Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A sudden hearing loss (SHL) research clinic to which 30 members of an ENT Society refer patients, accumulates information about incidence, prognosis, recovery patterns, and treatment of SHL. The diagnostic protocol includes laboratory, audiometric, and radiologic studies; patients are followed for a minimum of 10 months. Among 76 patients seen in 1973, the diagnosis of idiopathic SHL was retained in 52; more specific diagnoses were established in 24. The incidence of SHL in the general population is estimated at 10.7 cases per 100,000. Although the therapeutic protocol was individualized, all patients with idiopathic SHL were advised to restrict dietary sodium, to discontinue use of stimulants, and were given instructions regarding activity. Twenty-six patients received prednisone. Results indicate that prednisone may have a beneficial effect when administered before the 10th day of SHL. Increasing age, hypertension, diabetes, and severe vertigo were found to be poor prognostic indicators. Outcome was significantly better in patients seen early in the course of their illness than in those seen later. Possible etiologic factors include vascular dysfunction and inflammatory response. Further studies of controlled series are needed to establish standards for diagnosis of SHL and its recovery pattern.
 ...
PMID:Seventy-six cases of presumed sudden hearing loss occurring in 1973: prognosis and incidence. 85 Apr 55

The purpose of prescribing combined oral contraceptives (OCs) is achievement of good cycle control and effective contraception with the least side effects, using an OC with the lowest possible dose of estrogen. Triphasil, Triquilar, Nordette, Microgynon 30, and Brevinor are good 1st choices because of the low estrogen dose (30-35 mcg). Women who probably cannot tolerate breakthrough bleeding and who need simple packaging should use a monophasic, more progestogenic OC, e.g., Nordette or Microgynon 30. Physicians should suggest a low dose estrogen and low dose antiandrogenic progestogen (OC) (e.g., Diane-35 ED) for women who have acne. They should advise patients that when they take OCs, their menstrual periods usually become shorter, regular, and lighter. Women need not take a break from OC usage. Vitamin C, antibiotics, griseofulvin, rifampicin, and anticonvulsants (except sodium valproate) interact with OCs. Women using warfarin and oral hypoglycemics and wanting to start using OCs need to consult their physician about changing requirements for warfarin and oral hypoglycemics. The effectiveness of OCs can be diminished by diarrhea and vomiting. Absolute contraindications to OCs include pregnancy, use during the first 2 weeks postpartum, history of thromboembolism, undiagnosed abnormal vaginal bleeding, focal migraine, coronary heart disease, steroid-dependent tumors, recent impaired liver function, and cardiovascular accidents. Some relative contraindications are older than 35 years old and smoking, breast feeding, and hypertension. This article provides a section on how to manage common side effects. For example, if the side effect is acne, the physician should prescribe an OC with increased estrogen and reduced progestogen (e.g., Triphasil/Triquilar to Biphasil/Sequilar). This article lists trade names of various OCs and their estrogen and progestogen doses, e.g., Nordette has 30 mcg ethinyl estradiol and 150 mcg levonorgestrel.
 ...
PMID:Combined oral contraception. 147 9

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.
 ...
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

Acquired sixth nerve palsies in infants and children that occur without fever primarily suggest a tumor or intracranial hypertension. In a few instances, the cause is benign and spontaneous recovery occurs although relapses are occasionally seen. We report seven episodes of benign sixth nerve palsy in four children aged 5 1/2 months to 8 1/2 years. An ENT infection was the precipitating factor in four of these seven episodes. Recovery consistently occurred within 4 days to 6 weeks. None of the children had residual oculomotor impairment. The various etiologic hypotheses put forward in the literature are discussed. No study provides a pathophysiologic explanation for these transient palsies.
 ...
PMID:[Benign paralysis of the 6th cranial nerve in children]. 219 74

The diagnosis of obstructive sleep apnea is frequently made by taking a meticulous history coupled with a high index of suspicion. Snoring and hypersomnolence are clinical features common to individuals with sleep apnea. Since snoring is said to be a "disease of listeners," it is not uncommon that bed partners reported an increased incidence of depression and marital displeasure. It is for this reason that the spouse or bed partner should be interviewed, since the patient may not be aware of any sleeping problems. Physicians should also be alert to complaints of excessive daytime somnolence, because studies have shown that patients with obstructive sleep apnea are at increased risk for automobile crashes. It has been estimated that approx 58,000 motor vehicle accidents involving people with sleep apnea will occur in the US each yr. By proper diagnosis and treatment, the physician is in a unique position to prevent at least some of the automobile accidents that result from falling asleep while driving. Polysomnography is the only definitive way to obtain a diagnosis of sleep apnea. This allows the physician not only to diagnosis the disorder, but also helps in the evaluation of the severity of the syndrome and selection of therapy. An ENT evaluation is also important in ruling out anatomic disorders that can cause upper airway obstruction. Certain factors, such as alcohol and sedative ingestion, may aggravate the condition in a person predisposed to sleep apnea, and subtle changes, such as unexplained hypertension, polycythemia, and cor pulmonale, should lead one to investigate the possibility of sleep apnea as the etiology.
 ...
PMID:Diagnosis of obstructive sleep apnea. 229 95

This guide to choice of oral contraceptives, for U.S. clinicians, includes a review of the available types of pills, the pharmacology of the steroids in pills, safety issues regarding thrombosis, arterial disease and hypertension related to estrogens and progestins in pills, common side effects, and therapeutic uses of orals. Choice of an oral contraceptive narrows down to which of the 5 available progestins and their formulation, since all contain ethinyl estradiol as the estrogen. While Briggs' theory espoused picking a pill with the minimal metabolic effect, recent evidence suggests that some estrogenic activity may be preferable to the unopposed progestagen, actually an anti-estrogenic receptor effect, to prevent adverse lipid and blood pressure effects in users. Current pills with low doses of estrogens probably are not significant risks for women as regards thrombosis, particularly if predisposed women and smokers are excluded. Pills containing 0.35 mg ethinyl estradiol and 0.5 mg norethindrone, based on large population trials, are probably the minimal effective dose yet even these are more effective than most other contraceptive methods. Breakthrough bleeding and spotting have been further minimized, however, with multiphasic pills. It is best to start with a 0.30-0.35 mg estrogen oral contraceptive, such as Loestrin, Demulin, Orthonovum 1.35, Orthonovum 7/7/7 or Nordette, encouraging the patient to accept early side effects for 3 months before switching to others. Disorders that can be managed with oral contraceptives include recurring and pre-existing ovarian cysts, endometriosis, dysfunctional uterine bleeding and dysmenorrhea. Brief guidelines for handling normal side effects and treatment of the above disorders are included.
 ...
PMID:Choosing the best oral contraceptive. 274 45

Drug companies have been at work throughout the 1960s, 1970s, and 1980s trying to reduce the steroid content of their oral contraceptives (OCs). Researchers have been successful in reducing steroid content while maintaining effectiveness, thereby making OCs safer. In the 1st half of the natural menstrual cycle, a woman secretes estrogen as the dominant steroid product. In the 2nd half, estrogen is the principal reproductive hormone. Estrogens inhibit ovulation, possibly by inhibiting implantation, altering ovum transplant, or in some way preventing corpus luteum function, which is necessary to maintain early pregnancies and the endometrium. There are still only 2 estrogens and 6 progestins on the market today. They are probably the most thoroughly studied chemical ever seen in the history of pharmacy or medicine. 1 of the estrogens, mestranol, is really a drug of the past. In the body, mestranol is converted to ethinyl estradiol, the other estrogen on the market. Consequently, there is no reason to use mestranol itself. Within the dose range of 50-100 mcg, there's little difference in contraceptive effect. Progestins are the other active ingredient in the combination OC. Their principal action is the thickening of the cervical mucus, which prevents sperm penetration. Also, with sufficient progesterone, ovulation is inhibited, but this happens in only 40% of those patients taking, for instance, the "mini-pill" (which consists of progesterone only). The progestins and the estrogens work in concert to make OCs a highly effective contraceptive method. Recent surveys conducted by the Centers for Disease Control and National Cancer Institute looked into the relative effectiveness of OCs. Nordette had a use effectiveness failure rate of 3.5; Ovral, 3.6. Loestrin 1/20 -- norethindrone acetate, 1 mg, and estinyl estradiol, 20 mcg -- shows a failure rate of 4.5. This indicates that the threshold for an effective dose of estinyl estradiol in OCs is 30 mcg. For 1 mini-pill, Ovrette, the failure rate is 9.5 -- much higher. Depo-Provera has a failure rate of 0.7. The primary complaint from women taking OCs is spotting and breakthrough bleeding during the cycle. 30-50% of women given OCs stop taking them within a year. OC side effects include nausea, fluid retention, breast tenderness, leukorrhea, hypomenorrhea, headaches, spotting around the face, hypertension, and visual changes. 1 of the risks of birth control pills may be cervical dysplasia -- changes in the cells of the cervix. The relative risk of cervical cancer with OCs after 5-9 years is approximately 1.8. Clinical cases of deep vein thrombosis number 1/1000 per year among nonusers of OCs. Among users, the rate is 3 times as high: 3/1000. The most serious potential adverse effect is myocardial infarction. Of the excess deaths attributed to OCs (23.3 total per 100,000 users), 22.7 are due to myocardial infarctions and hemorrhage. The discussion also briefly reviews other methods of contraception -- Depo-Provera, male contraceptives, implants, the diapragm, and IUDs.
 ...
PMID:Prescription contraceptives: countering the risks. 405 Jun 70

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.
 ...
PMID:Avoidance of dual publication. Statement by the Council of Biology Editors. 468 30

2 young, menstruating females without any of the major risk factors (hypertension, diabetes mellitus, hyperlipidemia) developed acute myocaridal infarctions while taking oral contraceptives; their clinical histories and laboratory and arteriographic studies are presented. In the first patient (aged 29) who took Ortho-Novum 2 mg. for 11 months prior to infarction and who had an abnormal glucose tolerance test, selective coronary angiography revealed a segmental occlusion of the proximal left anterior descending coronary artery. In the second patient (aged 38) who took Enovid for several years prior to infarction, selective coronary angiography showed slight irregularity of the left anterior descending coronary artery; no evidence of akinesis or dyskinesis of the ventricular wall was noted. Although incidence of coronary artery disease in young, menstruating women has always been very low, recently there have been scattered case reports of women with acute myocardial infarction in absence of major risk factors; all cases shared the common features of oral contraceptive use prior to infarction, and unusual distribution and peculiar appearance of lesions in coronary arteries. Such reports, although rare, in young females taking synthetic estrogen do suggest that a relationship may exist between oral contraceptive agents and thromboembolic phenomena, especially coronary thrombosis. Mechanisms by which oral contraceptives might precipitate thrombosis are discussed. It is suggested that coronary artery disease should be suspected in young oral contraceptors suffering chest pain even though they are still menstruating and are free of major risk factors.
 ...
PMID:Coronary thrombosis in young women on oral contraceptives: report of two cases and review of the literature. 470 63

CSF fistulas are a major complication of head injury but also occur spontaneously or symptomatically in connection with tumours of the skull base, empty sella syndrome, ethmoidal encephalomyelocele, intracranial hypertension or postoperatively in connection with operations on skull base tumours or ENT operations. Their main risk is the possibility of meningitis. The main clinical symptom is CSF leakage from the nose, but meningitis may be the first manifestation. Isotope cisternography and metrizamide CT cisternography are the most important methods for precise localization, sometimes also for verification of a suspected fistula. Most traumatic CSF fistulas of the frontal and ethmoidal region have to be treated operatively. The method of choice is the transfrontal approach and the closure of the fistula opening using a pedicled pericranial flap or fascia lata graft. Most sphenoidal fistulas have to be treated by packing the sphenoidal sinus with muscle. The treatment methods of the rare spontaneous and symptomatic CSF fistulas are also described. The results of operative treatment are satisfactory. About 6% recurrences, which as a rule can be cured by reoperation, and a mortality rate of about 1-3% seem to be an acceptable price for prevention of an otherwise unavoidable and oftenly deadly meningitis. Future efforts are necessary to improve the operative technique in order to reduce the incidence of anosmia. Our descriptions and advice are based not only on literature reports but also on our own experiences with a combined material of 237 cases operated on for rhinorrhea.
 ...
PMID:Traumatic, spontaneous and postoperative CSF rhinorrhea. 653 67


1 2 3 4 5 6 7 Next >>