Résumé
Management of a pregnant patient with mechanical heart valve is a complex issue for all health care providers involved in the care of such patients. Complications may arise at any stage due to the increased haemodynamic load imposed by pregnancy or because of impaired cardiac performance often seen in these patients. In addition, the use of various cardiovascular drugs in pregnancy (especially anticoagulants) may lead tofoetal loss or teratogenic complications. Additionally, the risk of thrombo-embolic complications in the mother is increased by the hypercoagulable state of pregnancy. In this review, we have attempted to draw inferences to guide management of such patients based on the available literature. It seems that in pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labour. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Unfortunately there is no consensus on such data. An overview of the available literature forms the basis of this review. In conclusion, a guideline comprising pragmatic considerations is preffered.
Sujets)
Avortement spontané/induit chimiquement , Anticoagulants/administration et posologie , Acide acétylsalicylique/administration et posologie , Calendrier d'administration des médicaments , Femelle , Maladies foetales/induit chimiquement , Prothèse valvulaire cardiaque , Héparine/administration et posologie , Humains , Antiagrégants plaquettaires/administration et posologie , Grossesse , Complications cardiovasculaires de la grossesse/prévention et contrôle , Appréciation des risques , Thromboembolie/étiologie , Warfarine/administration et posologieRésumé
The importance of diet on the development and progression of prostate cancer was initially suggested by epidemiological studies. Since then, there has been a vast amount of research in this field. Compelling evidence now provides hope that evidence-based dietary alterations may markedly alter the natural history of this disease. Is there enough evidence for clinicians to be able to advise dietary modifications? The preliminary results no doubt are encouraging, but at present there seems to be no evidence to justify the widespread use of these proposed dietary interventions. However, as public awareness increases, all physicians involved with the care of patients with cancer of the prostate will need to be better armed with the current updates and advice on this issue.