ABSTRACT
The feasibility and cost-effectiveness of screening women for congenital thrombophilic alterations before oral contraceptive (OC) treatment was investigated. A total of 525 women (mean age 21.9 years, 73% aged < 25 years) were examined before their first OC course. At first screening, completely normal results were recorded in 485 (92.4%) women, the remaining showing single (n = 34) or multiple (n = 6) alterations. At second examination (possible in 37 of 40), activated protein C resistance (APCR) was confirmed in 21 cases (4.0%, 18 with factor V Leiden), protein C, or protein S reduction in 8 (1.5%) and 2 (0.4%) cases, respectively. No cases with antithrombin III deficiency were detected. The global estimated cost ($US) to detect one altered case was: $7795 for protein S, $2696 for antithrombin III (no case found), $1374 for protein C and $433 for APCR. The present study confirms that extensive thrombophilic screening before OC treatment is not currently advisable. APCR assessment, however, seems to have a favorable cost-effectiveness ratio: the alteration is frequent and has a synergistic effect with OC; sensibility and specificity of some methods are good; family history is unreliable to single out possible carriers; finally, carriers can be fully informed of their increased thrombotic risk if treated with OC and can receive thromboprophylaxis during life situations associated with high thrombotic risk (e.g., pregnancy and puerperium).
PIP: This article investigates the feasibility and cost effectiveness of screening women for congenital thrombophilic changes before oral contraceptive (OC) treatment. The study population included 525 women who were examined before their first OC course between September 1995 and May 1997 in Bologna, Italy. A completely normal result was seen in 92.4% women during the first screening, which was conducted before the first OC course. The second examination showed that activated protein C resistance (APCR) was confirmed in 21 cases (4.0%, 18 with factor V Leiden), and protein C and protein S reduction in 8 (1.5%) and 2 (0.4%) cases, respectively. Antithrombin III deficiency cases were not detected. The detection of one altered case is estimated to cost $7795 for protein S, $2696 for antithrombin III, $1374 for protein C, and $433 for APCR. The study confirmed that extensive thrombophilic screening before OC treatment was not advisable. However, APCR assessment was found to be cost-effective. The alteration was frequent and APCR had a synergistic effect with OC, and the sensibility and specificity of some methods for detection of APCR are good. Family history is not reliable for identifying possible carriers for the thrombophilic trait. Carriers can be fully informed of their high risk if treated with OC and can receive thromboprophylaxis in conditions where thrombotic risk is high.
Subject(s)
Activated Protein C Resistance/diagnosis , Contraceptives, Oral , Activated Protein C Resistance/epidemiology , Adult , Antithrombin III/analysis , Contraceptives, Oral/adverse effects , Cost-Benefit Analysis , Factor V/analysis , Feasibility Studies , Female , Humans , Italy , Mass Screening/economics , Pilot Projects , Pregnancy , Pregnancy Complications, Hematologic/prevention & control , Protein C/analysis , Protein S/analysis , Puerperal Disorders/prevention & controlSubject(s)
Crowns , Dental Cavity Preparation , Cementation , Child , Child, Preschool , Dental Pulp , Dentistry, Operative/methods , Humans , Molar , Stainless SteelABSTRACT
In 30 hypertensives with angina pectoris the acute action of beta-blockers Celiprolol and Metoprolol on the global and coronary haemodynamics was tested within cardiac catheter diagnostics. In accordance with no long-term effects Metoprolol acts negatively inotrope, chronotrope as well as pre- and post-load increasing. Celiprolol lowered the pre- and postload, and increased the cardiac output, but did not influence the heart rate. Both medicaments increased coronary flow and myocardiac oxygen consumption. From the mentioned effects important conclusions for therapy with both Beta-blockers can be derived.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Angina Pectoris/drug therapy , Hemodynamics/drug effects , Hypertension/drug therapy , Metoprolol/therapeutic use , Propanolamines/therapeutic use , Adult , Angina Pectoris/physiopathology , Celiprolol , Humans , Hypertension/physiopathology , Male , Middle AgedABSTRACT
Cystic Fibrosis is a lethal genetic disorder affecting the respiratory, gastro intestinal, exocrine end reproductive systems. From the orthodontic point of view, respiratory changes are of great interest. In fact, cephalometric tracings and cast analysis on 20 subjects with Cystic Fibrosis have revealed changes at the orofacial structures, strictly related to the respiratory dysfunctions. They can be summarized as: mesial shifting of the maxilla, dimensional increase of the mandibular body, ovoidal upper arch with a deeper palatal vault, tapering or trapezoidal lower arch. Even if causes can be hardly distinguished from effects, the role of the juvenile oral breathing in these cases seems to be any way undeniable with statistically significant results.
Subject(s)
Cystic Fibrosis/complications , Malocclusion/etiology , Mouth Breathing/etiology , Cephalometry , Child , Facial Bones/pathology , Humans , Malocclusion/pathology , Maxillofacial DevelopmentABSTRACT
In 30 patients the influence of ionic (Amidotrizoate) and non-ionic (Iopromide) contrast agents on the heart parameters contractility, relaxation, perfusion and the rate of extrasystoles was investigated. They were significantly less influenced by Iopromide than by Amidotrizoate. A negative inotropic action was detectable only for Amidotrizoate. It is concluded that non-ionic contrast media should be used especially for critical patients.
Subject(s)
Coronary Circulation/drug effects , Coronary Disease/diagnostic imaging , Diatrizoate , Myocardial Contraction/drug effects , Depression, Chemical , Humans , Iohexol , RadiographyABSTRACT
For 50 sucklings and small infants with cyanotic and acyanotic heart defects the non-ionic contrast medium Iopromide was tested against the ionic contrast medium Amidotrizoate in angiography. With consideration to the applied method the tested cardiospecific enzymes (CK MB, alpha-HBDH, lactate) as well as hematocrit, oxygen content of central venous blood, heart rate, systolic pressures in both ventricles and ECG showed no significant differences. The different end-diastolic pressures in both ventricles and the average pressure in the right atrium, however, showed the cardiotoxicity of Amidotrizoate. Conclusively the use of Iopromide is demanded for infants, small infants and sucklings.
Subject(s)
Angiocardiography , Diatrizoate , Heart Defects, Congenital/diagnostic imaging , Heart/drug effects , Double-Blind Method , Female , Humans , Infant , Infant, Newborn , Iohexol , Male , Randomized Controlled Trials as TopicSubject(s)
Cephalometry , Down Syndrome/ethnology , Down Syndrome/pathology , Humans , Racial Groups , United States/ethnologySubject(s)
Activator Appliances , Orthodontic Appliances, Removable , Orthodontics, Corrective/methods , Child , Female , Humans , Male , Malocclusion/therapyABSTRACT
During the diagnosis and subsequent monitoring of patients with acute leukaemia, and of those with terminal blastic crisis in chronic myelogenous leukaemia, the activity of total LDH, ALAT, AP, ASAT as well as the isoenzymes LDH-H, LDH-M were measured in the plasma. Enzyme and isoenzyme activity of LDH, which differed in quantity at the various times of measurement, reflected the varying proliferation rate, depending upon the individual and upon the time of measurement and, consequently, the tumour cell mass.
