Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A randomized comparative study of the Copper T 300, the standard Dalkon Shield and the Silicone Shell Loop D was conducted on 776 parous women. Net cumulative first event rates at 1 year and at 18 months, calculated by life-table analysis, were as follows: Copper T 300--pregnancy 1.2/1.9, expulsion 6.4/7.0, removal for pain or bleeding 7.4/10.8; Dalkon Shield--pregnancy 2.7/4.5, expulsion 5.8/5.8, removal for pain or bleeding 7.7/14.7; Shell Loop--pregnancy 3.8/4.9, expulsion 0.5/0.5, removal for pain or bleeding 9.1/13.1. None of the differences in event rates, except the lower expulsion rate of the Shell Loop, were significant. The continuation rates for the three devices at both 12 and 18 months were similar, indicating that there was little difference in their performance. As the results of this study showed a similarity of the incidence of events among very differently disigned IUD's, previously reported differences in performance of these and possibly other types of IUD's may very likely be more related to differences among clinics than to differences among the devices themselves.
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PMID:Randomized comparative study of the copper T 300, Dalkon shield, and Shell Loop in parous women. 112 75

The copper T (TCu) 22OC, a new long-acting copper-bearing intrauterine device (IUD), was evaluated against the TCu 300 IUD in a randomized study of 979 women. 463 women received the TCu 22OC and 516 received the TCu 300 device. The TCu 22OC has 5 solid copper sleeves on the vertical arm of the T and 2 sleeves on the horizontal arm, thereby providing an effective surface area of 200 sq. mm. The estimated period of effectiveness of the device is 20 years, thus obviating the need for periodic replacement that is characteristic of devices bearing copper wire. At the end of 1 year, the net cumulative first-event rates were: TCu 22OC- pregnancy 0.9, expulsion 3.7, and removal for bleeding/pain 14.4; TCu 300 - pregnancy 1.1, expulsion 3.1, and removal for bleeding/pain, 9.3. The overall continuation rates were also similar. The TCu 22OC could become the IUD of choice if these preliminary findings are borne out by long-term studies.
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PMID:The Copper T 220C: a new long-acting copper intrauterine contraceptive device. 124 47

The copper T-200 (TCu-200) and Silicone Shell Loop D (SCS-D) intraut erine devices were evaluated at the end of 1 and 2 years of use by means of a log-rank method of life-table analysis. 267 women received the TCu-200 device and 221 received the SCS-D. The pregnancy rates were similar for both the devices. The expulsion rate was significantly higher for the TCu-200 (p=.04), while the removal rate for bleeding/pain with the SCS-D was significantly higher at the end of 2 years (p=.01). The differences in relevant termination rates at the end of 1 and 2 years were not significant.
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PMID:Experience with the copper-T and Silicone Shell Loop in parous women: a randomized study. 124 59

For the purpose of lowering the pregnancy rate of the uterine cavity-shaped stainless steel IUD (first generation UCD) and maintaining its advantages, the copper-plated uterine cavity-shaped IUD (second generation UCD or UCDcu) was designed. A randomized use-effectiveness study in ten centres with the UCDcu and UCD have been analyzed at twelve months. The UCDcu had a significantly lower pregnancy rate (0.3 per 100 women) than the UCD (2.9 per 100 women), p less than 0.005. Whereas, the other cumulative rates such as expulsion, removals for bleeding and pain, and other personal were not significantly different for the two IUDs, p greater than 0.05.
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PMID:Comparison of two uterine cavity-shaped IUDs. 145 18

This evaluative review focused on the performance and safety of the Dutch-made Multiload copper IUD, primarily the Multiload-375 (MLCu-375) model which has a longer life expectancy (5 or more years) than the Multiload-250 (MLCu-250) model, usually cited for a life expectancy for three years. This copper-medicated IUD differs from the copper-T IUDs in shape and insertion technique. The review shows that (a) the MLCu-375 IUD seems to be slightly less effective in preventing pregnancies than TCu-380A IUD. Its efficacy is comparable to that of the Nova-T by two to three years of use; (b) the MLCu-250 IUD is similarly effective to TCu-200 but may be slightly less effective than TCu-220C; (c) no consistent differences were detectable in expulsion rates or in removal rates for bleeding/pain between the Multiload IUDs and comparative Copper-T IUDs; (d) the Multiload IUDs may perform better in nulliparous women than the T-shaped devices; (e) no or a very low incidence of uterine perforation is associated with insertions of the Multiload IUD; (f) ectopic pregnancy risks are similarly low in Multiload IUD users as in Copper-T-380A users; and (g) pelvic inflammatory disease (PID) risks are similarly low in Multiload IUD users as in users of T-shaped copper IUDs.
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PMID:The multiload IUD--a U.S. researcher's evaluation of a European device. 145 88

Data on 70 women who experienced expulsion of a copper releasing IUD were compared with data on 1536 women who still retained a copper releasing IUD to determine risk factors for IUD expulsion and calculate the magnitude of the association. The 18-40 year old women were part of an international multicenter clinical trial. Adolescents were at a 5.5 (unadjusted crude odds ratio) higher risk of IUD expulsion than women of at least 35 years old. The risk of expulsion decreased with age (odds ratio [OR] = 2.1 for 20-29 year olds and 1.1 for 30-34 year olds). Women whose menstrual flow was higher than normal were also at greater risk of IUD expulsion (OR = 2.4). The risk was the same for women who experienced severe pain during menstruation (OR = 2.4). The proportional hazards regression analysis showed maternal age (adjusted hazard ration = 5.4 for teenagers), amount of menstrual flow (2.4 for abnormal flow), and dysmenorrhea (1.8 for severe menstrual pain) were risk factors for expulsion of the copper releasing IUDs. Further, the trend test revealed a significant dose response pattern between maternal age and IUD expulsion (p .001) and between dysmenorrhea and expulsion (p = .011). The small sample size of nulliparous women (1 case and 7 controls) limited the ability of the analysis to identify parity as a risk factor which has been identified as a risk factor in other studies. In conclusion, these findings indicated that maternal age, amount of menstrual flow, and severe pain during menstruation are risk factors for expulsion of copper releasing IUDs.
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PMID:Risk factors for copper T IUD expulsion: an epidemiologic analysis. 145 89

During May 1988-May 1989, an obstetrician-gynecologist inserted the new frameless copper-releasing IUD, Flexigard, in 344 18-45 year old women attending the Family Planning Center at the University Medical School in Debrecen, Hungary. The physician was able to examine 336 patients during at least 1 follow-up visit during the 12 months, for a lost-to-follow-up rate of only 2.3% which is lower than the recommended 10%. At the end of 12 months 264 women continued to use Flexigard. The number of cumulative woman months of use stood at 3484. The net termination rate was 10.3 at 12 months. The leading reason for removal was bleeding/pain (cumulative removal rate= 4.4). The only personal reason for removal was planning a pregnancy (6 cases, rate = 1.9). The 12-month net continuation rate was 89.7. The low expulsion rate was only 1.5 which was probably due to the anchoring system which allows the upper part of the IUD to penetrate no more than 1 cm into the fundal myometrium. The 12-month cumulative pregnancy rate was 0.6. In conclusion, the design characteristics of Flexigard made it well tolerated. Further, it proved to be very effective, and insertion and removal were easy and safe.
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PMID:One-year clinical experience with FlexiGard. 148 69

Commentary is provided on the relationship between the use of the IUD and infertility from the development of pelvic inflammatory disease (PID), preventive behavior for those using an IUD, and recent reviews of the Dalkon Shield. Among IUD users who have never been pregnant, tubal infertility is increased 2-6 fold (200-600%), and most with tubal infertility will never bear a child. Tubal infertility develops in 11% of patients with PID, but most IUD users do not develop PID. The physicians responsibility is 1) to give formal and extensive recognition to the connection that IUD uses causes PID; 2) to inform patients of the potential risk of PID and sterility; 3) to develop proper patient selection for an IUD; 4) to identify and treat PID, which may appear initially as abnormal uterine bleeding and mild pain; 5) to recognize that the IUD facilitates the development of PID in patients with Neisseria gonorrhoea and Chlamydia trachomatis even though 25-50% of IUD patients have neither infection; 6) to recognize that the risk of PID is increased in the first 4-6 months of insertion and to research alternatives, e.g. the use of available antibiotics to treat selected patients to reduce infections, and 7) to realize that most PID occurs 6 months after insertion and indolent abscess formation is expected to increase among longterm copper IUD users. The reviews referred to in this article are ones claiming unfair removal of the Dalkon Shield in 1974 based on flawed study design and analysis of case control and the understanding that the Dalkon Shield is no worse than other IUDs and not related to PID. The author points out that neither review mentions that primary tubal infertility increased 6-fold among Dalkon Shield users who had used only 1 IUD in their life, and that infertility increased 3-fold among IUD users compared with the non-IUD using population. The case control studies provide enough evidence for the cause and effect relationship. The Kronmal et al. article did not present convincing new evidence even with reanalysis of the original Lee et al. data. In the Memford and Kessel review case controlled studies are excluded from consideration. Most PID goes unrecognized. The rate of PID cannot be determined. The goal is to protect patients and reduce population. The enemy is not physicians with opposing positions on this issue.
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PMID:Earth, motherhood, and the intrauterine device. 851 47

The biosynthetic enzyme peptidylglycine alpha-amidating monooxygenase catalyzes the formation of a variety of biologically active alpha-amidated peptides from respective COOH-terminal glycine-extended peptide precursors. Peptidylglycine alpha-amidating monooxygenase activity is dependent on copper, ascorbate, and molecular oxygen and is inhibited by the relatively selective copper chelator N,N-diethyldithiocarbamate or its disulfide dimer disulfiram (Antabuse). In the present study, chronic disulfiram treatment (100 mg/kg/day, for 12-25 days) resulted in significant changes in several neurochemical parameters in the mouse central nervous system, including levels of substance P-like, unamidated substance P-Gly-like, and protease-generated substance P-Gly-Lys-like immunoreactivities (SP-LI, SP-G-LI, and SP-G-K-LI, respectively). Combined high performance liquid chromatography/radioimmunoassay analyses of the extracted SP-LI, SP-G-LI, and SP-G-K-LI species indicated very similar chromatographic and immunochemical behavior as demonstrated for chemically authentic peptide standards. Additionally, changes in levels of monoamines and their metabolites were observed after drug administration. Complementary immunohistochemical analyses using affinity-purified anti-SP-G sera localized these drug-induced changes in levels of immunoreactive unamidated precursor to neural elements that normally express SP. As a functional corollary to alterations in neurochemical parameters, we observed significant disulfiram-induced increases in pain thresholds, potentiated by capsaicin treatment. Overall, our results indicate that the observed changes in steady state levels of immunoreactive SP and of the immature COOH-terminal extended forms of SP may reflect compensatory biosynthetic and posttranslational processing events in SP-containing neural systems after pharmacological challenge.
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PMID:Disulfiram administration affects substance P-like immunoreactive and monoaminergic neural systems in rodent brain. 168 29

This literature review compares the merits and disadvantages of the levonorgestrel-releasing IUD made by Leiras Pharmaceuticals, Turkey, Finland (LNG-IUD-20), with the Nova-T, Copper-T (TCu) and 220C, and Copper-T-38-Ag (TCu-380Ag). This IUD releases 20 mcg levonorgestrel daily from a Silastic sleeve on the vertical shaft containing 52 mg. The plasma level stabilized after a month at about 0.2 ng/ml, about half as high as that seen with Norplant implants. It is identical in size to the Nova-T. The Cu-T IUDs differ with respect to copper wire or sleeves, or silver-cored wire. The chief studies reviewed here were 2 multi-center trails primarily in European countries, and a 2 large multi-center trials in India. Cumulative pregnancy rates were 0.0 to 0.6 per 100 users for the LNG IUD, compared to slightly higher failures for inert or copper IUDs. While removal rates for bleeding, pain and pelvic inflammatory disease were lower for the LNG-IUD-20, removals for oligomenorrhea, amenorrhea and hormonal side effects were higher than for the other IUDS. In the Indian trials, removals for amenorrhea and irregular bleeding were much higher than rates reported in the European studies, resulting in significantly lower continuation rates overall. The results pointed to district benefits for the LNG-IUD-20, such as lower blood loss and anemia, relief of dysmenorrhea and menorrhagia, as well as possible lower risks of ectopic pregnancy in case of failure, less PID (pelvic inflammatory disease), and the claim by the maker that strictly correct placement is not necessary. Disadvantages of the LNG-IUD-20 are more difficult insertion due to the wider diameter; oligomenorrhea, amenorrhea and irregular bleeding; hormonal side effects such as acne, weight gain, nausea, headache and breast tension; and potential risk of functional ovarian cysts. The LNG-IUD-20 is considered comparable to copper IUDs in effectiveness, safety, longevity, and return to fertility after removal. Users should be counseled that the oligomenorrhea or amenorrhea is neither a medical problem or indicative of infertility, is common for the 1st 2 months, is reversible on removal, may signal an improved hemoglobin profile, relief of dysmenorrhea, and may be preferred to heavy bleeding from other IUDS. The program implications of this IUD are potential lower incidence of ectopic pregnancy and PID. The effect of its use on breast feeding, cost-effectiveness compared to Norplant, in-country manufacture, and cultural acceptance need to be determined in specific locales.
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PMID:An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs. 177 15


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