Benign breast disease and oral contraceptive use

A random selection of 1,230 upstate New York childbearing women was used to examine the history of oral contraceptive use in women with a clinical diagnosis of benign breast disease. We found that 73 women who had benign breast disease had a reduced duration of pill use. When determining the reason for this reduction, we found that in a significant portion (P less than .05) of our benign breast disease cases, the women had been advised by their physicians to discontinue pill use for breast-related reasons. We then surveyed a large group of upstate New York physicians. One third of them considered benign breast disease a potential contraindication for starting oral contraceptive use. Nearly one half throught the development of benign breast disease to be a potential contraindication for continuing oral contraceptive use. It is premature to conclude that oral contraceptive usage protects against benign breast disease.     

Pharmacologic treatment of depression during pregnancy.

CONTEXT: Despite the frequency of depression in women of childbearing age, information to guide patients and physicians through a consideration of treatment during pregnancy is limited. OBJECTIVE: To identify risk factors associated with treatment of major depression during pregnancy to help physicians develop treatment plans that optimize clinical care. DATA SOURCES: Reports of prospective controlled trials in English were identified from MEDLINE and Health STAR using the search terms antidepressant during pregnancy and depression during pregnancy, by manually searching bibliographies of review articles, and through discussions with investigators for 1989-1999. STUDY SELECTION: We selected studies in which maternal and infant health outcomes associated with antidepressant exposure were compared with those of non-teratogen-exposed controls. Four studies published since 1993 were identified and included in the analysis. DATA EXTRACTION: We abstracted information about identification of subjects, comparison groups, pregnancy, and birth outcomes. We organized the data along 5 domains of reproductive toxicity: intrauterine fetal death, morphologic teratogenicity, growth impairment, behavioral teratogenicity, and neonatal toxicity. DATA SYNTHESIS: Data were available for tricyclic antidepressants (collectively), fluoxetine, and newer selective serotonin reuptake inhibitors (collectively). Exposure to these agents did not increase risk for intrauterine death or major birth defects. Decreased birth weights of infants exposed to fluoxetine in the third trimester were identified in 1 study. The development of children whose mothers took tricyclics or fluoxetine during gestation did not differ from that of controls. Direct drug effects and withdrawal syndromes occurred in some neonates whose mothers were treated with antidepressants near term. CONCLUSIONS: Although few in number, new information from prospective studies provides a welcome change from decision making based on nonprospective data. Monitoring and interventions for patients with identified risks (eg, poor weight gain) are recommended.     

Sex steroid hormones and breast cancer: is there a link with oral contraceptives and hormone replacement therapy?

OBJECTIVE: To determine whether use of sex steroid hormones for contraception and hormone replacement therapy alters the risk of breast cancer, and whether the risk varies with their composition, duration of use, the period of a woman's life when the hormones are used, and after successful treatment for breast cancer. DATA SOURCES: The results of important epidemiological reports, readily available from the English literature and published since 1981, were evaluated, using reports of basic scientific work as a background to the problem. STUDY SELECTION: An attempt was made to obtain most of the relevant reports. Twenty case-control and seven cohort studies were available on the oral contraceptive pill (OCP) and eleven case-control and five cohort studies on hormone replacement therapy (HRT). DATA EXTRACTION: The relative risk estimates for breast cancer (and their 95% confidence intervals) determined by each report were tabulated according to the specific conditions of analysis, for example users under age 25, duration of use. Results by meta-analysis from previous studies were also used to determine risk. A significant positive association was present when the risk estimate exceeded 1.0 and the 95% confidence interval did not cross 1.0. DATA SYNTHESIS: Among OCP users, the vast majority of reports showed no significant risk of breast cancer--overall, longest duration of use, and use before first full-term pregnancy. However, a positive association between breast cancer and users under age 25 was found in three of eight reports. Similarly, the majority of reports showed no significant risk of breast cancer among HRT users, overall as well as in relation to duration of use and interval since first use. There was no increased risk with additional progestogen; it may be protective. An improved prognosis was found in users who developed breast cancer. On the limited data, use of hormones for postmenopausal symptoms did not appear to be harmful to women who had been successfully treated for breast cancer. CONCLUSIONS: The review revealed good evidence that use of sex steroid hormones had no significant effect on the risk of breast cancer, whether given for contraception or hormone replacement. There was some concern about increased risk with prolonged use of the OCP, especially in younger women. At present, use of these hormones is a matter of informed choice, with individual considerations of the risk-benefit ratio.     

Valproic acid (Depakene). A new anticonvulsant agent.

Valproic acid, a new anticonvulsant, is most effective in absence seizures (simple and complex), but it has produced improvement in tonicclonic seizures, mixed absence with tonic-clonic seizures, and myoclonic epilepsy. It is useful alone or as an adjunct to other anticonvulsants and may allow the dosage of the latter to be reduced. Some patients who are refractory to other anticonvulsants may respond to valproic acid. Adverse reactions occur in about 20% of patients. Gastrointestinal disturbances and drowsiness (usually noted when valproic acid is given with other anticonvulsants) are the most common reactions; hair loss is observed less frequently. Untoward effects are usually transient and do not require discontinuation of use of the drug.     

Management of epilepsy in women

There are many aspects to the management of epilepsy in women related to their role in reproduction. Some of these need to be considered in adolescents, some are related to pregnancy, concerning both the mother and her infant, and others with the menstrual cycle and the menopause. This review considers contraception, fertility, teratogenicity, and the use of folic acid. It also discusses the special investigations in pregnancy, hyperemesis, the effect of pregnancy on the control of epilepsy, the effect of seizures on the fetus, a first fit in pregnancy, pseudoseizures, seizures during delivery, vitamin K, breast feeding, postpartum maternal epilepsy, hereditary risks, counselling, catamenial epilepsy, the menopause, and bone density.     

口服避孕药及二甲双胍预治疗对多囊卵巢综合征患者不孕的治疗效果分析

目的:探讨多囊卵巢综合征(PCOS)患者应用口服避孕药和二甲双胍预治疗对促排卵效果的影响。方法:168例PCOS患者治疗前后常规化验内分泌、糖耐量、胰岛素释放实验,计算稳态模型胰岛素抵抗指数(HOMAIR),随机分成三组,A组(对照组)56例:直接用氯米芬促排卵,如未妊娠连用3个月;B组54例:先用口服避孕药(OCP)去氧孕烯炔雌醇(Marvlon)或炔雌醇环丙孕酮(Dain-35)预治疗3个月,然后用氯米芬促排卵;C组58例:同时口服OCP和二甲双胍三个月,然后促排卵。比较三组治疗前后内分泌变化、三周期累积排卵率和妊娠率。结果:B组和C组治疗后睾酮(T)及黄体生成素(LH)水平明显下降,排卵率和妊娠率均高于A组,P<0.05。C组治疗后胰岛素水平及HOMA IR明显降低,差异有显著性意义,P<0.05。结论:PCOS患者应用口服避孕药和二甲双胍预治疗可改善内分泌状态,提高促排卵效果和妊娠率。     

Effects of anticonvulsants on the electroconvulsive threshold lowered by DA, 5-HT or GABA depletion

A cannula was chronically implanted in the rat ventriculus, and anticonvulsants were administered through the cannula. The effects of the anticonvulsants applied, intraventricully, were investigated on the decreased electroconvulsive threshold induced by pretreatment with alpha-methyl-p-tyrosine (alpha-MT), p-chlorophenylalanine (PCPA) or allylglycine. The TRH analog, DN-1417, valproate (VPA), and phenobarbital (PB) raised the electroconvulsive threshold which had been lowered by alpha-MT. The reduced electroconvulsive threshold from PCPA was raised by DN-1417, but not by VPA or PB. The allylglycine induced lowering of the electroconvulsive threshold was raised by VPA and PB, but not by DN-1417. Phenytoin had no anticonvulsant effect on rats pretreated with these drugs. From these results, it was concluded that the anticonvulsant action of DN-1417 could be due to enhancement of dopamine and/or serotonin turnover.     

Forty years of combined oral contraception: the evolution of a revolution

The combined oral contraceptive (COC) pill has become an integral part of fertility choice in almost every country since its introduction in 1960 in the United States. It was the first contraceptive method to provide sexual freedom of choice for women through reliable personal, private control of fertility. Modern, very low-dose pills have maintained a high degree of contraceptive efficacy, but the margin for error in pill-taking appears much smaller. These COCs have a much lower incidence of side effects and serious complications than early high-dose COCs. Serious health risks from venous thromboembolism are rare, and not measurably higher for pills containing third-generation compared with earlier progestogens. Most women feel very well taking modern COCs, but myths about these drugs still abound. Most non-contraceptive health benefits of COCs are still not widely appreciated in spite of much evidence. Controversy still persists over the association between COC use and breast cancer. Although slightly more breast cancers are detected in current COC users (relative risk 1.24; 95% CI, 1.15-1.33), they are less advanced and less aggressive. Some women have pre-existing medical risk factors for COC use, and a detailed history for cardiovascular risk factors is one of the most important precautions.     

Practical neurology--5: Recurrent unresponsive episodes and seizures

Careful history-taking is essential when evaluating patients with suspected epileptic seizures. It should focus on ascertaining whether the episodes are seizures or a seizure mimic such as syncope. Recurrent unresponsive episodes associated with seizures may indicate a diagnosis of focal epilepsy or complex partial epilepsy. Adults with a clinical diagnosis of a focal seizure disorder require investigation with electroencephalography and magnetic resonance imaging. The goal of treatment should be to achieve a life free of seizures, with minimum adverse effects from anticonvulsant medication. The choice of medication should be individualised to a patient's seizure characteristics, circumstances and preferences. Dose adjustments should be made according to clinical response (seizure frequency and adverse effects), rather than on serum drug concentrations alone. Lifestyle advice, such as advice about driving restrictions, is important for the safety of the patient and others. All anticonvulsants are potentially teratogenic. Poorly controlled epilepsy in pregnancy imparts significant risks to the mother and baby, which need to be weighed against the risks of teratogenicity. The risk of major congenital malformations is highest with valproate, particularly in high doses.     

妈富隆用于避孕的临床观察

目的观察妈富隆避孕的临床疗效及并发症。方法对用妈富隆（A组）、口服避孕片1号（B组）及口服避孕片2号（C组）三组避孕药的避孕效果及并发症进行比较分析。结果三组避孕药妊娠发生率均为0,说明三组避孕药的避孕效果均较好,无差异。并发类早孕反应：A组为。例,B组8例,C纽4例,A组与B、C两纽相比有显著差异（P〈0．05）;并发不规则流血：A组1例,B组7例,C组15例,A组与B组比较,P〈0．05有显著差异;A组与C组比较,P〈0．01有极显著差异;并发乳房胀痛：A组0例,B组4例,C组5例,A组与B、C两组比较P〈0．05,有显著差异。三组均没有并发血栓性疾病、糖尿病及肿瘤性疾病,血脂、肝功均正常。结论妈富隆用于避孕效果好,并发症少,值得临床推广使用。     

Secondary dyslipidemia. Inadvertent effects of drugs in clinical practice.

OBJECTIVE--To examine the available literature on commonly prescribed drugs and their effects on blood lipid and lipoprotein levels. DATA SOURCES--The review was based on searches of English-language articles from 1975 to 1990 by Medlars II and MEDLINE programs, the Index Medicus for 1980 to 1990, and references from identified articles. Relevant journals published within the last 6 months were also examined. STUDY SELECTION--More than 500 articles were identified for inclusion. Articles were selected on the basis of appropriateness of design to demonstrate significant results, determined by consensus when necessary. DATA EXTRACTION--Studies were classified according to type (observational or interventional), length of follow-up, and type of controls. Quanitative analysis of lipid, lipoprotein, and apoprotein changes induced by drugs was computed as the percentage of change observed during the course of the study (interventional) or compared with the controls at a given time (observational). DATA SYNTHESIS--Steroid hormones that have strong progestogenic and androgenic properties, retinoids, cyclosporine A, and phenothiazines are potentially atherogenic. Steroid hormones with dominant estrogenic properties, several anticonvulsants, biguanides, high-dose ketoconazole, and aminosalicylic acid are potentially antiatherogenic. Corticosteroids appear to elevate all the lipoprotein cholesterol levels. Oral estrogens, retinoids, and corticosteroids also can elevate triglyceride levels. Other drugs with questionable effects on lipoprotein metabolism are reviewed. CONCLUSION--Although the long-term implications of drug-induced lipoprotein changes are still undefined, physicians need to consider these effects in clinical practice.     

Effect of Antenatal Expression of Breast Milk at Term in Reducing Breast Feeding Failures

Background

Though breast feeding is natural, during the first 2-3 days, when enough breast milk is not available with mother, she may introduce bottle feeding erroneously for improving nutrition to her baby. We studied the effect of antenatal expression of breast milk at term in reducing breast feeding failure as compared to conventional method of initiation of breast feeding.

Methods

A prospective study was carried out in 180 booked cases at term. Daily expression of breast milk at least once a day after 37 weeks of pregnancy was introduced in randomly selected 90 pregnant ladies. Prior examination was done to exclude any inverted or cracked nipples and appropriate treatment instituted.

Result

The study group who expressed breast milk daily after 37 weeks did not find it difficult to initiate breast feeding after vaginal or cesarean delivery. Sufficient milk started flowing within half an hour of initiation of breast feeding in most 85 (94.4%) subjects of study group as compared to 63 (70%) patients of control group, which was statistically significant. There was no increase in any delivery complication. There were two partial breast feeding failures in control group but none in study group.

Conclusion

Daily antenatal breast milk expression after 37 completed weeks of pregnancy significantly reduced the time for establishing full breast feeding and reduced breast feeding failures.Key Words: Antenatal milk expression, Breast feeding failure     

Thromboembolism and its management in pregnancy

OBJECTIVES: To formulate recommendations for the management of thromboembolism during pregnancy. DATA SOURCES: The English language published literature derived from Medline and covering the following aspects of thromboembolism in pregnancy was reviewed: epidemiology; pathogenesis; clinical features; investigations; the pharmacology of various anticoagulants; management and prophylaxis of deep vein thrombosis and pulmonary embolism; medicolegal aspects. STUDY SELECTION: Publications published between 1960 and 1990 were cited. These studies were selected because data appeared reliable and with appropriate conclusions. DATA SYNTHESIS AND CONCLUSIONS: Many questions are still not completely resolved, but the information gathered should provide firm guidelines to practitioners in the areas of diagnosis, the choice of anticoagulant drugs, methods of administration of the drugs, and measurement of therapeutic endpoints.     

复方灯盏花滴丸对大鼠心肌缺血-再灌注保护作用的研究

目的：观察复方灯盏花滴丸对缺血—再灌注过程心肌的保护作用。方法：采用结扎左冠状动脉法，与假手术组、缺血—再灌注组、复方丹参滴丸组相对比，研究了复方灯盏花滴丸对大鼠心肌缺血—再灌注过程超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH—Px)、丙二醛(MDA)、钙离子(Ca^2 )含量的影响。结果：复方灯盏花滴丸显著提高了再灌注心肌的SOD、GSH—Px活力(P＜O．01)，显著降低了心肌中MDA和Ca^2 含量(P＜0．05)。结论：复方灯盏花滴丸对心肌缺血—再灌注损伤具有一定的保护作用，该保护作用的机制可能与清除自由基功能和减轻钙超载有关。     

Patterns of contraceptive pill taking in an inner city practice

A total of 161 patients completed a questionnaire about their pattern of taking the oral contraceptive pill. Only 28% (45) of patients were taking the pill according to the manufacturer's instructions, and in the event of the pill being missed only 26% of patients would use a sheath. A tenth of the patients believed that amenorrhoea always indicated pregnancy, but 35% believed that amenorrhoea was harmful to the body. This group did not differ in their pill taking from the remaining 65% of patients.     

Characteristics of Contraceptive Use in Sao Paulo State, Brazil

Objective To know the characteristics of contraceptive use in Sao Paulo State collected by the Demographic and Health Survey （DHS） conducted in 1996. Methods Data of Sao Paulo in 1996 were analyzed compared with the previous DHS carried on in 1986focusing on Sao Paulo State. Contraceptive use among married or cohabiting women by age, number of children and schooling was closely examined. Age and timing of female sterilization were also analyzed. Results The results showed that unlike Brazil there was a stability of female sterilization in Sao Paulo State during 1986 and 1996. There was a pattern in Sao Paulo： up to 30 years old the pill was the most used contraceptive, after 30 there was a predominance of female sterilization, which increased with the number of children and decreased with schooling. The use of male methods had also increased in the 1986 and 1996 period, being greater in Sao Paulo than in Brazil. Sao Paulo also presented more diversity in the use of reversible contraceptives. Conclusions The predominant two contraceptive methods in Brazil and Sao Paulo changed from 1986 to 1996, i.e..from pill to female sterilization.     

Australian scientists develop male contraceptive

The Australian Information Service in Canberra reports that Australian scientists have formulated a contraceptive pill to temporarily stop spermatogenesis in man, thus producing infertility. The research was done by a team consisting of Dr. Henry Burger, director of the Medical Reserach Center at Prince Henry's Hospital in Melbourne, Dr. Bryan Hudson, Principal Research Fellow at the Howard Florey Institute of Experimental Medicine at the Univeristy of Melbourne, and Dr. David de Kretser, senior lecturer in Monash University's Department of Medicine at Prince Henry's Hospital. The contraceptive pill consists of progestagen (d-norgestrel) with androgen (methyltestosterone), a combination that suppresses the production of the sperm but conserves libido and potency. The testing program has yet to be undertaken in human volunteers. There will be three phases to the drug trial: pretreatment, during which the health of the volunteers and the safety of the drug will be established; the treatment phase, lasting six months, during which the volunteers will be given daily oral dose of the drugs; and the recovery phase, lasting at least three months, during which the restoration of normal spermatogenesis will be observed.     

三阴乳腺癌的危险因素和临床病理特征分析

目的 分析三阴乳腺癌患者的相关危险因素和临床病理特征。 方法 选取2013年2月-2016年6月在蚌埠医学院第一附属医院诊治过的180例乳腺癌患者,使用免疫组织化学法检测ER、PR及HRE-2的表达情况,60例三阴乳腺癌患者为观察组,120例非三阴乳腺癌患者为对照组,对比2组的年龄、抽烟饮酒状况、体质量指数、家族史、居住地、受教育程度、初潮年龄、泌乳情况、使用避孕药情况、产次、初产年龄、流产情况、绝经情况。将差异有统计学意义的指标筛选出来进行多因素Logistic回归影响分析。分析三阴性乳腺癌的相关危险因素和临床病理特征。 结果 2组患者在年龄、体质量指数、泌乳情况、避孕药物、产次、绝经情况方面差异具有统计学意义(P<0.05)。而2组患者在抽烟饮酒状况、家族史、居住地、受教育程度、初潮年龄、初产年龄、流产情况方面差异无统计学意义(P>0.05)。多因素Logistic回归影响分析结果表明:年龄<60岁、产次 ≥ 2次、绝经前状态对应的P值均>0.05,差异无统计学意义。体质质量指数、泌乳情况、避孕药物对应的P值均<0.05,差异有统计学意义。BMI ≥ 25 kg/m2、抑制泌乳、使用避孕药均是三阴乳腺癌的危险因素。三阴乳腺癌病理类型以浸润性导管癌为主,淋巴结转移率高,分期及分级更晚。 结论 三阴乳腺癌的恶性程度高于非三阴乳腺癌,肥胖、抑制泌乳、使用避孕药是三阴乳腺癌的危险因素。