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

Action taken by the Food and Drug Administration (FDA) toward the th erapeutic use of estrogens is reported. The FDA has 1st ordered revision of physician-labeling for estrogens, and 2nd has prepared a brochure explaining the advantages and disadvantages of estrogen therapy to patients. Some of the points made in the new labeling and brochure are: 1) the risk of cancer of the uterus increases with duration of use and dosage; 2) users of estrogens should be examined by their physicians at least every 6 months; 3) estrogens should never be given to pregnant women; 4) estrogens should not be given in cases of breast or uterine cancer, undiagnosed abnormal vaginal bleeding, clotting in the legs and lungs, or previous heart disease, angina, or stroke; and 5) estrogens should not be used to treat menopausal nervousness, as they have proved ineffective, or for improving the complexion. There is also no evidence that estrogens are effective in preventing threatened or habitual abortion. It is recommended that estrogens be administered cyclically (3 of 4 weeks), and that the dosage be reduced or discontinued every 3-6 months to assess the need for their continued use.
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PMID:Informing patients about estrogens. 82 30

This study is to calculate a risk of lung cancer in a cohort of 1411 sarcoidosis cases which were followed for a 3 year period from 1984 to 1987. The physicians were requested to answer the questionnaire about progress of the disease by mail. Excess death was investigated using standardized mortality ratio (SMR). The expected number of deaths was calculated from Japanese sex-age specific mortality rate in 1985, using person-year method. Death from all causes and cancers did not show any excess. SMR being 0.98 and 0.97 respectively. The SMR of lung cancer was 3.26 (male: 5.56, female: 3.03), being statistically significant. The SMR of lung infection was 4.2, with statistical significance. The SMR of other main causes of death in Japan i.e., cerebrovascular accident, ischemic heart diseases and heart failure was less than 0.88. It is probably that sarcoidosis is a risk factor of lung cancer. The SMR of leukemia and uterine cancer was 5.88 and 8.70, respectively, though the observed number of leukemia was too small to conclude how high the cancer risk is among sarcoidosis patients. Gastric cancer, hepatic cancer and colon cancers were not observed.
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PMID:Excess death of lung cancer among sarcoidosis patients. 166 41

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

Hormone replacement therapy (HRT) (oestrogen with or without progestin) is often initiated with the onset of menopause to decrease symptoms of oestrogen deficiency, such as vasomotor instability (hot flashes) and urogenital effects (1-3). HRT can also prevent long-term consequences of oestrogen deficiency, such as osteoporosis and cardiovascular disease (1-3). The decision to start HRT in peri- and postmenopausal women is complicated by concerns of increased risk for thromboembolic events, uterine cancer and breast cancer (2-4). Thromboembolic stroke is a particular concern due to its association with the use of oral contraceptives with high oestrogen content (3, 4). However, for older women it has been suggested that HRT use decreases or has no effect on stroke risk (5-9). Should these findings apply to a women with a history of thromboembolism, in this case ischemic stroke?
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PMID:Risk of hormone replacement therapy in stroke patients. 1097 73

This article reviews the symptoms and everyday problems associated with tamoxifen adjuvant therapy and their impact on patients' quality of life. In addition, the purported toxic effects of tamoxifen therapy (e.g., premature menopause, weight gain, and depression) are discussed, and data are presented that refute claims of the toxicity of tamoxifen therapy. From randomized controlled trials of adjuvant therapy, we know that tamoxifen therapy increases the rate of hot flashes, night sweats, and vaginal discharge; however, in observational studies these symptoms do not have a statistically significant impact on patients' quality of life as measured by standardized, self-report questionnaires. The Breast Cancer Prevention Trial found no evidence of excessive rates of depression or clinically significant differences in sexual functioning between women receiving placebo and those receiving tamoxifen therapy. Although several serious medical risks from tamoxifen therapy exist (e.g., uterine cancer, blood clots, stroke, and cataracts), there are additional benefits from tamoxifen therapy in addition to an increase in disease-free survival rates and overall survival rates, including a decrease in contralateral breast cancer and fractures. Ultimately, the decision to receive tamoxifen therapy is a personal choice for each woman to make on the basis of the evidence of tamoxifen therapy's benefits and risks, along with her own motivation to receive therapy. When the benefits of such therapy are small, some women may choose to avoid treatment, but others may wish to try therapy to determine whether possible side effects are relevant. For women in whom the absolute survival benefits are large, there may be less difficulty in making this decision.
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PMID:Impact of tamoxifen adjuvant therapy on symptoms, functioning, and quality of life. 1177 6

Couples in the Philippines are free to choose the family planning method that best satisfies their health needs and religious beliefs. All service delivery outlets of the Philippines Department of Health and participating agencies should have all approved, safe, effective, and legal family planning methods available. Oral contraceptives (OCs), IUDs, tubal ligation, and vasectomy are at least 92% effective. OCs protect against pelvic infection and reduce the risk of ovarian and uterine cancer. Older OC users who smoke face an increased risk of blood clotting, stroke, and heart attack. The progestogen-only pill is the best OC for lactating women. The IUD can be effective for 6 years assuming no pain or other side effects. Breast feeding mothers can use the IUD safely. IUD contraindications are anemia, active cervical or pelvic infection, abnormal vaginal bleeding, and genital cancer. Condoms protect against pregnancy as well as sexually transmitted diseases, including HIV/AIDS. When practiced correctly, natural family planning methods are 70-90% effective. They are the cervical mucus method, basal body temperature method, sympto-thermal method, and breast feeding. Norplant contraceptive implants are available to Philippine women on a trial basis. They release a progestin slowly into the blood stream, suppressing ovulation and thickening cervical mucus. The long-acting contraceptive injectables are DMPA, Cycloprovera, and HRP 102. Women must receive an injection every 3 months to protect against pregnancy. The first injection should occur within the first 5 days of the menstrual cycle. Women choosing tubal ligation and men choosing vasectomy should be sure in their decision because they are permanent methods and sterilization reversal procedures are rare in the Philippines. Men with diabetes, an infection at the incision site, clotting disorders, enlarged or painful testicles, and an inguinal hernia should not have a vasectomy.
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PMID:The family planning methods. 1217 21

The low dose oral contraceptive (OC) is the only drug which extends life and prevents ovarian and uterine cancer. The longer a woman uses it the greater the protective effect against these cancers. Yet women tend to avoid using it because of perceived side effects. The only country where it is considered safe is the Netherlands. The 1st OCs did cause considerable side effects, however, because of the high dose of hormones. Today's low dose OCs have not overcome the biases against these high dose OCs. Low dose OCs do not pose the myocardial infarct and stroke risks that the high dose OCs did. In fact, the US Food and Drug Administration advises low dose OCs as a safe contraceptive for 35-year old nonsmoking women. The elevated risks of cardiovascular disease in the high dose OCs are quite modest (reduction of life expectancy by several 10s of days) compared with the risk of smoking 1-2 packs of cigarettes a day (reduction of life expectancy by 4.5 years). A media review indicates many more negative than positive stories about OCs. In addition, people are more likely to overestimate risks in areas they perceive to be out of their control (e.g., using OCs). Data still do not provide a definitive answer on OCs role in breast cancer development, however. Nevertheless when examining OC use in 60-year old women with and without breast cancer, breast cancer rates are basically the same. A meta-analysis of OC use and breast cancer indicates a slight increase in breast cancer in 35-40 year old women, but a slight deficit of breast cancer cases in 40-45 year old women. The US National Institutes of Health plan on a new series of OC use and breast cancer studies.
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PMID:Time to end bias against the pill. 1222 24

This article will focus on the results of the Women's Health Initiative on the effects of hormone replacement therapy on coronary heart disease, stroke, venous thromboembolism, breast cancer, and colorectal cancer. Data from other relevant trials, including the most recent data on ovarian and uterine cancer risk and on gynecologic cancer patients, are also discussed to provide some guidelines on prescribing hormone replacement therapy in clinical practice, particularly in gynecologic cancer survivors.
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PMID:Hormone replacement therapy on ovarian and uterine cancer risk and cancer survivors: how shall we do no harm? 1588 64

A 63-year-old woman with a history of uterine cancer was admitted to our hospital with dyspnea and stroke. Echocardiography showed a huge vegetation attached to the posterior mitral leaflet with severe mitral regurgitation. Blood culture identified Streptococcus galactiae. The serum level of cancer antigen 125 (CA125) was elevated at 199.4 U/ml. Resection of infected tissue including mobile vegetation and replacement of mitral valve were performed. The postoperative course was uneventful and the patient was discharged after 4 weeks of antibiotic therapy. The values of CA125 returned to normal (less than 15 U/ml) on the 90th postoperative day. These findings have suggested that a high serum value of CA125 is a possible indicator of infection-related congestive heart failure.
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PMID:Normalization of cancer antigen 125 after mitral valve replacement in a patient with congestive heart failure due to mitral valve endocarditis. 1620 Aug 89

Selective estrogen receptor modulators (SERMs) bind to estrogen receptor (ER) and develop tissue-selective actions as estrogen agonists or antagonists. As such, SERMs have been developed to exert estrogen-like beneficial effects against some disorders including osteoporosis, while reducing estrogen-related risks, including breast cancer. Prevention of vertebral fractures by a SERM, raloxifene (RLX), in osteoporotic postmenopausal women has been well established. RLX does not increase or decrease cardiovascular events, overall mortality, cardiovascular mortality or the overall number of strokes, but there appears to be a small increase in stroke mortality. Both RLX and tamoxifen similarly reduce the risk of ER-positive invasive breast cancer. At the same time, RLX treatment is associated with 36% fewer uterine cancer incidence and 29% less thromboembolic events. Keeping these results in mind, it is our responsibility to critically evaluate and decide timing and length of treatment, as well as subjects with benefits or risks for the treatment of osteoporosis by SERMs.
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PMID:[Selective estrogen receptor modulators (SERMs)]. 1695 78


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