摘要:

Polycystic ovary syndrome is a heterogeneous clinical syndrome, which has been defined as the association of hyperandrogenism with chronic anovulation in women without specific adrenal and pituitary gland disease. A family history of polycystic ovary syndrome may be present in a subset of patients; however, the genetic basis of the syndrome remains unclear. Most often, the age of onset is perimenarchal and it is characterized by the appearance of menstrual disturbances, hirsutism, acne, and more rarely, a male pattern of alopecia. In some cases, premature adrenarche may present as a precursor to the development of the syndrome. Polycystic ovary syndrome is also associated with metabolic disturbances, such as obesity and insulin resistance with hyperinsulinemia, for which the pathophysiological role in the development of the syndrome has been recognized.The therapeutic approaches to polycystic ovary syndrome include lifestyle modifications, dietary-induced weight loss, insulin-sensitizing agents, antiandrogens, and oral contraceptives. These treatments may improve the clinical manifestations of excess androgen production and normalize menses in many adolescents and young women with polycystic ovary syndrome. Early recognition of the syndrome and thus, early treatment, may prevent and possibly ameliorate all the symptoms and the potential later development of metabolic and cardiovascular complications.

ISSN:1175-6349    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Patients with diabetes mellitus have a 2- to 4-fold increased risk of atherosclerotic cardiovascular, peripheral vascular, and cerebrovascular disease, which are the leading causes of morbidity and mortality in this population.Several epidemiological studies have shown an association between diabetic dyslipidemia, which is characterized by hypertriglyceridemia, low levels of high density lipoprotein-cholesterol, postprandial lipemia and small, dense low density lipoprotein-cholesterol (LDL-C) particles, and the occurrence of cardiovascular disease. Other studies have established the beneficial effects of lipid lowering on the reduction of major coronary events in diabetic patients.The recent National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines emphasize diabetes as a coronary heart disease risk equivalent. The NCEP ATP III states that elevated LDL-C is a major risk factor for coronary heart disease, and the primary goal of risk-reduction therapy is the reduction of LDL-C levels to 100 mg/dL.This article defines and describes diabetic dyslipidemia and its etiology and pathogenesis, as well as reviewing guidelines and recommendations for treatment of this disorder. Treatment of diabetic dyslipidemia includes 1) lifestyle modifications: physical activity and a diet low in saturated fats and cholesterol and high in complex carbohydrates and fiber; and 2) pharmacological treatment withoral antihyperglycemic agents: metformin and thiazolidinediones;weight reduction drugs: orlistat and sibutramine and;lipid-lowering drugs: HMG-CoA reductase inhibitors, fibric acid derivatives, nicotinic acid, and bile acid sequestrants.

ISSN:1175-6349    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Despite the wide variety of reversible contraceptives, unintended pregnancy rates in developed nations are still considered markedly elevated by most epidemiologists and clinicians. Indeed, the US has one of the highest unintended pregnancy rates among the industrialized nations of the world. Although many factors appear to influence this problem, what may play an important role in this apparent paradox is the process by which a woman obtains contraception. Although most nonbarrier methods have similar efficacy, the ability to use that method consistently and correctly will determine whether it provides maximal contraception. Oral contraceptives are the most popular method in the US; accordingly, the process by which US women obtain their contraception may not take into account the desire of many women to use nondaily methods. The recent introduction of nondaily methods in the US and elsewhere has provided more choice so that a successful contraceptive decision can be made in the first instance rather than after an adverse clinical outcome or unintended pregnancy with a method not as well suited to that woman's lifestyle. These new methods are not characterized by improved safety or efficacy; rather, they have novel components or delivery systems that may provide important options to women who may not be able to or willing to use existing methods of contraception. The transdermal patch, vaginal ring, and monthly injectable are combination estrogen/progestogen methods characterized by novel delivery systems and compliance regimens. The single rod implant is a facile and well accepted method that has not yet been approved for use in the US but has been an increasingly popular choice elsewhere. The levonorgestrel intrauterine system has been used in Europe for over 10 years and has recently been introduced in the US. This intrauterine contraceptive provides high efficacy and reliability, and may have considerable noncontraceptive benefit with regard to the nonsurgical treatment of uterine bleeding problems and endometrial protection for menopausal hormone therapy. The increasing popularity of these methods can be considered a testament to the desire of women to consider nondaily contraceptives as first-line, mainstream options. It is hoped that increasing use of these methods will lead to a considerable decrease in the rate of unintended pregnancy.

ISSN:1175-6349    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Low responders remain a difficult group of patients to manage in anin vitrofertilization (IVF) program. Such patients have low peak estradiol concentrations (<500 ng/L) and few dominant follicles on the day of human chorionic gonadotropin administration (<5 to <2), and therefore have few retrieved mature oocytes (≤4 to ≤6) with resultant lower pregnancy rates when stimulated with standard IVF therapy (daily gonadotropin dose 150–300IU [2–4 ampoules]). It is difficult to compare the various strategies that have been utilized to manage low responders because the definition of a low responder varies widely. Also, very few large prospective randomized trials have compared different protocols. Two stimulation protocols involving varying doses of leuprorelin and high doses of gonadotropins appear to be the most promising. The early gonadotropin-releasing hormone (GnRH) agonist cessation protocol involves routine pituitary desensitization with luteal phase start of leuprorelin 0.5mg for 10–14 days. With the onset of gonadotropin treatment, there is cessation of leuprorelin. The ‘microdose flare’ protocol utilizes oral contraceptive priming followed by diluted doses of leuprorelin 50µg given twice daily. Two days later, stimulation is started by adding high doses of gonadotropins. The microdoses of leuprorelin and the high doses of gonadotropins are then continued until the day of chorionic gonadotropin administration. Patients who do not respond to these protocols or those with severely diminished ovarian reserve are candidates for donor oocytes. The role of GnRH antagonists and thein vitromaturation of oocytes are potentially exciting strategies that are still being investigated.Ultrasound measurements of ovarian volume, baseline antral follicle counts, and Doppler measurement of ovarian stromal blood flow now make it possible to predict low response to IVF therapy. Low response can be expected if the smaller ovary has a volume <3 cm3, or the mean ovarian diameter in the two longest planes is <20mm. Antral follicle counts of ≤3 in each ovary are also associated with low response. Data on ovarian stromal blood flow are still unclear, but an ovarian peak systolic velocity of <10 cm/sec is associated with low response. If low response is anticipated based on baseline ultrasound scan, a switch to one of the two effective stimulation protocols should be initiated. This would reduce cancellation rates and improve pregnancy rates in the first cycle of IVF.

ISSN:1175-6349    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The two most common causes of hypercalcemia are primary hyperparathyroidism and neoplastic disease. Parathyroidectomy is the only curative intervention for the former condition. In the rare cases of patients with primary hyperparathyroidism who present with clinical symptoms due to their hypercalcemia, pharmacological treatment may be required. Fluid repletion and intravenous (IV) administration of bisphosphonates are recommended in the literature. Calcium receptor agonists (calcimimetic agents) are at the present time only available for use within clinical trials.Cancer patients usually present with symptoms of hypercalcemia. Rapid institution of antihypercalcemic treatment is essential in preventing life-threatening deterioration. Fluid repletion and administration of bisphosphonates are the treatment mainstays in hypercalcemia of malignancy. Five bisphosphonates are currently licensed in Europe for treatment of tumor-associated hypercalcemia: etidronate, clodronate, pamidronate, ibandronate, and zoledronate. In the US, pamidronate and zoledronate are licensed for use in this indication.Bisphosphonates containing nitrogen atoms (e.g. pamidronate, ibandronate, and zoledronate) are more potent than those without (e.g. etidronate, clodronate, and tiludronate). In patients with malignant hypercalcemia, the efficacy of the individual bisphosphonate depends on dose administered and initial serum calcium concentration. At present, pamidronate has been studied in the greatest number of investigations and in the largest number of patients. In the literature, the efficacy of pamidronate in restoring normocalcemia ranges between 40% and 100%, depending on the dose used and baseline serum calcium concentration. More recently, one study reported that pamidronate was inferior to zoledronate. In this study, the duration of response was also longer in the two zoledronate groups (30 and 40 days) than in the pamidronate group (17 days).The most serious adverse events of bisphosphonates concern renal function. Increases in serum creatinine levels have been more frequently reported following treatment of tumor-associated hypercalcemia with etidronate (8%) and clodronate (5%) than with the nitrogen-containing bisphosphonates pamidronate (2%) and ibandronate (1%). The frequency of increases in serum creatinine levels following treatment with zoledronate is difficult to estimate. Administration of the nitrogen-containing bisphosphonates has been associated with transient (usually mild) fever, lymphocytopenia, malaise, and myalgias. These events occur within 36 hours of the first dose and are self-limiting. Hypocalcemia occurs in up to 50% of patients treated with bisphosphonates for hypercalcemia of malignancy, although symptomatic hypocalcemia is rare.The toxicity and low efficacy of plicamycin (mithramycin) mean that use of this agent should be restricted to patients with hypercalcemia of malignancy who fail to respond to IV bisphosphonates. Calcitonin is characterized by good tolerability but poor efficacy in normalizing the serum calcium level. However, a major advantage of calcitonin is the acute onset of the hypocalcemic effect, which contrasts with the delayed but more pronounced effect of bisphosphonates. Combination calcitonin and bisphosphonate treatment may therefore be of value when rapid reduction of serum calcium is warranted. Gallium nitrate may be a valuable treatment for hypercalcemia of malignancy. It is characterized by high efficacy and few adverse events apart from renal toxicity (10% of cases). However, data are very limited and further trials are necessary.

ISSN:1175-6349    

出版商:ADIS    

年代:2003

数据来源: ADIS