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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Modern contraceptive methods are discussed, with special emphasis on oral contraceptives, which are regarded as the most effective. They are also regarded as generally safe, although there are contraindications and the drugs should only be prescribed after careful examination. The need for selecting the drug most suitable for the individual patients, mainly on the basis of the characteristics of the menstrual cycle (suggesting a predominance of estrogen or progestin, within safety limits, such as 50 mcg of estrogen), is emphasized. The examinations required include a general clinical, gynecological, and breast examination, cytology tests, evaluation of the menstrual flow pattern, measurements of arterial pressure, weight, glucose, cholesterol and triglyceride levels, and urine tests. They should be repeated at 6-month intervals, or 3-month intervals in the case of high-risk patients (varicose veins, obesity, heavy smokers, high cholesterol and triglyceride levels, history of jaundice, slight heart condition, clinical or potential diabetes, porphyria or predisposition to uterine myoma). Oral contraceptives are contraindicated in cases presenting a history of thromboembolism, phlebitis, cerebral apoplexy; sickle cell anemia, which indicates a predisposition to thromboembolic accidents; serious liver disease or recent hepatitis; serious heart disease; hormone-dependent neoplasia (breast cancer); predisposition to uterine cancer; erythematous lupus; metorrhagia of unknown origin; psychic disorders, especially of a depressive type. They should also be avoided for 3-4 years after puberty, in order to avoid interfering with the development of the hypothalamus and with growth. A carcinogenic effect of the pill and an increase in the risk of giving birth to abnormal children can be ruled out, although the incidence of abortions due to chromosome anomalies after suspending treatment is rather high (due to the previous inhibition of ovulation, a situation similar to repeated pregnancies at short intervals, which involve the same risk).
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PMID:[Current clinical problems of contraception]. 502 53

Tumoricidal reactions in dogs with spontaneous breast carcinoma occur after perfusion of plasma over protein A derived from Staphylococcus aureus and immobilized in collodion charcoal. When this treatment was extended to humans with breast cancer, hemodynamic and physiologic changes were noted. The evolution and spectrum of these reactions were evaluated during 47 plasma infusions in five patients. Initial treatment conditions consisting of rapid perfusion of plasma over high quantities of immobilized protein A were employed for 12 treatments in two patients. Within 30 minutes after treatments were begun, mean blood pressure, systemic vascular resistance, and stroke volume increased, as did heart rate, cardiac output, and rectal temperature; however, mean pulmonary artery pressure and total pulmonary resistance did not change. At 90 minutes, hypotension developed (lowest mean blood pressure was 59 +/- 14 mm Hg) that was associated with a decrease in systemic vascular resistance and total pulmonary resistance (536 +/- 66 and 146 +/- 44 dynes . second . cm-5, respectively). Cardiac output increased, tachycardia developed, stroke volume decreased, and rectal temperature increased. During the hypotensive phase, values of creatinine clearance and fractional excretion of sodium diminished. Noncardiogenic pulmonary edema appeared occasionally, with bronchospasm noted once. No hemodynamic changes were seen when saline solution was passaged over protein A immobilized in collodion charcoal or when autologous plasma was given without passage over protein A immobilized in collodion charcoal. Treatment conditions were modified by diminishing protein A quantity and plasma volume and slowing plasma perfusion rate, which resulted in significant attenuation of all cardiopulmonary responses. This report, then, defines for the first time the physiologic basis of the cardiopulmonary toxicity in humans after plasma perfusion over immobilized protein A.
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PMID:Cardiopulmonary toxicity in patients with breast carcinoma during plasma perfusion over immobilized protein A. Pathophysiology of reaction and attenuating methods. 688 Nov 80

The use of estrogen replacement therapy in postmenopausal women is under close scrutiny. The indications and side effects of replacement therapy are reviewed, and recommendations regarding its use are made. Hot flashes, atrophy of the vaginal epithelium, and prevention of osteoporosis have been established as indications for estrogen replacement therapy. Prevention of cardiovascular disease, aging changes of skin, and the occurrence of mental illness have also been suggested as indications, but beneficial effects of estrogen replacement therapy for these problems have not been clearly established. Studies have shown that side effects of estrogen replacement therapy include endometrial cancer, hypertension, gallbladder disease, and angina pectoris. Breast cancer may also be a risk factor, but a consensus of opinion has not been established. Pulmonary embolism, cerebral vascular accident, or myocardial infarction has not been associated with estrogen replacement therapy. The use of progesterone with estrogen replacement therapy has been shown to reduce the occurrence rate of endometrial carcinoma, but it does not prevent all the actions of estrogen. Oral administration of estrogen is the preferred route despite misgivings about portal absorption and liver metabolism. Further studies must examine this question. Various agents have been shown to be effective in treating some climacteric symptoms. These include progesterone for hot flashes and calcium for the prevention of osteoporosis. Other agents may also be effective but have not been tested critically.
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PMID:Estrogen replacement therapy. 702 79

Estrogen replacement therapy (ERT) has been shown to reduce the risk of cardiovascular disease (CVD) and osteoporosis in postmenopausal women. Studies also indicate a reduced risk of stroke and its consequent mortality among estrogen users, and ERT may also have a role in reducing the risk of Alzheimer's disease and increasing a woman's overall quality of life. On the negative side, some studies show a small duration-related risk of breast cancer with estrogen use and a significant increase in endometrial cancer; the latter is virtually eliminated with the addition of a progestin to the regimen. Although the definitive answer is not yet available, recent epidemiologic data suggest no reduction in protection against CVD and bone fracture with the addition of progestin, which is referred to as hormone replacement therapy, as opposed to using estrogen alone. A woman's potential risks associated with ERT or hormone replacement therapy must be weighed against her lifetime risks of developing CVD, stroke, and bone fracture. The reduction in mortality and morbidity rates with hormone use is generally viewed to be substantial and cost-effective. Health care professionals have an important role in shaping their patients' attitudes. Patients need more information from their physicians about the risks and benefits of estrogen therapy.
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PMID:Benefits and risks of estrogen replacement therapy. 757 95

We analysed hospital use for 58 common clinical conditions in the medical specialties, using data from the two districts covered by the Oxford record linkage study 1968-1986. Episode rates, person rates, and ratios of multiple admissions per person were computed. In young adults, poisoning was the most common reason for admission. In older adults, the most common clinical conditions included atherosclerotic diseases and smoking-related lung diseases. Comparing the first and last time periods studied, admission rates increased by 10% or more in 37 of the 58 conditions, including 7 of the 10 conditions with the highest overall hospitalization rates. Conditions in which admissions increased by 10% or more included myocardial infarction, other ischaemic heart disease, chronic obstructive lung disease, asthma, pneumonia, diabetes, poisoning, dementia, prostate cancer and breast cancer among others. Workload declined by 10% or more in 13 conditions, including stroke, subarachnoid haemorrhage, hypertension, thyrotoxicosis, acquired hypothyroidism, and tuberculosis. Secular trends in hospital use are generally attributable either to changes in disease frequency in the population or to changes in clinic- or hospital-based technology and practice.
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PMID:In-patient workload in medical specialties: 2. Profiles of individual diagnoses from linked statistics. 758 80

The preoperative evaluation and technique of combined thyroplasty and inferior constrictor myotomy are described and illustrated. The results in cases in which thyroplasty type I and inferior constrictor myotomy were done as separate procedures are compared to those in cases in which thyroplasty and inferior constrictor myotomy were combined in the same operation. The end results obtained with these two approaches did not differ significantly; however, with the exception of brain stem disease, patients undergoing the combined procedure at an early date are more likely to be spared gastrostomy and aspiration pneumonia. Diseases of the brain stem (ie, stroke and metastatic disease such as breast cancer) respond poorly to an inferior constrictor myotomy. In such cases the patient can best be rehabilitated with a thyroplasty type I along with a gastrostomy or laryngeal closure procedure.
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PMID:Combined thyroplasty type I and inferior constrictor myotomy. 797 99

The prevalence of obesity in the UK, defined as a Body Mass Index (BMI) exceeding 30, is increasing. Obese people with BMI greater than 30 have a much greater risk of dying earlier than people with desirable levels of fatness (as do extremely lean people with BMI less than 20). The relationship between obesity and the likelihood of suffering certain metabolic diseases such as coronary heart disease, stroke and diabetes is now thought to be associated as much with the distribution of the excess fat as with the amount of excess fat. Fat distribution is usually measured in the population by the waist to hip circumference ratio (WHR). A high WHR seems to be a proxy measurement for an excess of intra-abdominal fat. Subcutaneous fat mass can be estimated using skinfold measurements. Exact determinations can only be performed directly using expensive equipment, such as computed tomography (CT). People with high WHR measurements can be said to have a 'central' fat distribution: people with low WHR measurements can be said to have a 'peripheral' fat distribution. 'Central' fat distribution carries most metabolic risks and is associated with a predisposition towards coronary heart disease, stroke, diabetes, breast cancer and gallstones. In some cases, the distribution of fat is a stronger risk factor than total obesity. 'Peripheral' fat distribution carries least metabolic risk. However, risks related to the mechanical problems of carrying excess fat, such as varicose veins, are increased. The risks of obesity therefore depend on the distribution of fat as well as total fatness.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Obesity in men and women. 789 23

No one has yet conducted a definitive, prospective, controlled study in 35-50 year old women that examines the relationship between oral contraceptive (OC) use and thromboembolism, myocardial infarction (MI), stroke, and cancers of the breast and genital organs. The available data derive from large studies on women in all age groups. These studies, mostly from the US and the UK, demonstrate that older women are somewhat more likely to be at risk of thromboembolism, MI, and stroke. Yet, the risk does not tend to be limited to OC users and is likely associated with other risk factors for cardiovascular disease. The risk of thromboembolism is greatest in smokers. It is also associated with the estrogen dose, which is lower today than it was in the past (= or 50 mcg vs. = or 100 mcg). The relationship between breast cancer and OC use is not clear, but the data suggest that the risk of breast cancer is elevated slightly among current OC users. The data confirm, however, that OCs protect against endometrial and ovarian cancer. Since many women older than 35 years old need safe, reversible contraception, the US Food and Drug Administration Advisory Committee concluded that healthy older women with no risk factors can safely use OCs. Women who should avoid OCs include those with a hormone-related history of thromboembolism, coronary artery disease, hypertension, diabetes, and other conditions that might cause adverse effects. Women with a clear family history of endometrial or ovarian cancer could likely benefit from OC use. Prospective studies of such women who do use OCs should be conducted to determine whether the protective effects of OCs can be extended. If the results are favorable, providers can emphasize OC benefits rather than risks. OCs are safe and effective for women over 35 who have no risk factors.
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PMID:Risks of oral contraceptive use in women over 35. 812 Aug 60

The menopause is defined as cessation of menstruation, ending the fertile period. The hormonal changes are a decrease in progesterone level, followed by a marked decrease in estrogen production. Symptoms associated with these hormonal changes may advocate for hormonal replacement therapy. This review is based on the English-language literature on the effect of estrogen therapy and estrogen plus progestin therapy on postmenopausal women. The advantages of hormone replacement therapy are regulation of dysfunctional uterine bleeding, relief of hot flushes, and prevention of atrophic changes in the urogenital tract. Women at risk of osteoporosis will benefit from hormone replacement therapy. The treatment should start as soon after menopause as possible and it is possible that it should be maintained for life. The treatment may be supplemented with extra calcium intake, vitamin D, and maybe calcitonin. Physical activity should be promoted, and cigarette smoking reduced if possible. Women at risk of cardiovascular disease will also benefit from hormone replacement therapy. There is overwhelming evidence that hormone therapy will protect against both coronary heart disease and stroke, and there is no increased risk of venous thrombosis or hypertension. A disadvantage of hormone replacement therapy is an increased risk of forming gall-bladder stones and undergoing cholecystectomy. Unopposed estrogen therapy gives a higher incidence of endometrial cancer in women with an intact uterus, but the contribution of progestins for about 10 days every month excludes this risk. Breast cancer in relation to estrogen-progestogen therapy has been given much concern, and the problem is still not fully solved. If there is a risk, it is small, and only after prolonged use of estrogen (15-20 years). The decision whether or not to use hormone replacement therapy should, of course, be taken by the individual woman in question, but her decision should be based on the available scientific information. It is the opinion of the authors that the advantages of hormone replacement therapy far exceed the disadvantages. We suggest that every woman showing any signs of hormone deprivation should be treated with hormone replacement therapy. This includes women with subjective or objective vaso-motor symptoms, genito-urinary symptoms, women at risk of osteoporosis (fast bone losers), and women at risk of cardiovascular diseases.
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PMID:Postmenopausal hormone replacement therapy--clinical implications. 819 55

The evidence of the effects of combined oral contraceptives (COCs) on mortality and morbidity is reviewed. All the 11 case-control studies published since 1980 reported and approximate halving of endometrial cancer risk among COC users. The CASH study showed that the protective effect was apparent after 12 months' use, and users had 40% of the risk of non-users after 2 years' use. A study showed that 5 patterns of self-perceived prolonged, heavy, frequent, irregular, or painful bleeding during menstruation were reported less frequently in COC users than in users of other methods. Benign breast disease is rarer, and functional ovarian cysts are less frequent in COC users. Lower-dose preparations may carry a lower risk of myocardial infarction. Smoking possibly potentiates the risk associated with oral contraceptive (OC) use, and it is a major risk factor for myocardial infarction. The Oxford/FPA study found a 2-3-fold increase in incidence of non-haemorrhagic stroke among current OC users. The epidemiologic data on the current risk of venous thromboembolism in relation to OC use are equivocal. New lower dose COCs have a smaller adverse effect on the lipid profile: they cause a smaller increase in low density lipoprotein cholesterol (LDL) and a variable but smaller decrease in high density lipoprotein cholesterol (HDL). The large CASH study, based on 2088 cases, found a significantly elevated relative risk (2.7) of breast cancer, but only in women who had used the OC for at least 11 years. Of 6 case-control studies of hepatocellular carcinoma and OC use published since 1983, all but one showed a large elevated relative risk of around 4-fold. Delayed return of fertility has been observed in nulliparous women 30 who had 2 years; continuous exposure to COCs, although this may not be associated with low-dose, modern OCs. Malignant melanoma, pituitary adenoma, gallbladder disease, and chronic inflammatory bowel disease have been possibly associated with adverse side effects, but results are so far inconclusive.
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PMID:Combined oral contraceptives: risks and benefits. 832 3


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