Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Microval, a low dose progestin oral contraceptive (OC) containing .03 mg levonorgestrel, provides contraception through 3 mechanisms: rendering the cervical mucus impermeable to sperm, slowing the descent of the egg through the fallopian tube, and causing endometrial atrophy unfavorable to nidation. The Pearl index is about 1%. Formal contraindications to Microval include suspicion of pregnancy, recent history of hepatitis or hepatic insufficiency, and breast or uterine cancer, while relative contraindications include ovarian dystrophy, mastopathy, and history of extrauterine pregnancy, jaundice, or pruritus of pregnancy. As with any other OC, a complete physical examination should be done before prescription to rule out contraindications, and follow-up examinations should be given twice yearly. Irregular cycles, spotting, amenorrhea, edema, and breast discomfort are not unusual at the beginning of treatment. Rifampicine, barbiturates, phenylbutazone, and the hydantoin group of drugs render Microval ineffective. The pill should be taken every day without exception at the same hour, and it is advisable to use another method of contraception during the 1st month of Microval use. A single pill taken 12 hours late can bring a risk of pregnancy. Low dose progestins are of interest for patients with contraindications to synthetic estrogens who desire an OC, but they can induce a relative hyperestrogenism with ovarian dystrophy and other symptoms, and they can cause menstrual irregularity.
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PMID:[Microval]. 392 36

A case report of cholestatic jaundice in a 25 year old woman, who had had jaundice at age 4 years, and had taken Stediril (a combined oral contraceptive) for 1 month, implicates either the pill or a possibly hereditary hyperlipidemia. The jaundice developed in 2 weeks with vomiting, epigastric pain, anorexia, then discolored urine and feces, and intense pruritus. On hospitalization the patient had moderate bilirubinemia (56 mg/1), low alkaline phosphatase (13 U.K.) and slightly high serum glutamate pyruvate transaminase (270 U.W.). There were elevated serum cholesterol (3 gm/1), triglycerides (2.05 gm/1), total lipids (10.6 gm/1), and a definitely increased pre-beta lipoprotein, suggesting hyperlipidemia type IV (Frederickson classification). Liver biopsy showed fibrosis of the portal spaces lymphocytic infiltration, canalicular and intrahepatocytic thrombi. On laparoscopy the liver had a regular lower border, normal volume color and surface. Albumin, prothrombin and flocculation tests were normal. The patient's jaundice lasted about 1 month, then liver function slowly improved, although pruritus remained intense. Probably this jaundice was due to oral contraceptives, in a patient predisposed either by jaundice in childhood or endogenous hyperlipidemia.
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PMID:[Cholestatic icterus due to oral contraceptives]. 426 76

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

A resident at the Family Practice Clinic of the University of California, Davis, inserted a levonorgestrel implant (Norplant system) into a 25-year-old African-American women as she requested. The resident used the 7-step method recommended by the manufacturer to insert the implant. The woman went to the emergency department 24 hours after the insertion because the insertion site had diffuse redness, swelling, and blistering. Physicians prescribed 500 mg dicloxacillin every 6 hours for 10 days to treat suspected cellulitis. She returned to the clinic 1 week later, at which time the redness and blisters had disappeared. No drainage, fluctuance, or tenderness remained at the insertion site, which was clean. At her 3 month follow-up appointment, the insertion site itched constantly. The physician noted a fan-shaped area of hyperpigmentation at the insertion site. The physician prescribed 0.1% triamcinolone cream and told her to return for follow-up care. She returned in 3 months with complaints of itching and pain at the site. The physician noticed a fan-shaped keloid over the implant site and at the wound site. The patient asked for the implants to be removed. The physician did not encounter any difficulties in removing the 6 capsules and injected aqueous triamcinolone acetate into the keloid. Her mother had also experienced keloid formation. Resolution of the keloid at the implant site was noted at her 6-month follow-up visit. Based on a review of the literature, the cause of blister formation and subsequent keloid formation was likely multifactorial. The risk for keloid formation is highest in people with deeper skin pigmentation regardless of race, a family history of keloid, own history of keloid, and ethnic background. Patients should be counseled about the possibility of skin reactions such as keloid to implants.
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PMID:Keloid formation from levonorgestrel implant (Norplant System) insertion. 785 93

This controlled cohort study aimed to evaluate the safety and efficacy of Norplant contraceptive implants in developing countries. Women initiating Norplant implants were index subjects and women initiating intrauterine devices (IUDs) or surgical sterilization were controls. Consenting participants at 32 clinics in eight developing countries were admitted and followed-up every 6 months for 5 years. Major and less serious health events during follow-up were recorded. Incidence rate ratios of health events adjusted for clinic were estimated for initial and current method use. This paper reports non-reproductive health events. The study involved 7,977 women initiating use of Norplant, 6,625 of IUD, and 1,419 of sterilization. Five years follow-up was completed for 94.6% of the women. The study accumulated 78,323 woman-years of observation. The initial method chosen accounted for 84.4% or more of observed woman-years in users of Norplant, IUD, or sterilization. Twenty-two of the recorded 34 deaths were due to accidents, suicide or homicide. Few deaths or major health events were due to cancer or acute cardiovascular diseases and were not associated with the contraceptive method used. The incidence rates of major health events were low and with two exceptions, there was no significant excess risk of serious morbidity for Norplant users compared with controls; among Norplant initiators gallbladder disease occurred at an incidence rate of 1.5 per 1,000 woman-years and was weakly associated with use of Norplant (rate ratio 1.52 [95% C.I. 1.02, 2.27]). For current Norplant users compared to controls, the rate ratio of a combined variable of hypertension and borderline hypertension was significantly elevated (1.81, [1.12, 2.92]). The occurrence of less serious health events was also low and several of them were significantly more often reported among Norplant users. Headache-migraine, weight gain, mood disturbances, pruritus, eczema, and acne had incidence rates among Norplant users of 11.5, 4.5, 2.8, 1.5, 1.4, and 0.9 per 1,000 woman-years, respectively, and were significantly higher than in controls. Respiratory health problems, nonspecific symptoms, and several ill-defined conditions were also significantly more often reported for Norplant users, but some of the excess incidence may be attributable to reporting and detection bias. The study confirms the safety with respect to serious disease of Norplant, IUDs, and sterilization.
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PMID:Post-marketing surveillance of Norplant((R)) contraceptive implants: II. Non-reproductive health(1). 1137 47

A comparative cohort study on the insertion of Norplant by midwives and physicians had been carried out to compare its safety. A total of 500 acceptors participated in the study, 292 of whom belonged to the group of midwives and 202 to the physicians group. They came from suburban areas surrounding the city of Yogyakarta, Indonesia. Although both groups were statistically different in terms of age and body weight, they were not so clinically. Norplant was delivered outside the hospital during the mass campaign (safari susuk), but standardized hospital asepsis was taken. Follow-up was done 1 week thereafter to detect the presence of complications or side effects, such as pain, inflammation, abscess and sense of itching. The statistical analyses used in this study were the t-test, chi-square test, and relative risk. Results showed that midwives inserted Norplant more rapidly compared to physicians (2.36 vs. 3.45 minutes, respectively), although it did not have clinical importance. 23.6% of the cases among the midwife group showed a variety of complications while that of the physician group was 19.7%, the relative risk being 1.20 (0.82-1.75). More detailed complications such as pain, inflammation, abscess, and itching did not show significant difference. The risk of complication in all cases was influenced by neither the duration of insertion nor by the level of education. The study concluded that midwives could insert Norplant as safely as physicians.
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PMID:[Insertion of Norplant by midwives and physicians: comparative cohort study]. 1231 76

The family planning service at Aristide Le Dantec Hospital in Dakar, Senegal, has begun inserting and removing the contraceptive implant system Norplant. A local anesthetic is injected in the arm, then a trocar (sometimes a scalpel) is used to make a 2 mm incision in the skin of the inner arm. One then inserts the six capsules subdermally through the trocar. After inserting the first capsule, it is necessary to pivot the trocar at a 15 degree angle in order to insert the next capsules. After Norplant insertion and removal of the trocar, health workers wrap gauze around a bandage to secure the site rather than use sutures. The insertion procedure takes only 13 minutes. Norplant protects against pregnancy for five years. The Family Planning Association of the Dominican Republic has trained more than 100 physicians at an international training center in Santo Domingo in the insertion and removal of Norplant. Norplant should be inserted during menstruation or immediately after delivery to assure absence of pregnancy. It should be inserted in lactating women six weeks after delivery. Possible insertion-related complications include pain and itching. They tend to be rare, however, (1%, according to Family Health International's experience), and vary considerably from country to country and from clinic to clinic. An infection at the insertion site and expulsion of implants tend to occur two months after insertion. 37.5% of local reactions occur after the fourth month. Most complications are directly attributable to inexperience, inadequate training, or lack of sterile insertion technique. Malplaced implants are difficult to remove. A 4 mm long incision at the insertion site is required for implant removal. Removal lasts 15-20 minutes. Capsules must be removed at five years and new capsules inserted (usually at the same site) if one still wants to use Norplant. A local anesthetic is needed for removal.
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PMID:[Insertion and removal of Norplant]. 1231 70

The Norplant contraceptive system consists of 6 silastic capsules 34 mm long by 2.4 mm in diameter each containing 36 mg of levonorgestrel. Norplant provides a constant daily dose of 30 mcg of levonorgestrel beginning 24 hours after insertion and lasting for 5 years. 3 contraceptive effects are provided: the cervical mucus becomes less permeable for sperm, the endometrium atrophies, and ovulation is inhibited in about 50% of cycles. The failure rate is lower than those of pills and IUDs. It is somewhat higher for women weighing over 70 kg than for those weighing less. The safety of Norplant is due to the absence of estrogen. It has no effect on blood pressure, and the risks of ectopic pregnancies or infection at the insertion site are minor. The principal side effect is disturbance of the menstrual cycle, which usually decreases after 3-6 months of use. Other minor effects should not cause termination of the method if the user has been forewarned. Women using Norplant should be followed regularly. Norplant is particularly indicated for women desiring longterm contraception or a very effective method for spacing, postpartum women, and women with contraindications to oral contraceptives and IUDs. Contraindications include pregnancy or suspicion of pregnancy, unexplained vaginal bleeding, liver or cardiovascular disorders, jaundice or pruritus during the last pregnancy, thrombophlebitis or pulmonary embolism, falciform anemia, and breast cancer. Studies are underway to verify that Norplant does not affect lactation. Norplant should be removed immediately if the woman develops migraine headaches or visual problems, signs of thrombophlebitis or hepatic disorders, increased blood pressure, or if she becomes pregnant or must undergo a surgical procedure requiring lengthy bed rest. Norplant should be inserted under scrupulously aseptic conditions during the 1st 7 cycle days under local anesthesia. Large studies in Egypt, Indonesia, Chile and elsewhere have confirmed Norplant's efficacy, lack of harmful lipid effects, and rapid return of fertility after treatment. A 3-year program of clinical trails of Norplant will be conducted in Rwanda with the financial assistance of the UN Fund for Population Activities and the technical assistance of the Population Council, after which Norplant may be added to methods available in all health facilities.
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PMID:[An implantable contraceptive: Norplant]. 1234 82

To improve counselling information to Nigerian family planning clients, we compared non-menstrual events reported by 248 Norplant users and 214 Uniplant users. Women using Norplant were significantly older and of higher parity and greater contraceptive experience than Uniplant users. Other admission characteristics of the two groups were similar. The total women-months of use of Norplant was 2,946 (mean 11.9 +/- 0.6 SE) months while that for Uniplant was 2,315 (mean 10.8 +/- 0.2 SE) months. About 36% of Norplant users and 15% of Uniplant users reported non-menstrual adverse events, the commonest ones being pain/itching at the insertion site, unexplained low abdominal pains and clinically diagnosed pelvic inflammatory disease (PID). The numbers of women reporting drug-related adverse events were 61 (24.6%) and 23 (10.8%), respectively, among Norplant and Uniplant users. Drug-related serious adverse events were reported by 3 (1.2%) Norplant users and 5 (2%) Uniplant users. The adverse events leading to Uniplant removal were severe urticaria, breast lumps, pruritus vulvae, headache with raised blood pressure, adnexal pains and ovarian cysts, and static weight while those leading to Norplant removal were breast lump and headache with raised blood pressure. Weight gain was reported by only 7 (3%) of Norplant users. Although of no serious clinical consequences, drug-related adverse events should be added to the counselling information to prospective users.
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PMID:Nonmenstrual adverse events associated with subdermal contraceptive implants containing normegestrel and levonorgestrel. 1503 62