Polycystic ovary syndrome (PCOS)

Polycystic ovaries syndrome (PCOS) is one of the most common female hormonal disorders. Its multiple components--reproductive, metabolic, neoplasic and cardiovascular--have a major impact on the public health. Androgen excess and resistance to insulin, probably from genetic origin, are responsible for most of the clinical symptomatology. Resistance to insulin seems to be accompanied by a greater risk of glucose intolerance, type 2 diabetes, lipidic anomalies and can involve the development of cardiovascular diseases. In addition, sleep apnea syndrome is more progressively described in PCOS. Infertility, menses disorders and hirsutism often push these patients to consult their physician. A better understanding of the physiopathological mechanisms led to the emergence of new therapeutic options increasing the sensitivity to insulin. Besides the pregnancy wishes, cares aim to attenuate the marks of the hyper-androgenism (hormonal treatment and cosmetic) and to correct cardiovascular, respiratory and gynaecological risk factors. In case of infertility by anovulation, cares must be performed by trained experts to minimize the risk of ovarian hyper-stimulation syndrome and multiple pregnancies. A gradation from loose weight to clomiphene citrate ovulation induction, ovarian drilling, low dose gonadotropin, in vitro fertilisation, or in vitro maturation of oocytes should bring back good reproduction potential.     

Patientin mit Migräne und Cervicalsyndrom nach Hysterektomie

Background

In 2005, Mrs ES, a 54 year-old patient, consulted our acupuncture outpatient service for the first time, having suffered from intense headaches and permanent tensions in the shoulder and neck region for 7 years. The clinical symptoms were exacerbated by all kinds of stress. Although the patient had worked the same stressful job for years, the headaches only first manifested after she'd had a hysterectomy.

Aim

Pain reduction and improvement of stress tolerance at the work place

Methods

acupuncture, analysis of life style, means of stress prophylaxis

Results

Between the 4th and 10th treatment session, only one migraine episode occurred which was related to the consumption of red wine. For the following three years, the patient remained free of symptoms. Then tensions and headache attacks returned.

Discussion

According to TCM, long-term exposure to emotional stress situations can lead to the stagnation of liver qi. 7 years ago, this manifested as a blood stagnation of the lower heater (myomatous uterus). From the point of view of western medicine, the problem was solved by hysterectomy – however, stagnation now came to appear elsewhere in the body, this time, in the head. In this case, western medicine could offer only symptom-oriented therapeutic interventions whereas TCM enabled us to work on the underlying problem and reach, if only temporarily, an improvement of the clinical situation.     

Lidocaine intoxication in newborn following maternal pudendal anesthesia: report of three cases

Pudendal nerve block may be indicated during instrumental delivery in situations where peridural anesthesia is unavailable. We report three cases of neonatal lidocaine intoxication following maternal pudendal block during delivery. Clinical features were hypotonia, pupillary mydriasis fixed to light, apnea, cyanosis and seizures. Two neonates required mechanical ventilation. Lidocaine was found in the serum of two babies. In all three cases, recovery was complete. The pharmacokinetics of lidocaine in a highly vascularized perineum during labor increase the risk of neonatal intoxication. A possible intoxication by local anesthetics should be considered in neonates presenting an acute distress in the delivery room.     

Anwendungsbeobachtung der seriellen Akupunkturbehandlung von Lumbago und Kopfschmerz in der Allgemeinpraxis

Background

The German Acupuncture Trials (GERAC) have brought good results regarding the acupuncture treatment of lumbago and headache. However, for reasons of scientific practicability, patients included in these trials were restricted by certain criteria (among others, excluding patients after spinal surgery, past experiences with acupuncture, patients with ischialgia). Also, microsystems and other acupuncture-related techniques, such as moxibustion or cupping, were not included.

Objective

The objective of this treatment observation was the assessment of early as well as late results of acupuncture treatment series for lumbago and headache performed on the mixed patient collective of a general practitioner's practice.

Methods

The observation included all patients who received acupuncture for chronic back pain or headache. The treatment observation consists of data collected from 192 treatment series (10 acupuncture sessions each) for lumbago, and 86 treatment series (10 acupuncture sessions each) for headache. There were no restrictions regarding microsystems or acupuncture-related techniques. Acupuncture was administered according to the criteria of Traditional Chinese Medicine; there were no restrictions regarding the selection of the acupuncture points.

Results

The benefit of the treatment in the lumbago group was rated none or poor in 18 cases (9.4 %), moderate in 35 (18.2 %), and very good in 139 (72.4 %) cases. In the headache-group the benefit was rated none or poor in 2 cases (2.3 %), moderate in 28 (32.6 %), and very good in 56 (65.1 %) patients.

Conclusion

The results were encouraging: not only in the restricted setting of a large scientific study, but also within the mixed patient collective of a general practitioner's practice, acupuncture can lead to good results in the therapy of chronic back pain and headache.     

高置换率和低置换率CRRT对急性重症胰腺炎并发急性呼吸窘迫综合症患者呼吸循环的影响

目的:观察高置换率和低置换率连续性肾脏替代治疗(CRRT)对重症胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)时呼吸循环及外周血TNF-α水平的影响.方法:回顾性分析2001年以来在我院接受治疗的SAP合并ARDS、并接受呼吸机和CRRT治疗的患者,共22例.按每位患者接受CRRT置管率的不同分为2组:A组(10例,CRRT置换率为2 L/h),B组(12例,CRRT置换率为4 L/h).记录给予CRRT治疗前、治疗后6, 12, 24 h的实测呼吸频率、心率和无创动脉血压;于上述相应时点抽取动脉血做动脉血气分析,并留取血样,使用ELISA法测定血清TNF-α水平.结果:CRRT后两组患者的氧合指数和呼吸均有明显的改善(与治疗前比较,P＜0.01),血压、心率也趋于稳定(与治疗前比较,P＜0.05或＜0.01),其中B组的变化更为显著(与A组比较,P＜0.05或＜0.01);CRRT后两组患者的外周血TNF-α水平均有明显降低(与治疗前比较,P＜0.01),其中B组患者血TNF-α水平的改变更为显著(与A组比较,P＜0.01).结论:高置换率CRRT能较低置换率CRRT更有效地清除SAP合并ARDS患者体内的炎症因子,因而更有利于其呼吸循环功能的改善.     

Ernährungstherapie nicht nur bei kindlichen Kopfschmerzen

Food intolerance is a well-known factor in functional headache in children. Severe migraine in children can be significantly mitigated by a strict diet. But in the long term, a simpler nutritional change seems to be more appropriate in order to achieve a long-lasting influence on children's headache. A nutritional change of at least 6 weeks' duration should reduce the headache frequency and intensity in the range of 50 % or more in order to be defined as successful. Not only migraine, but also tension-type headache respond in a relevant dimension to nutritional treatment. In case of higher migraine frequency combined with allergic comorbidity, the efficacy of the nutritional regime seems to be even more pronounced. In daily counselling, a combination of written information and a short personal explanation seems to represent a practicable procedure.