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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Oral contraceptives (OCs, long-acting progestins (LAPs), and IUDS are reviewed in terms of new information on safety and efficacy. OC formulations are described and their mechanism of action and efficacy indicated. Reports are provided for thromboembolism, hemorrhagic and thrombotic stroke, ischemic heart diseases, alterations in lipid and hypoprotein and carbohydrate metabolism, hypertension, coagulation changes, breast and cervical cancers, and such minor side effects as menstrual irregularities, nausea, headaches, weight gain, premenstrual syndrome effects, and mood and libido changes. Noncontraceptive health benefits and clinical considerations are discussed. Norplant, as the only long acting progestin available in the US is described in terms of its formulations, mechanism of action, sequelae and metabolic effects, menstrual irregularities, metabolic effects, nuisance side effects, candidates for insertion, method of insertion and removal, and continuation rates. 2 IUD types are identified as the only ones available in the US, Progestasert T and T-Cu-380A (Paragard). Mechanism of action, efficacy, candidates, major sequelae such as salpingitis, infertility, and uterine perforation, minor sequelae such as metrorrhagia and dysmenorrhea, and other considerations are indicated. OCs in the US contain an average of 35 mg of ethinyl estradiol and assorted progestins e.g.s, ethynodiol diacetate, norethindrone acetate, nortestosterone derivatives with a complex mechanism of action. The failure rate for use effectiveness is 6 pregnancies/100 woman years. Modern formulations have combined rates of no more than 50 to 100 adverse events/100,000 users. Some of the effects are indicated as follows: Thromboembolism accounts for 60% of adverse effects and appears to be declining along with hemorrhagic and thrombotic stroke, however, modern use studies are only partially available. Myocardial infarction related to OC use may be embolic, and has a low risk at 7/100,000 users. Low-dose contraceptives substantially reduce the associated risks. Those with risk factors need close monitoring. Norplant is useful for those not wanting to take a daily regimen and is commonly accompanied by menstrual irregularity and sometimes headaches. Continuation is 80% after the 1st year and 40% after 5 years. Candidates for IUDs are parous women in monogamous relationships, who are not at risk for salpingitis, which is related to IUD use, or sexually transmitted diseases. Continuation is 70% after 1 year compared with 50% of OC users.
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PMID:Modern trends in contraception. 212 11

Hemodynamic measurements were performed in 10 healthy women undergoing elective laparoscopy for the investigation of infertility. A standardized anesthetic technique which included the application of positive end-expiratory pressure (PEEP), 0.49 kPa (3.7 mmHg) was utilized. The following variables were studied: cardiac output, stroke volume and left ventricular ejection time (determined non-invasively with impedance cardiography), heart rate, blood pressure, total peripheral vascular resistance and end-tidal carbon dioxide (ET-CO2). The combination of 25 degrees head-down tilt and PEEP ventilation during laparoscopy was associated with a pressure response that restored arterial pressures to essentially pre-anesthetic levels. Net cardiac effects were small. With this regime low pressure 0.7-1.1 kPa (5-8 mmHg) intra-abdominal insufflation with CO2 was associated with only minor cardiovascular changes. There were no indications that 0.49 kPa PEEP during laparoscopy produced adverse cardiovascular effects. The application of PEEP reduced (P less than 0.001) ET-CO2. There was no net increase in ET-CO2 after CO2-insufflation compared to the measurement after induction of anesthesia. This is in contrast to earlier studies without PEEP where a significant net increase in ET-CO2 was reported after CO2-insufflation.
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PMID:Hemodynamic changes during laparoscopy with positive end-expiratory pressure ventilation. 297 54

During the 20 years since the oral contraceptive was introduced, it has been used by some 150 million women around the world, and is perhaps the most carefully monitored medication in history. This vast body of research shows that for the overwhelming majority of healthy women under 30, the benefits of the pill continue to outweigh the risks. The most serious life threatening risks are those involving the cardiovascular system: heart attack, stroke, and throboembolism. However, deaths from these causes would be reduced by 1/2 if women using the pill did not smoke; further reductions would result if women with high blood pressure, high chloresterol levels and diabetes millitus did not use the pill. There is no evidence thus far to justify fears that the pill might be associated with an increased risk of cancer. Most studies show that not only is there no association between pill use and cancer of the ovaries, uterus and breast, but pill use may protect against ovarian and endometrial cancer. Women taking the pill are 1/4 as likely to develop benign breast lumps as nonusers, 1/14 as likely to develop ovarian cysts, 2/3 as likely to develop iron deficiency anemia, and 1/2 as likely to develop rheumatoid arthritis -- all relatively common conditions. In addition, pelvic inflammatory disease, a major cause of infertility, appears to occur only 1/2 as often among pill users as among nonusers. The risk to life among pill users younger than 30 who do not smoke is very small (virtually the same as that of users of the IUD, diaphragm, or condom) and is much lower than the risk of birth-related deaths among women who use no birth control.
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PMID:The pill at 20: an assessment. 720 90

To highlight an emerging risk factor for stroke in the young, we report two patients who experienced ischemic cerebrovascular symptoms in unusual clinical settings of hormone therapy. Expanding indications for estrogenic therapy, including infertility and gender identity disorders, may constitute an emerging risk factor for ischemic stroke in young individuals.
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PMID:Ischemic cerebrovascular disease and hormone therapy for infertility and transsexualism. 862 20

We describe the case of an acromegalic woman with primary infertility who was treated with clomiphene, and subsequently developed pituitary apoplexy.
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PMID:Clomiphene-induced pituitary apoplexy in a patient with acromegaly. 873 10

Turner syndrome afflicts approximately 50 per 100,000 females and is characterized by retarded growth, gonadal dysgenesis, and infertility. Much attention has been focused on growth and growth promoting therapies, while less is known about the natural course of the syndrome, especially in adulthood. We undertook this study to assess the incidence of diseases relevant in the study of Turner syndrome. The study period was from January 1, 1984 to December 31, 1993, and the study base was all women living in Denmark during the study period. We used data from the Danish Cytogenetic Central Register and the Danish National Registry of Patients to assess morbidity. This study supports several earlier studies reporting increased morbidity and confirms results of a recent study on cancer in Turner syndrome. Women with Turner syndrome seem to have an increased incidence of fractures, osteoporotic fractures in adulthood, and non-osteoporotic fractures in childhood. Furthermore, diabetes mellitus, both NIDDM and IDDM, was found with a markedly increased incidence in Turner syndrome, as well as ischemic heart disease, hypertension, and stroke. The risk of cancer, except cancer of the large bowel, does not seem to be elevated in Turner syndrome. Our data suggest that patients with Turner syndrome are extraordinarily prone to abnormalities constituting the metabolic syndrome (e.g., hypertension, dyslipidaemia, NIDDM, obesity, hyperinsulinemia and hyperuricemia). The present data may help to explain the decreased life span found in patients with Turner syndrome.
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PMID:Morbidity in Turner syndrome. 947 75

Laboratory services of the early 21st century will be heavily influenced by significant demographic redistributions and shifts in the incidence and prevalence of disease. A persistent influx of immigrants literally will change the face of the U.S. population. Persons born between 1946 and 1964 will reach middle and old age and will require testing for arthritis, diabetes, cardiac dysfunction, Alzheimer's disease, and stroke. Efforts to combat infertility will expand. Tuberculosis, wrongly assumed to be under control, will continue to proliferate. Testing will be needed for the millions of people living with AIDS and for the millions more infected or suspected to be infected with HIV. Cancer screening and information from genetic markers will widen. Public screenings will be routinely offered in assorted sites. As the national focus shifts from curing illness to promoting health, laboratory tests will assess healthy persons to a greater degree than ever.
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PMID:Changing disease patterns, shifting demographics: effects on laboratory services. 1017 18

A serum prolactin (PRL) level is obtained in response to a specific clinical presentation, including symptoms of hyperprolactinemia (such as amenorrhea and galactorrhea); serum PRL measurement may also be performed as part of an infertility evaluation. An initial level above the normal range should be followed by a repeat level from a blood sample drawn in the morning with the patient in a fasting state. The medical history and a few laboratory tests can eliminate the most common physiologic and pharmacologic causes of hyperprolactinemia, including pregnancy, primary hypothyroidism and treatment with drugs (such as neuroleptics) that reduce dopaminergic effects on the pituitary. In the absence of such causes, radiologic imaging of the sella turcica is necessary to establish whether a PRL-secreting pituitary adenoma or other lesion is present. The vast majority of patients are treated medically, with dopamine agonist drugs. Surgery is reserved for the patient with the uncommon tumor that does not respond to medical therapy or has a large cystic component or for the occasional patient who cannot tolerate dopamine agonists or who experiences pituitary apoplexy.
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PMID:Diagnostic evaluation of hyperprolactinemia. 1064 17

Research on different types of stem cells is of major interest because of its apparent very promising therapeutic prospects, such as for Parkinson's and Alzheimer's disease, spinal cord injuries, stroke, diabetes, cardiac failure, liver failure, cartilage injuries, severe blood diseases, cancer etc. Stem cells can be derived from different sources: adult tissue, foetal tissues, and from in vitro fertilised embryos. Depending on their origin they have varying capacity to multiply and differentiate to other cell types. It is at present not possible to predict which types of cells will be best suitable for various therapeutic situations. Embryonic stem cells have been shown capable of differentiating into all the different tissues and cell types of the body, but they cannot form a new individual. Because of the ethics question involved, The European Group on Ethics on Science and New Technologies for the European Commission and Parliament (EGE), and the Ethics Committee of the Nordic Council of Ministers have prepared reports and given guidelines for research on stem cells. According to the guidelines, every country should regulate the research. Only embryos, which cannot be used in infertility treatment, and have been donated for research, can be used. Creation of embryos solely for research purposes, including somatic cell nuclear transfer, is not regarded as acceptable for the time being. Both partners of the donating couple have to sign an informed consent document. Ongoing research in Sweden is well in line with these European and Nordic recommendations.
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PMID:[Ethical aspects of stem cell research. Legislation and guidelines in Europe]. 1157 92

Only 13% of couples in Ghana practiced contraception in 1988. During the period of nursing following childbirth, it is traditional for the new mother to abstain from sexual intercourse. She is subject to considerable social scorn should she conceive too soon after a previous delivery. Conceiving in short order, nonetheless, women long resorted to clandestine, unsafe abortions during the postpartum interval. The government of Ghana legalized the practice of induced abortion in 1985 so that women could limit their fertility in safety with registered and certified medical practitioners. The author studied 900 women seeking an induced abortion or reporting complications resulting from induced abortion performed outside a hospital setting to see why, in spite of high knowledge of contraception, Ghanaian women resort to abortion instead of using contraception. Subjects were recruited from the KorleBu Teaching Hospital in Accra, the Tema General Hospital of Tema, the Nsawam Hospital of Nsawam, and two abortion clinics in Accra. 55% were married, 25% were teenagers, and 56% were residents of Accra, while the rest were from rural areas. Among those who were married, 45% were the third wives. Most of the women had some formal education and some degree of economic independence. 99% knew of at least one method of contraception, only 21% had ever used a modern method, 6% had used a condom, 4% had used withdrawal sometimes, and 3% had used the rhythm method. The women reported not using modern contraceptives mainly because of the belief that they cause harmful side-effects. For example, it was commonly thought that the oral contraceptive pill causes infertility and withdrawal causes stroke in men. Women also viewed contraceptives as messy, complicated, and/or difficult to use. 54% said they decided to abort their fetus because the pregnancy was out of wedlock; single parenthood is stigmatized in Ghana. 25% decided to abort to better space their children.
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PMID:Misperceptions about contraceptives keep abortion incidence high in Ghana. 1228 87


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