black race, and hypertension. Many tumors are asymptomatic and may be diagnosed incidentally. Although a causal relationship has not been established, fibroid tumors are associated with menorrhagia, pelvic pain, pelvic or urinary obstructive symptoms, infertility, and pregnancy loss. Transvaginal ultrasonography, magnetic resonance imaging, sonohysterography, and hysteroscopy are available to evaluate the size and position of tumors. Ultrasonography should be used initially because it is the least invasive and most cost-effective investigation. Treatment options include hysterectomy, myomectomy, uterine artery embolization, myolysis, and medical therapy. Treatment must be individualized based on such considerations as the presence and severity of symptoms, the patient's desire for definitive treatment, the desire to preserve childbearing capacity, the importance of uterine preservation, infertility related to uterine cavity distortions, and previous pregnancy complications related to fibroid tumors.
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PMID:Uterine fibroid tumors: diagnosis and treatment. 1755 38

Many risk factors have been implicated in the pathogenesis of erectile dysfunction (ED), but it is not clearly evident which of these factors are more relevant among the young population. The aim of this project was to find the most significant risk factors for this disease in young patients. We included 434 patients with organic ED younger than 40 years and 272 age-matched controls. All participants had their complete history taken (including the International Index of Erectile Function-5 [IIEF-5]) and underwent physical examination and some laboratory investigations. Univariate analysis was then applied to study the significance of the following factors in the predisposition of ED: smoking, use of recreational drugs, obesity, dyslipidemia, diabetes mellitus, hypertension, coronary heart disease, and chronic pelvic pain syndrome. This analysis showed that smoking, use of recreational drugs, dyslipidemia, hypertension, and obesity were the significant factors (P < .05 for each factor). When these significant factors were studied in the multivariate model, the only factors that sustained the statistical significance were smoking (P < .05; odds ratio [OR], 1.78; 95% confidence interval [95% CI], 1.16-2.72) and use of recreational drugs (P < .05; OR, 3.18; 95% CI, 1.15-8.82). In addition, a negative correlation was detected between the smoking index of the impotent patients and their IIEF-5 score (r(2) = 0.67; P < .05). In conclusion, smoking and the use of recreational drugs are the most significant risk factors for organic ED in patients younger than 40 years.
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PMID:Analysis of risk factors for organic erectile dysfunction in Egyptian patients under the age of 40 years. 1923 10

Primary care physicians often prescribe contraceptives to women of reproductive age with comorbidities. Novel delivery systems (e.g., contraceptive patch, contraceptive ring, single-rod implantable device) may change traditional risk and benefit profiles in women with comorbidities. Effective contraceptive counseling requires an understanding of a woman's preferences and medical history, as well as the risks, benefits, adverse effects, and contraindications of each method. Noncontraceptive benefits of combined hormonal contraceptives, such as oral contraceptive pills, include regulated menses, decreased dysmenorrhea, and diminished premenstrual dysphoric disorder. Oral contraceptive pills may be used safely in women with a range of medical conditions, including well-controlled hypertension, uncomplicated diabetes mellitus, depression, and uncomplicated valvular heart disease. However, women older than 35 years who smoke should avoid oral contraceptive pills. Contraceptives containing estrogen, which can increase thrombotic risk, should be avoided in women with a history of venous thromboembolism, stroke, cardiovascular disease, or peripheral vascular disease. Progestin-only contraceptives are recommended for women with contraindications to estrogen. Depo-Provera, a long-acting injectable contraceptive, may be preferred in women with sickle cell disease because it reduces the frequency of painful crises. Because of the interaction between antiepileptics and oral contraceptive pills, Depo-Provera may also be considered in women with epilepsy. Implanon, the single-rod implantable contraceptive device, may reduce symptoms of dysmenorrhea. Mirena, the levonorgestrel-containing intrauterine contraceptive system, is an option for women with menorrhagia, endometriosis, or chronic pelvic pain.
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PMID:Contraception choices in women with underlying medical conditions. 2176 49


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