1,721,047 research outputs found
[Severe hypertriglyceridemia in pregnancy. A clinical case report].
No full textCholesterol (TC) and triglyceride (TG) plasma levels physiologically increase during pregnancy. The lipid increment is respectively 23%-53% above pregravidic level for TC and two-three fold the pre-pregnancy level for TG. If the TC and TG are higher than normal values in pregnancy the patient must be carefully monitored. Acute pancreatitis is the main consequence of hyperlipidemia and it can occur either during pregnancy, in the third trimester, or in the puerperium. Mortality is high both for the mother (21%) and the fetus (20%). The authors report a case of 37-year-old pregnant woman at 35 week gestation with hypercholesterolemia (TC = 425 mg/dl) and severe hypertriglyceridemia (TG = 3315 mg/dl). The patient was admitted to the hospital for treatment with an appropriate diet and drug lowering lipid levels (gemfibrozil). The baby was delivered by cesarean section at week 36. The neonatal weight at birth was 2670 g and the Apgar score was 9 at the first minute. After delivery the maternal triglyceride levels showed a remarkable reduction. According to a review of the literature, severe hypertriglyceridemia in pregnancy should be treated with a careful restriction of calories and fat; for preventing acute pancreatitis hospitalization for intravenous fluid therapy and plasma exchange must be required
Effect of long term hormone replacement therapy on adrenocortical and cardiovascular stress response in menopausal women.
No full textLipid and lipoprotein (Low Density Lipoprotein) apheresis in pregnancy [Lipidoaferesi ed LDL-aferesi in gravidanza]
No full textPregnancy and delivery in a women with a severe genetically determined hyperlipidemia is a rare event, but not impossible. Increasing morbidity and mortality of both mother and child due to severe hyperlipidemia already existing, or induced by change of sex hormones concentration may occur during pregnancy. Reasonable therapeutic measures are to be undertaken to prevent complications, inevitably. However, it is also well-known that lipid lowering drugs are contraindicated during pregnancy. Notwithstanding, when critical clinical conditions occur there is the need to provide a therapeutic option. Lipid and Lipoprotein apheresis are recognized effective and reasonably safe, although invasive treatment for severe disorders of lipid and lipoprotein metabolism. Therapeutic Lipid apheresis (Plasma-exchange, Cascade Filtration) and Lipoprotein apheresis (Dextran Sulphate, H.E.L.P., and D.A.Li. Low Density Lipoprotein apheresis) offer an alternative, to be used in selected cases to reduce high LDL-cholesterol levels or insurgent elevation of Triglyceride-rich lipoproteins in plasma, during pregnancy. The existing evidence suggested that Lipid and Lipoprotein apheresis do not interfere with physiologic adaptations of lipid and lipoprotein metabolism during pregnancy in hyperlipidemic subjects, seemingly. This review is aimed at reporting existing clinical evidence on how women with severe hypercholesterolemia who became pregnant on long-term Lipid and/or Lipoprotein apheresis treatment, or affected by severe hypertriglyceridemia and hyperchylomicronemia, who were treated by therapeutic apheresis because of their acute exposure to the risk of pancreatitis during pregnancy, have been treated. Existing guidelines and reccommendations are also reviewed
[Attitudes toward estrogen replacement therapy. Study conducted on a sample population of women attending an ambulatory care center for the treatment of menopause].
No full textHormonal Replacement Therapy (HRT) is the most effective treatment of menopausal disturbances and has an established role in reducing the cardiovascular risk and in preventing the postmenopausal osteoporosis. Nevertheless several reports have evidenced that compliance with hormonal replacement therapy was not as good as expected, and that physician's and women's opinions can strongly influence the HRT choice, and the continuation of HRT use. The aim of this study was to assess the opinions and the expectations of menopausal women toward HRT. PATIENT AND METHODS. We utilized a questionnaire exploring social and affective conditions, and in particular women's opinions and experiences on menopause, hormonal therapy, the possibility of information, the reasons for accepting or refusing hormonal therapy. The questionnaires were administered to 226 menopausal clinic patients (Menopausal age: 2-10 years) in spontaneous menopause. RESULTS. 28% of the women were taking HRT at the time of the survey. Worries about menopause were reported by 27.4% of the group; this percentage was similar in both user and non-user groups. 70% received information on HRT from family doctors, and 63% from mass-media or conversations. 70% believes that the main problem of menopause is osteoporosis, and its prevention represents the most frequent aim that patients feel can be achieved by HRT. 67.5% of the group is afraid that long term treatment can be dangerous, however only 57% asked for detailed information to the doctor. To the question "Are you informed that HRT can reinduce menstrual bleeding?", 57.5% of the patients answered yes; 30% considered it to be a problem. CONCLUSIONS. Our study was carried out in a menopausal clinic and this can influence the answers of the respondents. Most women received some information on HRT, but their knowledge was only partial and did not eliminate the unrational fear of hormone therapy. Although long term use of HRT is to prevent CVD and menopausal osteoporosis, many of our patients specifically asked for treatment to be as short as possible. Women expectations's towards HRT are mainly referred to osteoporosis prevention and treatment: this may be explained by the high frequency of osteoarticular pain found in our patients; nevertheless it is possible that the more rational fear of osteoporosis hides the unconscious fear of a dramatic physical breakdown caused by the menopause. Detailed information to family doctors, to specialists, and to patients along with a further improvement of therapeutic regimens will allow a greater diffusion of HRT, bringing its short and long term benefits to an increasing number of women
Utilizzazione di un contraccettivo orale contenente 20 mcg di etinilestradiolo e 150 mcg di desogestrel in un gruppo di donne
No full textFattori di rischio cardiovascolare in menopausa. Dati di prevalenza di uno studio su popolazione: il Progetto DiSCo (Dati inediti)
No full textNell’ambito di un vasto studio comunitario rivolto alla prevenzione e al controllo delle malattie non trasmissibili, sono stati determinati la prevalenza della menopausa ed il livello dei principali fattori di rischio cardiovascolare
La prevenzione ed il trattamento dei fattori di rischio per la malattia cardiovascolare nella donna in pre e postmenopausa: linee guida a confronto
Full text linkLe linee guida elaborate nel 2011 dalle società di cardiologia americane (American Heart Association: AHA) ed europee (European Atherosclerosis Society: EAS; European Society of Cardiology: ESC) hanno centrato in modo specifico il profilo di rischio e gli interve ti di prevenzione dedicati alla donna. Queste indicazioni riconoscono, da un lato, la scarsa presenza femminile negli studi sul rischio cardiovascolare (RCV) e dall’altro l’evidenza di alcune differenze tra peso relativo dei fattori di rischio, stima del rischio cardiovascolare totale, ed efficacia dei differenti interventi tra uomo e donna. Inoltre, nella valutazione del profilo di rischio vengono inserite nuove variabili legate alla funzione riproduttiva ed in particolare alla storia di gravidanze patologiche (ipertensione in gravidanza, preeclampsia, diabete gestazionale). La donna presenta a 60 anni il rischio che l’uomo presenta 10 anni prima, e quindi l’età media della menopausa, intorno ai 50 anni, rappresenta un momento critico di valutazione e l’occasione per incoraggiare ad adottare misure di prevenzione primaria. Le linee guida dell’AHA ed EAS/ESC concordemente riportano gli interventi utili di prevenzione e di terapia per la salute cardiovascolare nella donna e tra questi esprimono un parere negativo sulla utilizzazione della terapia ormonale sostitutiva in menopausa. Specularmente, le società di ginecologia hanno discusso la mole di evidenze sul ruolo della terapia ormonale cercando di conciliare i risultati degli studi epidemiologici e producendo delle nuove linee guida sull’uso della terapia in menopausa. Dal confronto delle linee guida emerge dunque il potenziale ruolo della figura del ginecologo nell’ambito del RCV della donna: identificare precocemente il soggetto a rischio, incoraggiare l’aderenza a misure di prevenzione comprendenti sia il corretto stile di vita che l’uso di farmaci e/o procedure mirate, discutere i rischi ed i benefici in base ai quali consigliare alla donna sintomatica una adeguata terapia ormonale all’inizio della menopausa
Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound
No full textTo compare the accuracy of magnetic resonance (MRI) and colour Doppler-ultrasound (US) in the diagnosis of late pregnancy bleeding and to assess the accuracy of the different MR sequences in visualizing the origin of haemorrhage. 42 patients in the third trimester of pregnancy underwent to US and MRI for the evaluation of painless vaginal bleeding. Multiplanar HASTE, True Fisp, 3D T1 GRE and sagittal DWI sequences were acquired. Two radiologists, blinded to the results of US, reviewed each case, resolving by consensus any discrepancy. Reference standards were surgical and pathological findings. The reference standards identified 22 placenta previa, 11 placental abruptions (1 coincident with a placental chorioangioma), 1 thrombohaematoma and 1 fibroma with haemorrhagic degeneration. MRI identified correctly all these condition with an interobserver agreement of 0.955. DWI and T1 weighted sequences were statistically superior to Haste and True Fisp sequences in detecting the cause of bleeding (p < .001). US had 6 false negatives and 2 false positive results, its diagnostic accuracy resulting lower than MRI (p = .001). MRI accurately evaluates pregnancy bleeding with an excellent interobserver agreement and can grant new and additional data when US is negative
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