Acerca de un caso de dismorfia muscular y abuso de esteroides / A Case of Muscular Dysmorphia and Steroid Abuse

Introducción: La fenomenología de la dismorfia muscular —un subtipo del trastorno dismórfico corporal (TDC)— y las consecuencias clínicas del abuso de esteroides que suele acompañarla son poco conocidas y esto posiblemente explica que sea subdiagnosticada en nuestro medio. Objetivos: Presentar el caso de un paciente hombre con dismorfia muscular y abuso de esteroides y analizar las ventajas de la farmacoterapia sumada a la psicoterapia de enfoque dual en este tipo de pacientes. Método: Reporte de caso. Resultados: Paciente hombre de 43 años que consultó al Programa Equilibrio, en Bogotá, por preocupación extrema con la forma de su cuerpo, el tamaño de sus músculos, ejercicio compulsivo, consumo rígido y estereotipado de alimentos hiperproteicos, abuso crónico de esteroides y trastorno depresivo mayor. Conclusiones: La fenomenología de la dismorfia muscular posee semejanzas y diferencias con la anorexia nerviosa y otras patologías del espectro obsesivo-compulsivo. Mientras que en la anorexia hay una búsqueda enfermiza por la delgadez, en la dismorfia muscular la hay por el volumen. A diferencia de otros trastornos del control de impulsos, en la dismorfia muscular se observa una mayor expresión de lo compulsivo que de lo impulsivo. Los síntomas y signos del abuso de esteroides pueden contribuir a la expresión de alteraciones afectivas y sistémicas...

Introduction: The phenomenology of muscular dysmorphia, -a subtype of Body Dismorphic Disorder (BDD) _ as well as the clinical consequences of steroid abuse that usually accompanies it are barely known and this possibly explains why it tends to be underdiagnosed in our country. Objectives: To present a clinical case of a male with Muscular Dysmorphia and Steroid Abuse, and analyse the advantages of using pharmacotherapy added to a dual psychotherapeutic approach. Method: Case report. Results: 43 year old male, who consulted “Equilibrio” program (in Bogotá-Colombia), with extreme preoccupation regarding the shape of his body and size of his muscles, compulsive exercise and rigid and stereotyped hyperproteic food consumption. Additionally, he presented chronic steroid abuse and a Major Depressive Disorder. Conclusions: The phenomenology of Muscular Dysmorphia presents similarities and differences with Anorexia Nervosa and other pathologies from the Obsessive Compulsive spectrum. While in Anorexia Nervosa there is a pathological search for thinness, in Muscular Dysmorphia it is for volume. Contrary to other impulse control disorders, in Muscular Dysmorphia one can find a higher expression of the compulsive over the impulsive. The signs and symptoms of steroid abuse can contribute to the expression of affective and systemic alterations....

Effect of mifepristone on steroid receptor expression and biotransformation of oestrogen and progesterone in rat uterus and deciduoma.

BACKGROUND: [corrected] Mifepristone is a synthetic antiprogestin which terminates early pregnancy. Since it interferes with the progesterone maintained decidua, we compared the effect of mifepristone on oestrogen and progesterone receptors, and on the biotransformation of these hormones in normal and deciduous uterus. METHODS: Ovariectomized rats were treated with an oestrogen-progesterone hormone regimen and deciduoma was induced by trauma in one horn of the rat uterus while the other served as a control under an identical hormonal milieu. Hormone receptor and biotransformation studies were done using radiolabelled oestradiol and progesterone with high specific activity. RESULTS: The artificially formed decidual tissue was comparable with that of early pregnancy. Mifepristone replenished oestrogen and progesterone receptors which were suppressed by progesterone in both the normal and decidualized uterine horns. Inhibition of oestrogen receptors by progesterone correlated with decreased oestradiol levels at the site of action. Metabolism of progesterone to less potent compounds was promoted by mifepristone. The enzymatic activities of 17beta-hydroxysteroid dehydrogenase (which metabolizes oestradiol), and 20alpha-hydroxysteroid dehydrogenase and 5alpha-reductase (which metabolize progesterone) were altered by mifepristone. CONCLUSION: The effect of mifepristone in varying the hormone receptor population and the availability of different levels of active metabolites of ovarian hormones have an Important role in the antiprogestin action of mifepristone.

In vitro metabolic interaction between diphenytriazol and steroid hormone drugs / 药学学报

<p><b>AIM</b>To observe the metabolic interaction between diphenytriazol and steroid hormone drugs, and provide some useful information for clinical medication.</p><p><b>METHODS</b>The steroid hormone drugs which may be co-administrated with diphenytriazol were selected, such as mifepriston, estradiol, medroxyprogesterone acetate, progesterone, norethisterone and so on. Diphenytriazol was incubated with each drug in rat liver microsome. The residual concentration of diphenytriazol or steroid hormone drugs in the microsomal incubates was determined by reversed-phase high-performance liquid chromatography, separately. The inhibition constants (K(i)) for each of them were calculated.</p><p><b>RESULTS</b>The inhibition constant K(is) of diphenytriazol for the metabolism of mifepristone, estradiol, medroxyprogesterone acetate, progesterone and norethisterone were (201.3 +/- 1.0), (94 +/- 4), (128.7 +/- 2.2), (64 +/- 5) and (80 +/- 4) micromol x L(-1), respectively. The inhibition constants K(i) of steroid hormone drugs for the metabolism of diphenytriazol was (66.9 +/- 2.2) micromol x L(-1) for estradiol, (60.0 +/- 2.3) micromol x L(-1) for medroxyprogesterone acetate, (163 +/- 10) micromol x L(-1) for progesterone and (88 +/- 5) micromol x L(-1) for norethisterone, respectively.</p><p><b>CONCLUSION</b>Diphenytriazol shows metabolism interaction with steroid hormone drugs such as estradiol, medroxyprogesterone acetate, progesterone and norethisterone.</p>

Combined use of methotrexate and mifepristone for ectopic pregnancy management: a meta- analysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the clinical effect and safety of combined use of methotrexate and mifepristone for treatment of ectopic pregnancy.</p><p><b>METHODS</b>By searching in the major databases of CNKI, CBMdisk and Pubmed according to the criteria of evidence-based medicine, we collected data of randomized controlled trials pertaining to combined use of methotrexate and mifepristone in the treatment of ectopic pregnancy.</p><p><b>RESULTS</b>Twenty-three randomized controlled trials involving totally 1 706 patients were collected according to the inclusion criteria, and meta-analysis of the data indicated that combined use of methotrexate and mifepristone can be of great value in the management of ectopic pregnancy in comparison with exclusive use of methotrexate [ combined odds ratio (OR) was 2.84 with 95%confidence interval [CI] (2.18, 3.69), Z=7.79, P<0.000 01].</p><p><b>CONCLUSION</b>The clinical evidence derived from the analysis suggests that the combination of methotrexate and mifepristone for ectopic pregnancy management can be effective with good safety security and minimal side effects, but still, this conclusion needs further verification by randomized, double-blind, and controlled trials with larger sample size and more rigorous trial design.</p>

Comparison or oral versus vaginal misoprostol & continued use of misoprostol after mifepristone for early medical abortion.

BACKGROUND & OBJECTIVE: Medical abortion though legalized in India, is still not very popular. A disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion which may reduce acceptability. Due consideration needs to be given to the issues related to medical abortion for improving the reproductive health status of women suffering from consequences of unsafe and illegal surgical abortion. The present study compared the efficacy of oral and vaginal administration of misoprostol after a single dose of 200 mg of mifepristone and evaluated the influence of continuing misoprostol for one week on efficacy and side effects. METHODS: A double-blind randomized controlled trial with 150 healthy pregnant women requesting medical abortion with < 63 days of amenorrhoea was conducted in the gynecological and family planning clinic at All India Institute of Medical Sciences, New Delhi. Mifepristone (200 mg) was administered orally on day one, followed by 0.8 mg misoprostol either orally or vaginally on day three. Women in the oral group and one of the two vaginal groups continued 0.4 mg of oral misoprostol twice daily for seven days. RESULTS: Complete abortion rate in each of the groups was 96-100 per cent. The addition of misoprostol 0.4 mg twice a day from day 4-10 did not help in increasing successful outcome or shortening of duration or amount of bleeding. INTERPRETATION & CONCLUSION: Medical abortion for pregnancy up to 63 days using misoprostol 0.8 mg vaginal/oral after pretreatment with mifepristone 200 mg is a safe and successful procedure. No differences in efficacy or duration of bleeding were observed with addition of oral misoprostol for 1 wk after abortion.

Making unsafe abortion safe: medical method.

WHO reported 13.0% of maternal deaths are related to unsafe abortion in developing world. To improve this, medical method of abortion has been in clinical use for over a decade. The antiprogestogen mifepristone followed two days later by a prostaglandin analogue is registered as a medical alternative to surgical termination of early intra uterine pregnancy. Since registration of medical method, research has continued to improve the medical abortion. Multicentre trials have shown that 200 mg of mifepristone orally and 800 ug of misoprostol vaginally results in a higher complete abortion percentage (95.0%). The gold standard method at present is 200 mg mifepristone orally followed by 800 ug ofmisoprostol vaginally 48 hrs later gives 95.0 to 97.0% success rate. With much improvement and efficacy more women accept medical method for abortion with higher satisfaction and provide more privacy to women especially where social stigmas are attached to induced abortion. Use of drug is safe and non-invasive and training is simple and complications are minimal. This is important in developing world where limited trained personnels are available to perform surgical evacuation. The disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion and fear of uncertainty and side effects. The termination of pregnancy is legalised in Nepal now, these medicines could be made available in market.

Effect of RU486 on apoptosis and p53 expression at the boundary of fetal-maternal interface of rhesus monkey (Macaca mulatta) / 生理学报

Primate placentation involves a series of cell proliferation, immigration and apoptosis which account for the progressive tissue remodelling at the implantation site. p53 is an important proto-oncogene involved in the regulation of cell-cycle and apoptosis. To study the effect of RU486 on apoptosis and expression of p53 at the fetal-maternal interface, the location of apoptotic cells and expression of p53 were examined using in situ 3'-end labeling method, immunohistochemistry and Western blot assay at the fetal-maternal interface of normal and RU486 treated rhesus monkey. Western blot analysis showed the specificity of the anti-human antibody used with the monkey tissue. In the placental villi, the apoptotic nuclei were observed mainly in the syncytiotrophoblast and part of the cytotrophoblast within the cell column; p53 protein was detected mainly in the cytotrophoblast. In the endometrium, positive signals for apoptosis and p53 were detected in some stromal cells. After two days of mifepristone treatment, the apoptotic cells increased significantly in both placental villi and endometrium. In the villi, the increased apoptotic nuclei were mainly localized to the cytotrophoblast. At the same time, p53-positive nuclei also increased in both villous cytotrophoblast cells and endometrial stromal cells, after the treatment of RU486. These results suggest that apoptosis and expression of p53 are essential in regulating trophoblastic homeostasis by controlling its proliferation in normal placenta, whereas the up-regulation of p53 protein may play an important role in apoptosis that happens at the fetal-maternal interface induced by RU486.

Medicamentos para la interrupción de la gestación: una revisión de la literatura y sus posibles implicaciones para México América Latina / Medical methods for pregnancy termination. A review of literature and its potential role in Mexico and Latin America

In this document, we review the relevant aspects of the different medical methods of abortion. We describe the principal medical regimens currently used in North America, Europe, and a growing number of developing countries. We also describe specific treatment regimens (which usually involve a combination of two drugs), physiological methods of action, potential side effects and complications, method requirements, including follow-up visits, any existing contraindication, and acceptability of these methods among patients. Finally, we comment on the potential role of medical abortion in Mexico and throughout Latin America.

RU486 / RU486

La controversia detrás la píldora es más de política. RU 486 no es un simple, comentario sobre un remedio a largo plazo. Un aborto farmacéutico puede durar hasta 48 horas, con cuatro visitas médicas requeridas. El proceso involucra una dos - parte de dosis de mifepristone y misoprostol. Mifepristone bloquea los efectos de progesterona y termina la preñez. La segunda dosis, misoprostol, ocasiona contracciones para expulsar el huevo dentro de 24 horas RU 486 es un 96 por ciento efectivo y considerado para ser un procedimiento noinvasor. Las mujeres pueden tomar RU 486 inmediatamente después que ellos detectan preñez. El aborto quirúrgico, sin embargo, requiere que las mujeres tengan no mas de siete de semanas encintas para poder realizarce la operación. Sin embargo, los problemas verdaderos yacen no con el proceso de tomar RU 486, pero con la pugna política sobre su legalización. En 1989, la Administración de Bush emitió un "el alerta de importación" prohibiendo investigación adicional y el uso de mifepristone El Presidente Clinton levantó la prohibición contra RU 486 en el Enero 1993...