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.     

A Comparison Study of the Effects Injectable Contraceptive Cyclofem on Blood Coagulation and Fibrinolysis

Forty-six healthy women received Cyclofem (25mg medroxyprogesterone acetate with 5mg estradiol cypionate) and other forty-five women, as control, received oral contraceptive pill (Orttm-Novum 1/35, containing norethisterone enantate 1mg and estradiol valerate 35μg) for nine months. Blood samples were taken during the follicular and luteal phases of pre- treatment, and for Cyclofem group, immediately prior to the 3rd and 9th injections and 1 and 3 weeks after the 3rd and 9th injections; for Ortho-Novum group, blood samples were taken on the irst day of the 3rd and 9th pill cycles and 1 and 3 weeks later in both cycles. For both groups after at least 3 months nonhormonal method of contraception, blood sampling was repeated at follicular and luteal phases of a normal mentrual cycle. Coagulation and fibrinolysis parameter were detected including hemoglobin, platelet count, prothrombin time, APTT, fibrinogen, factor Ⅶ, factor Ⅹ, plasminogen, t-PAL AT Ⅲ(functional and immunological assays) and protein C. In the Cyclofem group, hemoglobin, platelet count, fibrinogen and factor Ⅹ were not changed. Factor Ⅶ significantly reduced. Prothrombin time and APTT showed minor changes. Plasminogen and protein C decreased while t-PAI aad AT Ⅲ increased. These changes showed a dynamic balance between coagulation and fibrinolysis. In Ortho-Novum 1/35 group, platelet count, factor Ⅹ and fibrinogen increased and prothrombin time and APTT accelerated. In fibrinolysis and anticoagutation system, plasminogen increased as well as protein C, but AT Ⅲ declined. Those changes showed a tendency of hyper-eoagutability state, fibrinolysis and anticoagulation were enhanced to a certain extent.The result of our study is that there are slight changes on coagulation and fibrinolysis in Cyclofem injectable contraceptive users.     

Neurological problems linked to "pill" in 3 women

Dr. George B. Jacobs, attending neurosurgeon at the Hackensack Hospital in New Jersey, reported an association between cerebral arterial disease and oral contraception in 3 women at the American College of Angiology meeting in New York City. There was no evidence of any previous neurological, vascular, or systemic problems which might have predisposed the women to cerebroarterial disease. All 3 patients began to complain of headaches within a few days or weeks after starting oral contraceptives. In 1 patient, the headaches disappeared after pill discontinuance; but minimal right hemiparesis is still present. In another, who developed right hemiparesis, marked speech difficulties, and expressive and receptive aphasia, the hemiparesis and aphasia have improved very little since pill discontinuance. The neurological disabilities of the third patient have been improving gradually since the pill was discontinued.     

米非司酮治疗子宫肌瘤的效果分析

目的 探讨米非司酮治疗子宫肌瘤的效果。方法 自2001年1月～2003年3月采用米非司酮治疗子宫肌瘤82例,用药方法 从月经第5天开始口服米非司酮25mg,每晚1次,共30天,第31天至90天每晚服米非司酮12.5mg,3个月为一疗程,停药后待出现第二次转经再继续每天服用米非司槽12.5mg,连服3个月经周期。82例均服完2个疗程。结果 肌瘤完全消失19例,肌瘤缩小50例,总有效率为84.1％,子宫肌瘤平均体积缩小44.9％,未发现肌瘤体积增大者。无明显不良反应。结论 米非司酮是治疗子宫肌瘤较理想的一种方法。     

流产后关爱服务对流产后妇女口服避孕药使用状况的影响

目的：调查流产后关爱服务（PAC）对流产后妇女口服避孕药使用情况的影响,探讨如何促进流产后计划生育服务、降低重复流产率。方法调查2012年10月至2013年10月在我院计划生育科入院终止妊娠的妇女,流产后立即服用口服避孕药2个月。分别于出院1个月、3个月及半年后随访,了解其服药情况、后续避孕方法的选择以及有无重复流产,共随访850名妇女。结果服用2个周期者731例,占86.0%。随访妇女2个周期后避孕方法的使用情况,继续使用口服避孕药者115例（13.5%）,使用其他方法者631例（74.2%）;未采取任何避孕方式者104例（12.2%）。49.8%的妇女因为担心不良反应而不愿意选择口服避孕药为后续避孕方式。服药期间出现不良反应者15例（1.8%）,为恶心或头晕不适。6个月内意外妊娠者34例（4.0%）,再次行人工流产26例,重复流产率为3.1%。结论口服避孕药作为一种高效、安全的避孕方法,尽管非常适合绝大多数的妇女在流产后立即开始使用,但是由于对其不良反应的担心使得目前坚持使用口服避孕药的妇女比例较低。对于流产后妇女,关于避孕方法的选择和使用的咨询内容还需要细化,需要更有针对性,同时咨询要有长期性,才有利于增加妇女长期采用口服避孕药避孕的信心。     

Factors influencing the acceptability and prolonged use of oral contraceptives.

The prospect of increasing the incidence of continued oral contraceptive (OC) users led to a planned study in which 100 women were given OCs for 1 year. Follow up occurred monthly for the first 3 months and was thereafter 3-monthly. Patients obtaining special attention could continue the pills for a longer duration and had minimum medical problems compared with those where individual attention was lacking. The difference lay presumably in prompt attention towards any trouble and the correct selection of pills. The survey indicates that the success of OCs depends on good educational status of the patients, special individual attention by the doctor, proper appraisal for the correct pill regimen, and frequent follow-up visits. Prompt discovery and treatment of any trouble can prevent disappointment and disillusionment with this method of contraception.     

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.     

Effects of sex hormones on serum levels of nitric oxide and plasma angiotensin II in postmenopausal women

OBJECTIVE: To observe the effect of estrogen and progestin on the blood levels of nitric oxide and angiotensin II in aid of the application of hormone replacement therapy in postmenopausal women. METHODS: The serum nitric oxide and plasma angiotensin II levels in postmenopausal women were determined before and 3 months after oral intake of estradiol valerate 1 mg/day (n = 10) or estradiol valerate, 1 mg/d plus medroxyprogesterone acetate, 2 mg/d (n = 30). RESULTS: The serum nitric oxide levels of postmenopausal women were significantly increased by 3 months of oral estradiol valerate 1 mg/d (P < 0.05), whereas the plasma levels of angiotensin II tended to decrease. The positive correlation between the increases of nitric oxide and the changes of estradial 3 months after oral intake of estradiol valerate 1 mg/d was significant. Compared with the baseline, no significant changes were observed in both serum nitric oxide levels and plasma angiotensin II levels 3 months after oral intake of estradiol valerate, 1 mg/d plus medroxyprogesterone acetate, 2 mg/d (P < 0.05). CONCLUSIONS: The vascular functions can be improved through increasing the serum nitric oxide level after 3-month oral intake of estradiol valerate, 1 mg/d in postmenopausal women, and estradiol valerate plus medroxyprogesterone acetate intake may attenuate the beneficial effects.     

Fertility control - when?

The population problem needs immediate action; even with perfect contraception now and a birthrate of 2.25 births per woman, the population will increase for 65 years to a growth of 40-50%. Elimination of unwanted fertility is seen as a desirable alternative goal which would be more readily attainable. Development of a new male contraceptive pill, or more likely, a new pill for women, is estimated to take 210 months under current Food and Drug Administration (FDA) protocols. It is recommended that : 1)use-patent protection for 10 years be started, 2)government and industry interact financially, and 3) FDA protocols realting to development of a contraceptive drugs be relaxed.     

甘露消毒丹加减方体内抗DHBV病毒作用实验研究

目的：研究甘露消毒丹加减方在鸭体内抗DHBV病毒的作用。方法：从5日龄龙岩麻鸭中筛选出先天感染DHBV的鸭子72只，分为病毒对照组，甘露消毒丹加减方大、中、小剂量组，拉米夫定组，拉米夫定加大剂量甘露消毒丹加减方组，每组12只。喂养13d后，除病毒对照组外各组鸭子开始给药，28d为1个疗程。于用药前、用药第7d、第14d、第21d和第28d及停药后第5d采集血样，检测各组鸭血清DHBV—DNAOD490值。结果：甘露消毒丹加减方中、小剂量组给药后各时点血清DHBV—DNAOD490值与给药前比较，差异无统计学意义；与给药前比较，大剂量组在给药后第14d、第21d和第28d血清DHBV-DNAOD490值降低（P〈0．01，P〈O．05）；与给药前及病毒对照组各相应时点比较，拉米夫定组和拉米夫定加大剂量甘露消毒丹加减方组在给药后第7d、第14d、第21d和第28d血清DHBV—DNAOD490值降低（P〈0．01，P〈0．05）。结论：甘露消毒丹加减方对DHBV有一定抑制作用。     

Contraception among two thousand private obstetric patients

In this survey of 2000 private obstetric patients regarding their contraceptive history and practice the attempt was made to determine the following: 1) what percentage of the deliveries of this group were the result of planned pregnancies; 2) what methods of contraception had the patients used; 3) what is the relative effectiveness of the methods used; and 4) how long did it take for the patients to become pregnant after discontinuing contraceptive use. The data was collected on a 33 column code sheet with the information taken from the 2000 consecutive obstetric histories taken at the initial office visit, usually at the 8th or 9th week of pregnancy. Over 99% of the patients were white. Over 85% of the women were between the ages of 20 and 35 and 60% were Jewish. About 30% of the husbands were professional men; 23% were business owners or executives; 38% were white collar workers; and 10% were manual workers. Of the 2000 pregnant women 64% had stopped using contraception with the plan of becoming pregnant; 18.7% became pregnant while still using contraception; and 17.4% became pregnant without using contraception and without indicating an intention to become pregnant. The condom and diaphragm represented 85% of the total contraceptives used, and the relative effectiveness of these methods as used by this group was approximately the same and more effective than the other methods used. 3/5 of the planned pregnancies occurred within 3 months and more than 9/10 within 1 year from the time contraception was discontinued. On the basis of this data it appears that physicians should change their practice and become concerned with a couple's reproductive problems at 1 year, rather than waiting until inability to conceive has continued for 2 years.     

正交设计法研究盐酸小檗碱滴丸制备工艺

目的研究盐酸小檗碱滴丸制备的工艺因素,确立最佳制备工艺条件。方法以滴丸的丸重差异、溶散时限、硬度及圆整度评价等作为综合质量评定指标,采用正交设计实验优选滴丸的处方和成型工艺。结果以聚乙二醇6000为基质,液体石蜡为冷凝剂,熔融液温度80℃条件下,盐酸小檗碱滴丸制备以药物与基质比例1∶7、冷凝液温度0℃、滴距3cm为最佳条件。结论制得的滴丸丸重差异小、溶散时间短、综合质量好,符合滴丸的质量要求,可用于盐酸小檗碱滴丸制备。     

单次小剂量米非司酮用于紧急避孕的疗效观察

目的：比较米非司酮单次和两次用于紧急避孕的有效性,副反应及可接受性。方法：征集无保护性交或避孕失败后72小时内来我院就诊的健康妇女220例。采取双盲随机比较试样方法。分为Ⅰ组（n=112）和Ⅱ组（n=108）予以治疗。Ⅰ组单次服用米非司酮1片（10mg）。Ⅱ组第一次服用米非司酮一片,12小时后再服一片,总量为20mg。服药后按时随访,了解避孕效果、副反应、下次月经情况。结果：两组各发生1例妊娠,失败率分别为0．89％和0．93％,避孕有效率分别为91．09％和91．12％,P〉0．05,无统计学差异。各种副反应发生率较低,均在10％以内。月经趋于正常者分别为90％和87％,P〉0．05。结论：单次小剂量米非司酮10mg用于紧急避孕同样是安全有效的。     

来曲唑在多囊卵巢综合征不孕症妇女的促排卵效果观察

目的探讨来曲唑用于多囊卵巢综合征不孕症妇女促排卵治疗的效果及其对生殖激素的影响。方法选择2007年1月1日-2007年11月30日在我院生殖中心门诊就诊的43例多囊卵巢综合征妇女，拟行促排卵治疗并指导同房。于月经周期的第3-7天，每日口服来曲唑2．5mg（22例），或于月经周期的第5—9天，每日口服氯米芬50mg（21例）。超声监测卵泡发育，并于月经周期的第8天和HCG日抽取静脉血测定黄体生成素、雌二醇、睾酮，当最大卵泡的平均直径≥18mm时，肌注HCG10000IU诱发排卵，观察排卵率、妊娠率、子宫内膜厚度及生殖激素的变化。结果来曲唑组的排卵率显著高于氯米芬组（P〈0．01）；周期妊娠率两组无差异（P〉0．05）；其优势卵泡数以及成熟卵泡数均显著低于氯米芬组（P〈0．05）；来曲唑组在HCG注射日子宫内膜的厚度显著厚于氯米芬组（P〈0．01）；其在月经的第8天和HCG日血清E2水平显著低于氯米芬组（P〈0．01）；血清T水平显著高于氯米芬组（P〈0．05）；来曲唑组在HCG日血清LH水平明显高于氯米芬组（P〈0．01），但在月经的第8天与氯米芬组无差异（P〉0．05）。结论来曲唑用于多囊卵巢综合征的不孕症妇女，具有良好的排卵率，且不影响子宫内膜的生长。     

福尔肝脂消丸治疗脂肪肝71例疗效观察

目的：观察福尔肝消丸治疗脂肪肝的临床疗效。方法：福尔肝脂消丸由白术、白芍、三七、青皮、山楂等9味中药组成，制成水密丸，每克含生药0．3g。每次口服10g，每日4次，3个月为1疗程。共服药1个疗程，观察治疗前后患者临床疗床症状，血脂（CHOL、TRLG、LDL），肝功能（ALT、AST、GP），肝脏B超变化。结果：治疗71例脂肪肝患者，总有效率83．1％。结论：福尔肝脂消丸具有减轻和缓解临床症状，恢复和改善肝功能，明显降低血脂和调节脂肪代谢的作用。     

A clinico-pathological study of Neogynon as a new oral contraceptive steroid

Clinical experience, and a pathology study, of 184 women on Neogynon (.25 mg d-norgestrel and .05 mg of 17-ethinyl estradiol, micro 20) was assessed for a total of 3129 cycles. 53 women were nursing babies before use of the pill, and 44 continued to do so throughout pill usage. Endometrial biopsies were taken premenstrually, during the period of full hormonal effect, for 40 cases before and then 6-12 months after initiation of pill usage; biopsies were studied for effect of the combined steroid on the building up of endometrium. The combination pill was 100% effective, with no failures. 23 cases (12.5%) failed to continue through the 18th cycle. 4 cases stopped after the 2nd cycle and 6 more after the 4th; the remaining stopped after the 12th cycle. No change in menstrual pattern was noticed in 136 (73.9%) of the cases; 14 presented with menorrhagia and endometrial biopsy of one of these showed regressive and mixed endometrial changes. 2 cases of intermenstrual spotting were reported. Hypomenorrhea was reported in 16 cases. Side effects were generally effects on the central nervous system: 7 cases of headache and dizziness, 7 cases of mild depression, and 3 cases of sexual anorexia. No gastrointestinal side effects were reported. 44 cases (of 53) continued lactation, and 9 noticed a progressive decrease in the amount of milk produced. 8 cases gained weight and 13 lost, 2 enough to quit using the pills. Hair loss was a noticeable complaint in 5 cases. Endometrial biopsies revealed grades of arrest of endometrial development. 85% showed a resting endometrial pattern, whereas 15% were atrophic. Endometrial response was rather irregular and mainly of the mixed type in 90% of the cases and about 10% were proliferative.     

头孢曲松钠治疗HIV抗体阳性混合感染梅毒者49例临床分析

目的 探讨头孢曲松钠治疗男性吸毒人员中HIV抗体阳性混合感染梅毒的治疗效果。方法 将新投吸毒人员体检中发现的梅毒患者分成HIV抗体阳性组49例和HIV抗体阴性组101例，两组均予以头孢曲松钠1.0g 肌肉注射 1次/d，疗程均为15d，治疗前均予以强的松10mg 口服, 2次/d 连用3d，分别于治疗后的第1, 3, 6, 9, 12个月门诊随诊，进行体检及RPR试验，并进行疗效评价。结果 HIV抗体阳性组治疗后的第1，3，6，9，12个月的总有效率分别为2%、39%、51%、74%、74%，疗效明显低于HIV抗体阴性组的总有效率92%、94%、95%、96%、96%，差异有统计学意义，均为P＜0.01。结论：头孢曲松钠治疗男性吸毒人员中HIV抗体阳性混合感染梅毒者的疗效较差，易出现血清固定，对于其治疗需要考虑患者的免疫状态。     

Colonic Crohn's disease and use of oral contraception

The prevalence of use of oral contraception before the onset of disease was established in 100 consecutive women attending follow up clinics for inflammatory bowel disease. A significant excess of women with Crohn's disease confined to the colon had taken oral contraceptives in the year before developing symptoms (10/16 (63%] compared with women with small-intestinal Crohn's disease (12/49 (24%); p less than 0.02) and women with ulcerative colitis (3/35 (9%); p less than 0.0005). When the patient groups were matched for age and year of onset of disease usage of oral contraception before the onset of disease was still more common among women with isolated colonic Crohn's disease (9/12, 75%) than among those with ulcerative colitis (2/12 (17%); p less than 0.02) and was also more common than would be expected from reported figures for oral contraception in England and Wales (31.4% of women aged under 41; p less than 0.005). A survey of current patient records showed that isolated colonic disease was at least twice as common among women with Crohn's disease (63/218, 29%) compared with men (25/181, 14%; p less than 0.001). These data support the suggestion made previously that oral contraceptives may predispose to a colitis that resembles colonic Crohn's disease.     

替吉奥单药与XELOX方案一线治疗老年晚期胃癌的疗效比较

目的:比较替吉奥单药与XELOX方案一线治疗老年晚期胃癌的疗效及不良反应.方法:将41例老年进展期胃癌患者随机分为单药组和联合化疗组.单药组20例,替吉奥单药口服,每次40~60 mg(体表面积<1.25 m2剂量为每次40 mg;体表面积为1.25~1.5 m2剂量为每次50 mg;体表面积>1.5 m2为每次60 mg),每天2次,连用14 d,每3周重复;联合化疗组21例,XELOX方案化疗,奥沙利铂130 mg/m2,静脉滴注3 h,第1天;卡培他滨1000 mg/m2,每天2次,连服14 d,每3周重复.每用药2个周期后评价疗效.结果:单药组有效率30.0%、疾病控制率65.0%,中位无进展生存时间为5.6个月;联合化疗组有效率42.9%,疾病控制率66.7%,中位无进展生存时间为6.2个月.2组差异均无统计学意义(P>0.05).联合化疗组的周围神经毒性发生率高于单药组(P<0.05),其他化疗不良反应发生率差异均无统计学意义(P>0.05).结论:替吉奥单药治疗老年进展期胃癌可取得不弱于联合化疗方案的近期疗效,且有较低的不良反应.     

橘荔散结丸对子宫肌瘤雌、孕激素受体水平的影响

目的观察橘荔散结丸对子宫肌瘤患者子宫肌层及瘤体组织雌激素受体(ER)和孕激素受体(PR)的影响。方法选用免疫组化的方法,检测15例仅服用橘荔散结丸3个月以上又手术治疗的患者子宫肌瘤及子宫肌层ER、PR水平,选择15例未曾服用相关中西药物而手术治疗的子宫肌瘤患者做对照。结果2组肌瘤组织EP、PR的水平均高于子宫肌层组织(P<0.05),而对照组EP、PR显著高于治疗组(P<0.05)。结论降低子宫肌瘤患者子宫肌层及其瘤体组织中的EP、PR水平可能是橘荔散结丸治疗子宫肌瘤的主要机理之一。