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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Progestins counteract the positive effect of the estrogen component in oral contraceptives (OCs) on cholesterol levels thus increasing the risk of atherosclerosis. Low androgenic potency progestins do not have a negative effect, however. Other research indicates that the lower the estrogen dose in OCs the lower the risk of deep vein and superficial thrombosis. OC users, especially low dose OC users, with no other risk factors (e.g. smoking and hypertension) are not at increased risk of cardiovascular disease. Some research demonstrates elevated risk of stroke in OC users, however. Elevated cholesterol, obesity, diabetes and other factors further increases the risk of stroke. Combined OCs protect against endometrial and ovarian cancer and this effect increases with use and continues after use. Moreover OC users are not at increased risk of pituitary adenoma. Results of some studies shows an increased risk of cervical cancer, but other only demonstrates a slight increase. So far research does not indicate the following to increase breast cancer risk among OC users: early age at 1st OC use, formulation, family history, and history of benign breast disease. There is an increased risk for liver tumors in OC users, nevertheless it is rare. OCs do not raise the risk of diabetes or gallbladder disease. High dose formulations increases the risk of high blood pressure, but not so with low dose formulations. OC use does not impair, fertility, but delayed conception often occurs. Most research demonstrates no increase in pelvic inflammatory disease in OC users. OCs do not cause congenital malformations. Combined OC use is contraindicated for breast feeding mothers, but progestin only OCs can be used with no advance effects. Results of 1 study demonstrates an increase in HIV infection in OC users, but another study has opposite results. The article concludes with recommended clinical management practices.
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PMID:Reassessment of the metabolic effects of oral contraceptives. 185 68

The overall risk of oral contraceptive (OC) use is minimal when women over 35 years of age, smokers, and those with multiple risk factors (thromboembolic disorders, cerebrovascular or coronary artery disease, liver tumors, breast cancer, estrogen-dependent neoplasms, undiagnosed abnormal genital bleeding, and congenital hyperlipidemia) are excluded. OC use increases the risk of hypertension by 1-5%, depending on age, parity, and duration of use, but even this small risk is decreased when multiphasic OCs are prescribed. Deep venous thrombosis in the leg is 4 times more prevalent in OC users than nonusers and the risk of superficial thrombosis is doubled. Again, fewer thromboembolic complications occur when the estrogen dosage is low. The risk of myocardial infarction is not believed to increase with OC use as long as other risk factors--smoking, obesity, hypertension, age over 35 years, hypercholesterolemia--are not present. Studies involving the original high-dose OCs revealed a 3-fold increase in the risk of thrombotic stroke and a 2-fold increase in the risk of hemorrhagic stroke, but low-dose OCs appear to have no effect on the potential for stroke. The impact of OC use on breast cancer cannot yet be determined given the very long latency period of this cancer. In terms of benign breast disease, OC users have been shown to be at substantially reduced risk of lesions, fibroadenomas, and fibrocystic changes. OCs also protect women from endometrial and ovarian cancer, although the pill seems to accelerate the progression of cervical dysplasia. Other beneficial effects of OC use include reductions in the incidence of pelvic inflammatory disease, endometriosis, ectopic pregnancy, and ovarian cysts.
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PMID:Oral contraceptive pills. Part II: Potential complications and health benefits. 228 19

All doctors, and most of their patients, are familiar with the consequences of stroke. In 1985 more than 70,000 men and women over the age of 65 died after a stroke and only one third of the survivors of stroke made a good recovery. It is thus a major source of chronic disability, placing a very heavy burden on patients' relatives and friends and consuming a great deal of NHS resources. The purpose of this Report is to set out guidelines for the clinical, radiological and pathological assessment of stroke, to suggest how to care for and rehabilitate patients who have suffered a stroke, and to evaluate and recommend measures for its prevention. The Report emphasises the need to use standard terms for the clinical description and classification of stroke, and the assessment of degrees of disability. It traces its changing epidemiology in the UK and in other countries and assesses the significance of putative risk factors such as hypertension, smoking, obesity, alcohol, diabetes, serum cholesterol, oral contraceptives and ischaemic heart disease. It sets out the indications for admitting patients to hospital and how they should be investigated, including the value of CT scanning at different intervals after the stroke has occurred. The Report describes the organisational aspects of the care of stroke patients during the acute phase, in the early recovery phase and in the longer term rehabilitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Stroke. Towards better management. Summary and recommendations of a report of the Royal College of Physicians. 230 9

We examined the incidence of nonfatal and fatal coronary heart disease in relation to obesity in a prospective cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease, stroke, and cancer. During eight years of follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed angina pectoris. A higher Quetelet index (weight in kilograms divided by the square of the height in meters) was positively associated with the occurrence of each category of coronary heart disease. For increasing levels of current Quetelet index (less than 21, 21 to less than 23, 23 to less than 25, 25 to less than 29, and greater than or equal to 29), the relative risks of nonfatal myocardial infarction and fatal coronary heart disease combined, as adjusted for age and cigarette smoking, were 1.0, 1.3, 1.3, 1.8, and 3.3 (Mantel-extension chi for trend = 7.29; P less than 0.00001). As expected, control for a history of hypertension, diabetes mellitus, and hypercholesterolemia--conditions known to be biologic effects of obesity--attenuated the strength of the association. The current Quetelet index was a more important determinant of coronary risk than that at the age of 18; an intervening weight gain increased risk substantially. These prospective data emphasize the importance of obesity as a determinant of coronary heart disease in women. After control for cigarette smoking, which is essential to assess the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.
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PMID:A prospective study of obesity and risk of coronary heart disease in women. 231 26

A total of 3,861 school children in the age group 5-15 years were examined to establish the normative values for auscultatory blood pressure and to study the prevalence of sustained elevation of blood pressure in Indian children. Age-sex specific norms of systolic and diastolic blood pressure in the right upper limb were worked out. When the influence of age was minimised, the systolic and diastolic pressure still showed a positive correlation with height and weight. Two hundred and fifty five (6.60%) of the children screened were detected to have blood pressure level in excess of +2 SD of the mean for age and sex on first contact. The number declined to only 16 (0.41%) on re-evaluation 2 months after the initial contact. These 16 children continued to remain hypertensive during monthly follow up for 5 months. Family history of obesity, hypertension, or myocardial-infarction and/or stroke was met with in significantly higher (p less than 0.001) number of children with sustained hypertension as compared to normotensive students.
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PMID:Normal blood pressures and the evaluation of sustained blood pressure elevation in childhood. 180 54

Acute fatal pulmonary embolism is one cause of sudden death which should be guarded against. It is the most often missed diagnosis in sudden death cases within the hospital. Clinical pictures of 10 patients with acute fatal pulmonary embolism proved by autopsy were examined to elucidate the problems of diagnosis, and to look for an effective treatment, and a method of prevention. Common risk factors were old age and immobility due to stroke or postoperative state. Common past histories were hypertension, diabetes mellitus, obesity, atrial fibrillation and hyperlipidemia. Electrocardiogram and echocardiogram showed that in these patients there was definite evidence of acute right ventricular overload. High doses of intravenous urokinase should be given whenever acute cardiovascular collapse develops in such high risk patients. Emergent pulmonary angiogram and pulmonary embolectomy could be life-saving in patients with acute massive pulmonary embolism. Prevention is, however, the best treatment. In addition to anticoagulation medication, frequent change of body position and early mobilization are important precautions to prevent fatal pulmonary embolism developing in such patients.
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PMID:[Acute fatal pulmonary embolism: its prevention, diagnosis and treatment]. 236 72

A prevalence study of hypertension in 8 family practices in low socio-economic areas of Cape Town examined 1,046 patients over the age of 15 years. The crude prevalence rate of hypertension was 20.26%. There was no significant sex difference. Systolic pressure, diastolic pressure and hypertensive status increased with age and body mass index (BMI). There were complex relationships with regard to sex in that the female sex was predictive of hypertensive status after the age of 45 years unexplained by differences in BMI. After adjusting for age, BMI and sex differences, widowhood, poor education, obesity, a family history of hypertension or stroke and a past history of hypertension were significant predictors of hypertensive status. Smoking status, occupational social class or property ownership were not predictive. Fifty-one per cent of hypertensive subjects were treated. Of those receiving treatment, 30% were controlled resulting in a control prevalence of only 18%. Younger male subjects were better controlled by treatment. A strong need for improved diagnosis and treatment of hypertension in family practice exists in this region.
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PMID:The epidemiology of hypertension in family practice in Cape Town. 236 91

A prospective study of 252 patients (average age 73, range 26-95) admitted to a regional general hospital over a 12-month period was carried out. 241 patients had stroke verified by the initial neurological examination and CT scan, and of these baseline data were not available on 27%. 34% died before or were not willing or able to provide data at follow-up. 39% survived and completed the study. Prestroke life events and social support could not predict the outcome of stroke rehabilitation measured as survival, length of stay, functional recovery (Barthel's Index) or placement at the follow-up 12 months after the onset of stroke. Age and arteriosclerotic heart disease predicted poor survival at follow-up. Premorbid hypertension, stroke, diabetes, obesity, tobacco smoking, and alcohol consumption did not significantly influence the outcome. Problems in stroke rehabilitation research are discussed.
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PMID:Life events and social support in prediction of stroke outcome. 248 93

A case-control study of biliary tract cancer was conducted in Niigata prefecture where the mortality of the cancer is the highest in Japan. The cases were 109 patients with gallbladder cancer and 84 with bile duct cancer, and the controls were 386 sex- and age-matched neighborhood controls. For gallbladder cancer, a past history of biliary tract disease, a positive family history of cholelithiasis and a taste for oily foods were high risk factors. Intakes of animal proteins and fats such as fish, eggs, meat, etc., ingestion of vegetables and fruits, and taking snacks were low risk factors for gallbladder cancer. For bile duct cancer, a past history of biliary tract disease, a family history of cerebral vascular accident, a thin constitution and taking a small amount of foods were high risk factors, and a family history of heart disease, obesity, intakes of alcohol, animal proteins and fats, or frequent intakes of vegetables and fruits were low risk factors.
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PMID:A case-control study of biliary tract cancer in Niigata Prefecture, Japan. 251 77

For the characterization of the left-ventricular thickness of the wall, of the diameter and of the functional parameters in obesity in a short-term investigation on 18 extremely adipose female normotonics and 17 normotonics with normal weight the echocardiographic investigation in the M-mode in the short parasternal axis was performed. The women with overweight had a by 28% (p less than 0.001) greater fractional shortening, a by 8% (p less than 0.01) greater ejection fraction, a by 23% (p less than 0.05) greater stroke volume and a by 34% (p less than 0.001) greater cardiac output as well as a by 13% smaller left-ventricular end-systolic volume than normotonic women with normal weight. Index of stroke volume and cardiac output did not differ. The women with overweight had a significantly larger left-ventricular end-diastolic diameter and a thicker interventricular septum as well as a larger thickness of the left-ventricular posterior wall in the systole. The results allowed the conclusion that changed left-ventricular parameters both with regard to the form and to the function in obesity per se might be the expression of the physiological adaptation to an increased requirement and the borderlines to the transition into a disturbed left-ventricular function and development of a left-ventricular hypertrophy were not fixed. Long-term studies should bring further explanation concerning these problems.
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PMID:[The relation of anthropometric parameters and echocardiography findings in the evaluation of left ventricular form and function in extreme obesity]. 252 19


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