Malignant hypertension in women of childbearing age and its relation to the contraceptive pill

Eleven of 34 women aged 15-44 with malignant phase hypertension were taking oral contraceptives at presentation. All had had normal blood pressure before starting to take the pill. In four the interval between the start of oral contraception and the diagnosis of malignant hypertension was less than four months, and in eight no other cause for the hypertension was found. Underlying renal disease and renal failure were less common among pill users than among non-users with malignant hypertension who were of similar age. No pill user became normotensive after withdrawal of the pill, but blood pressure was well controlled (diastolic less than 90 mm Hg) in three patients taking only one drug. By contrast, all 23 non-users needed two or more antihypertensive drugs to control blood pressure. Ten year survival was 90% among pill users and 50% among non-users. These results suggest that oral contraceptives may be a common cause of malignant hypertension in women of child-bearing age. If the pill is stopped and underlying renal disease excluded the long term prognosis for such patients is excellent.     

玉泉丸对盐酸二甲双胍药效学的影响

目的研究玉泉丸对盐酸二甲双胍（MH）药效学的影响。方法采用腹腔注射链脲佐菌素制备糖尿病大鼠模型,测定给药期间玉泉丸组、MH组、玉泉丸＋MH组大鼠血糖值,给药结束后制备肾脏组织病理切片,观察。肾脏组织变化情况。结果MH组、联合用药组给药后大鼠血糖值下降明显;玉泉丸组大鼠的血糖值下降缓慢;玉泉丸组、联合用药组肾脏损害减轻并趋于正常组水平,MH组肾脏损害程度与模型组无明显变化。结论玉泉丸与MH联合用药用于糖尿病的治疗时,玉泉丸在降低血糖方面无明显协同作用,而有一定的抑制作用,但能起到改善糖尿病并发症的作用,对肾脏组织的损害有一定的修复功能。     

Glycemic status in women using combined oral contraceptive pill

This study was undertaken to determine the effects of low-dose combined oral contraceptives(OCs) containing 30 gm Ethinyl estradiol with 150 microg Levonorgestrel on carbohydrate metabolism by a glycaemic variable -- fasting blood glucose level. It is now known that impairment of carbohydrate metabolism is a potential risk factor for cardiovascular disease and other metabolic disorder. Sixty women age between 15-35 years using OCs served as experimental group and thirty age matched hormonal contraceptive non users were selected for control group. Experimental group was again subdivided into OCP (Oral contraceptive pill) users for last one year group, three year group and five year group. The result showed that there were no significant differences on blood glucose level between users and non-users women. It is concluded that the cyclic administration of monophasic low dose OCs did not altered blood glucose levels and there by have no additional adverse impact on women health reaffirming the ongoing oral contraceptive pill distribution program.     

Plasma lipids can be reliably assessed within 24 hours after acute myocardial infarction

Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients. The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 +/- 0.10 vs 6.18 +/- 0.09 mmol/l) and women (6.75 +/- 0.30 vs 6.44 +/- 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P less than 0.0005). Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there with a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance. These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients' basal lipid state.     

肝硬化患者口服葡萄糖耐量试验的变化

目的:探讨口服葡萄糖耐量试验(OGTT)血糖变化与肝硬化患者肝功能状况的关系.方法:肝硬化患者按child-Pugh肝功能分级分为:A级;B级;C级3组,健康人为对照组.行OGTT,采用葡萄糖氧化酶法测定血糖浓度.结果:60min和120min血糖浓度均显著高于对照组(P＜0.05),120min血糖与血清白蛋白浓度呈显著负相关(P＜0.001),与血清总胆红素浓度、凝血酶原延长时间等呈显著正相关(P＜0.001).结论:OGTT的120min血糖值与肝硬化患者的肝功能状况密切相关,是反映肝硬化患者肝脏处理糖负荷能力的良好指标.     

化浊行血丸治疗颈动脉粥样硬化症的临床研究

[目的]观察化浊行血丸对颈动脉粥样硬化症的临床疗效。[方法]将确诊的动脉粥硬化性脑梗死患者70例随机分为化浊行血丸和阿托伐他汀钙两组,分别在常规治疗基础上给予化浊行血丸和阿托伐他汀钙治疗6个月,并观察治疗前后患者血脂、颈动脉内膜中层厚度及斑块面积的变化。[结果]两组患者治疗后的血清总胆固醇、甘油三酯、低密度脂蛋白及颈动脉内膜中层厚度及斑块面积均较治疗前显著降低(P0.01,P0.05),化浊行血丸组高密度脂蛋白较治疗前明显升高(P0.01),且化浊行血丸组未见不良反应。[结论]化浊行血丸具有安全显著的调脂、稳定斑块和抗动脉粥样硬化的作用。     

Should the pill be stopped preoperatively?

Many women are now advised not to take birth control pills from 4 to 6 weeks before elective surgery out of concern over serious thromboembolic complications. However, stopping the pill may lead to unwanted pregnancies, and drug prophylaxis for deep vein thrombosis carries risk of morbidity. A study in the 1970s of more than 60,000 British women showed a 4 to 6-fold increase in the relative risk of spontaneous venous thrombosis in young women taking the pill. However, the incidence of spontaneous deep vein thrombosis was remarkably low--43 cases in 23,000 women taking the pill (0.19%) compared with 8 cases in 23,000 women not taking it (0.035%). Since 1968, when the 2 studies were commenced, only 5 deaths (3 of current users and 2 of past users) from pulmonary embolism have been reported. Epidemiological studies have relied almost entirely on cases diagnosed clinically. The clinical diagnosis of deep vein thrombosis after surgery in young women taking the pill (12/1244, 0.96%) was about twice that of women not taking the pill (22/4359, 0.5%), but this difference was not statistically significant. The literature showed 3 studies conducted on young women taking the pill in which Iodine 125 fibrinogen scans were used to diagnose deep vein thrombosis after surgery. The incidences of thrombosis in patients taking the pill were 4.6% in patients who underwent gynecological operations for benign disease, nil in 99 patients who underwent various abdominal operations, and 20% in 33 patients who had emergency appendectomies. Present evidence indicates that the risk to young women of becoming pregnant from stopping the pill or of developing side effects from prophylaxis may be greater than the risk of developing postoperative deep vein thrombosis. It is important to define the true incidence of postoperative deep vein thrombosis so that a rational policy can be adopted. Until such time, the routine use of prophylaxis for deep vein thrombosis in women on the pill is probably unecessary.     

Kaiser study links "pill" and risk of hypertension

A continuing study of the relationship between oral contraceptives and hypertension is being conducted at the Kaiser Permanente Medical Center in Walnut Creek, California. All 12,000 subjects participating between December 1968 and December 1971 initially received a battery of tests, medical questionnaires and an examination by both a gynecologist and an internist at Kaiser's Automated Multitest Laboratory (AML), and were subsequently divided into 3 groups; 3569 never (pill) users, mean age 34.5 years; 4252 past users, mean age 13.6 years; and 3851 current users, mean age 29.8 years. Women whose hypertensions was diagnosed at the initial AML examination were classified by age and oral contraceptive use. New cases of hypertension occurred more frequently among never users or past users. 5 new cases of the disease occurred in 3569 women who had never taken oral contraceptives--a rate of 1.4 per 1000. 4 new cases were detected among 4252 past users--a rate of .9 per 1000, while 19 cases were detected among 4252 past users-a rate of 4.9 per 1000. The total age-adjusted rate for current users was found to be 6 times that for never users (p .001). Incidence of hypertensive disease at entry into the study was higher for current users that for past or never users at every age level, except that under 25 years. Comparison of rates for past users and never users failed to show a consistent pattern of difference and the total age-adjusted rate between past and never users was similiar. The actual rate of occurrence of new cases in all 3 groups is though to be an underestimate because some women failed to return for repeat AML examinations. A review of all Kaiser clinic outpatient charts is in progress to detect missing data, and a second review is being conducted to allow computation of an incidence rate based on person-years of observation. Alaysis of currently accumulating data is planned within 6 months, and a report on the initial investigation, led by Dr. Savitri Ramcharan, appears in the book Oral Contraceptives and High Blood Pressure.     

十二指肠腔内套管置入术改善非肥胖型2型糖尿病大鼠糖代谢的作用

目的观察十二指肠腔内套管置入术（endoluminalsleeve,ELS）对非肥胖型2型糖尿病（type2 dabetesmellitus,T2DM）大鼠糖代谢的影响。方法24只雄性自发性糖尿病Goto—Kakizaki（GK）大鼠按随机数字表法分为手术（ELS）组和假手术（sham-operation,SO）组,每组12只。观察术前（0周）,术后1、3、6、12、24周2组空腹血糖（fastingplasmaglucose,FPG）水平,术前（0周）,术后6、24周行口服葡萄糖耐量试验（oralglucosetolerancetest,OGTT）,描绘血糖随时间变化曲线,计算葡萄糖耐量曲线下面积（areaunderthecurve,AUC）,并测定葡萄糖负荷2h后胰高血糖素样肽-1（glucagon-likepeptide-1,GLP-1）水平。结果术前2组大鼠间各项指标差异无统计学意义;与术前比较,ELS组术后1、3、6、12、24周FPG显著降低,差异有统计学意义（F组内=5．982,P=0．023）,术后6、24周AUC、血糖峰值低于术前,差异有统计学意义（F组内=11．602,P=0．003）,且OGTT血糖峰值出现时间由原来的60min提前到30min,葡萄糖负荷后的GLP-1水平明显升高,差异有统计学意义（F组内=43．24,P=0．012）;SO组术后各指标差异无统计学意义。结论十二指肠腔内套管置入术对非肥胖型T2DM大鼠具有稳定控制血糖和改善糖耐量的作用。     

五指山小型猪糖耐量试验及血脂分析

目的 确定五指山小型猪的正常糖耐量水平,并检测血脂,筛查糖、脂代谢异常小型猪.方法 选择未去势的五指山小型猪,禁食不禁水12h后按1.2 ml/kg体重的剂量静脉注射50％葡萄糖注射液,并分别在注糖前、注糖后10、30、60、90和120 min采血测定血糖值.同时采取空腹血清送实验室检测血糖（Glu）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）等生化指标.结果 静脉注糖后血糖水平出现显著性波动,注糖后10 min内血糖水平达到峰值,随后逐渐下降,直至注糖后90 min恢复到给糖前水平.有7头小型猪的糖耐量部分血糖值超过95％置信度上线值,有12头小型猪部分相关的血清生化指标值超过95％置信度上线值.相关性分析发现Glu与TG、TC、HDL-C、LDL-C这4个指标都存在显著的相关性,多因素分析表明TG、HDL-C与Glu显著相关.结论 筛选出糖代谢或脂代谢异常,以及糖耐量减低的小型猪.     

Short-term effect of oral contraceptive pills on some haemostatic parameters in healthy Nigerian women

The objective of this study was to determine the effect of low-dose combined oral contraceptive pill, Lo-femenal, on the following haemostatic parameters: platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen, of apparently healthy Nigerian women over a period of three months. A total of sixty-seven women were recruited for the study consisting of forty-seven subjects and twenty age-matched controls, who were aged between 17 and 37 years. All haemostatic parameters were determined using standard haematological techniques described by Dacie and Lewis, before, and three months after continuous use of oral contraceptive pills in the subjects. The same parameters were determined three months apart in control subjects who were on oral contraceptive pills. Statistical analysis of data was done using the chi-squared test and statistical significance was based on p value < 0.05. The mean values of platelet count and fibrinogen were significantly increased (p=0.0000 and 0.0003 respectively), while the PT and TT reduced significantly (p=0.007 and 0.0000 respectively) after three months of contraceptive use. There was no significant difference in the value of APTT (p=0.17) before and after oral contraceptive use. No differences were observed in the values in the controls. The findings in this study indicate some degree of pro-coagulant activity in the subjects, and the need to properly assess and monitor haemostatic parameters in pills users before commencement and while on them.     

Serum copper in rural women taking combined oral contraceptive

This prospective case-control study included 78 women between 15 to 45 years of age from rural area to see changes in serum copper level as a consequence of oral contraceptive use. Among the subjects, 34 women were included as controls because of not taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. Women in the control group were motivated to consume oral pill (Sukhi) for 3 consecutive cycles. At the 3(rd) month, 25 such women became available and henceforth included as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for a duration of 4 months onwards. Considering different duration of oral contraceptive (OC) use, subjects were grouped as follows: Group I (n=34)--> controls, Group II (n=25)--> 3 months, Group III (n=17)--> 4 months - 2 years and Group IV (n=27)--> >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Copper (mgm/dl) by Atomic Absorption Spectrometry using UNICAM-AA Spectrometer. Mean+/-SD of Serum Copper significantly increased in all 3 contraceptive groups in comparison to controls (p<0.001). Further study including larger population from rural area was recommended to see correlation among serum copper and other trace elements with side effects of hormonal contraceptives. This preliminary study tried to explore the possibility of establishing biochemical monitoring of serum trace elements in OC users.     

小鼠间断性禁食模型的建立及其对葡萄糖内稳态的影响

目的探寻稳定、可靠替代传统热量限制的小鼠模型建立方法及其对葡萄糖内稳态的影响。方法将40只SPF级16周龄C57BL/6J小鼠(雌雄各半)随机按性别及喂养方式分为四组。自由饮食组给予基础饲料自由取食,间断禁食组正常饮食和禁食各24 h交替进行,禁食日可自由饮水。监测各组小鼠体质量和血糖变化情况,并与建模前和建模12周行经腹腔葡萄糖耐量实验和经腹腔胰岛素耐量实验。结果小鼠间断性禁食12周后,体质量和空腹血糖未见明显变化。腹腔注射葡萄糖后血糖上升幅度减轻,腹腔注射胰岛素后血糖下降比例增加。与对照组相比,上述耐量实验曲线下面积均明显减低(P0.05)。结论小鼠间断性禁食后胰岛素敏感性增加,糖耐量改善,且该造模方法操作简单,可作为替代传统热量限制模型的有效选择。     

间断服用米非司酮对皮下埋植避孕使用者月经状况的影响

目的观察服用米非司酮能否改善皮下埋植避孕使用者的月经状况。方法 165例皮下埋植后对象随机分成2组,实验组85例在皮下埋植术后30、60、90、120、150以及180天口服米非司酮片50mg;对照组80例不服用药物,共观察13个月。结果实验组在服药前、服药3个月、6个月、停药后1个月与对照组在皮下埋植术前、术后3个月、术后6个月、术后7个月比较,两组血清雌激素（E2）水平差异无显著性（P〉0.05）;服药前两组孕激素（P）水平差异无显著性（P〉0.05）;服药3个月、6个月、停药后1个月实验组血孕激素水平明显升高（P〈0.05）。实验组总出血天数、出血次数均短于对照组（P〈0.05）;实验组和对照组均无避孕失败。结论服用米非司酮可以改善皮下埋植避孕使用者的月经状况;且不影响皮下埋植剂的避孕效果。     

糖耐量低减者和新诊断2型糖尿病者动态血糖谱的特点

目的采用动态血糖监测系统(CGMS)了解糖耐量低减(IGT)者和新诊断2型糖尿病(T2DM)者动态血糖谱的特点,以便指导制定合理的干预治疗方案。方法对6例糖耐量正常(NGT)者、10例IGT者和20例新诊断T2DM者的CGMS资料进行分析。结果(1)随着糖耐量受损加重,CGMS平均血糖值、血糖值标准差、血糖≥7.8mmol/L时间百分比等逐渐升高(均P<0.05),CGMS血糖谱波动幅度逐渐增加。(2)IGT组餐后血糖达峰值时间为餐后109min±32min,全天血糖≥7.8mmol/L时间为3.0h±0.8h;新诊断的T2DM组餐后血糖达峰值时间为92min±22min,全天血糖≥11.1mmol/L时间为12.6h±1.3h。IGT组和新诊断T2DM组中,早餐后血糖上升速度较快、幅度较高且持续时间较长。结论(1)CGMS检查能比较准确地显示IGT者和新诊断T2DM者动态血糖波动规律,有利于指导制定针对性的干预治疗方案。(2)IGT者全天持续约3h血糖≥7.8mmol/L。(3)随着糖耐量受损加重,餐后血糖上升速度加快、峰值增高,血糖曲线波动幅度逐渐增加。     

Comparison of insulin secretion and insulin sensitivity between normal and impaired glucose tolerance subjects with normal fasting plasma glucose

To examine glucose-stimulated insulin secretion and insulin sensitivity in the normal subjects and patients with impaired glucose tolerance, we performed the oral glucose tolerance test (OGTT) and modified insulin suppression test in 34 non-obese subjects. The plasma glucose and insulin concentrations were measured during fasting and every 30 min up to 120 min following 75 g of oral glucose loading. Ten subjects were classified as impaired glucose tolerance (IGT), and 24 subjects were as having normal glucose tolerance. In addition, the insulin-stimulated glucose uptake was estimated in all subjects by measuring the final 30 min steady-state plasma glucose (SSPG) of a continuous infusion of somatostatin, insulin and glucose for 4 hours (modified insulin suppression test). The mean plasma glucose concentrations of fasting and 60, 90, 120 min during OGTT study were significantly higher in the IGT subjects than in the normals. In addition, the mean incremental glucose areas under the curve during OGTT study were also greater in the IGT subjects than in the normals. The mean serum insulin concentrations were significantly higher at 90 and 120 minutes in the IGT patients than in the normals. During the modified insulin suppression test, the mean SSPG concentrations were significantly higher in the IGT patients than in the normals under the similar steady-state plasma insulin in both groups. There was a good correlation between the incremental insulin areas under the curve (OGTT) and the SSPG in the normal subjects (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Contraceptive efficacy of the pill

Some women who use the pill are at a high risk of unplanned pregnancy. Health practitioners must evaluate drug medication data, gastrointestinal disturbances, and determine a patient's ability to use the pill effectively to identify those at high risk. Of the many types of contraceptives, the pill still comes the closest to being the most effective contraceptive. Nevertheless, the expected failure rate is lower than actual user rate due to a variety of reasons, such as forgetfulness in taking the tablets and temporary malabsorption problems. Since combined preparations of the pill such as the triphasic pill effect the hypothalamic-pituitary region, the endometrium, and the cervical mucosa, one would expect a high level of protection. Evidence indicates, however, that the triphasic pill is comparatively less effective than the fixed dose oral contraceptives. Additionally, studies reveal that certain women should not use oral contraceptives (e.g. women who smoke) because of increased risk to their health. Several benefits have been identified, however, in those women who are not considered high risk, such as a reduction in dysmenorrhea and irregular menstrual bleeding. Unfortunately, little is known on how to detect noncompliant users or how to motivate them to use the pill effectively. Yet research into alternative delivery routes, such as dermal patches and implants, has not reached the commercial level. In Australia, 25% of women of reproductive age choose oral contraceptives.     

开搏通对冠心病患者胰岛素抵抗作用的临床研究

目的：探讨开搏通对冠心病患者胰岛素抵抗的影响。方法：予80例冠心病患者服用开搏通12.5mg/次，每天2次，治疗前及治疗4周后采用氧化酶伦酶法检测糖耐量（OGTT），放射免疫法检测胰岛素（IS）释放试验，测定血糖（BG）、胰岛素（IS）、计算空腹血胰岛素（FInS）与空腹血糖（FBG）比值、糖耐量曲线下面积（AUCG）、胰岛素释放曲线面积（AUCI）及胰岛素敏感指数（ISI）。结果：服用开搏通4周后，BG、IS、FInS/FBG、AUCG`AUCI产较治疗前下降（P＜0.05或P＜0.01），ISI较治疗前增高（P＜0.05）。结论：开搏通能提高冠心病患者胰岛素敏感性，改善胰岛素抵抗。     

胃转流手术治疗Ⅱ型糖尿病的治疗体会

目的探讨胃转流手术治疗2型糖尿病的临床疗效.方法回顾性分析5例接受胃空肠转流术治疗2型糖尿病患者的临床资料,分析手术前后口服糖耐量及空腹血糖、体重指数及胰岛素抵抗指数的变化.结果术后1月患者的口服糖耐量,体重指数及胰岛素抵抗指数均较术前有显著好转（P〈0.01）,空腹胰岛素无明显的统计学意义（P〉0.05）.术后随访,3例血糖控制在正常范围,不需药物控制,2例明显好转,血糖值〈1/2（术前血糖值-治愈标准值）.结论胃转流手术能有效的治疗2型糖尿病.