Use of the Levonorgestrel Intrauterine System to Treat Heavy Menstrual Bleeding in Adolescents and Young Adults with Inherited Bleeding Disorders and Ehlers-Danlos Syndrome.

STUDY OBJECTIVE: To report on the rate of amenorrhea among adolescents and young adults with a bleeding diathesis after insertion of the 52-mg levonorgestrel intrauterine system (LNG-IUS) DESIGN: Retrospective chart review SETTING: Tertiary care, multidisciplinary Gynecology-Hematology clinic or Adolescent Gynecology clinic PARTICIPANTS: The cohort included 35 females aged 12-25 years presenting from January 2010 to January 2020 with heavy menstrual bleeding, 23 with an inherited blood disorder, and 12 with Ehlers-Danlos syndrome INTERVENTIONS: The 52-mg LNG-IUS MAIN OUTCOME MEASURES: Primary outcome was bleeding profile after LNG-IUS insertion. Secondary outcomes included rates of amenorrhea, intrauterine device (IUD) expulsion, IUD discontinuation, and unplanned pregnancy. RESULTS: Mean age at menarche was 11.6 years, with mean age at insertion of 16.9 (range 11-23). Most participants were white (n = 26, 74.3%). Von Willebrand disease was present in 16 patients (45.7%) and Ehlers-Danlos syndrome in 12 (34.3%). Most (91.4%) had tried at least 1 hormonal regimen prior to LNG-IUS. Most participants (81.8%) reported improvement in bleeding, with 60.6% reporting spotting or amenorrhea. LNG-IUS expulsion occurred in 3 participants (9.1%) within the first 21 days, despite hemostatic agents at time of insertion. Mean continuation was 5.08 years (95% CI, 4.24-5.92), with 79% likelihood that participants kept their IUD in place for at least 2.5 years, and some up to 6 years. CONCLUSION: The 52-mg LNG-IUS is an effective treatment option for adolescents and young adults with heavy menstrual bleeding and a bleeding diathesis, with high rates of amenorrhea. Rates of IUD expulsion appeared higher during the first 30 days, but long-term continuation remained high.

Liver transplantation improves cirrhosis-associated impaired oral glucose tolerance.

BACKGROUND: Thirty-five percent to 80% of cirrhotic patients have impaired glucose tolerance (IGT) or diabetes mellitus (DM). Diabetic cirrhotics have higher morbidity and mortality than nondiabetics. Therefore, it would be worthwhile to determine whether liver transplantation improves glucose homeostasis in these patients. METHOD: A total of 26 patients awaiting liver transplantation were evaluated for impaired glucose homeostasis by fasting blood glucose and/or oral glucose tolerance tests (OGTT). Five patients underwent transplant surgery within 1 year of OGTT and had a repeat OGTT 3-6 months after transplantation. RESULTS: Sixty-five percent (17/26) of the patients had abnormal glucose homeostasis. Twenty-three percent (6/26) met American Diabetes Association criteria for DM, and another 42.3% (11/26) had IGT. All patients had normal HbA1C levels. After transplantation, the 2-hr blood glucose improved in four patients and the mean 2-hr glucose level was reduced (204 +/- 94 vs. 132 +/- 53 mg/dl [mean +/- SD, P=0.051]). CONCLUSION: Liver transplantation can reverse cirrhosis-associated impaired glucose tolerance.

The effect of spray-dried porcine plasma on growth performance in the early-weaned pig.

A total of 904 weanling pigs were used to investigate the effects of 1) spray-dried porcine plasma (SDPP), 2) blends of SDPP and spray-dried blood meal (SDBM), and 3) added dietary methionine in a SDPP-based diet on starter pig performance. In Exp. 1, 534 weanling pigs (initially 6.4 kg and 21 +/- 2 d of age) were used to determine the effects of either 0, 2, 4, 6, 8, or 10% SDPP and lactose as a replacement for dried skim milk in the Phase I diet (d 0 to 14 postweaning). All pigs were fed the same diet from d 14 to 28 postweaning. Average daily gain from d 0 to 14 increased (linear, P < .01) with increasing SDPP. From d 14 to 28, ADG decreased (linear, P < .03) as level of SDPP fed during Phase I increased. However, for d 0 to 28, ADG was increased (linear, P < .01) with increasing SDPP in the Phase I diet. Feed intake increased with increasing SDPP from d 0 to 14 and d 0 to 28 (quadratic, P < .04 and P < .08, respectively); however, gain/feed (G/F) was not affected. In Exp 2, 298 weanling pigs (initially 5.5 kg and 19 +/- 2 d of age) were used to determine the effects of replacing SDPP with SDBM in the Phase I diet. Pigs were fed either a diet containing 10% SDPP or diets with SDBM replacing 25, 50, 75, or 100% of the lysine provided by the SDPP.(ABSTRACT TRUNCATED AT 250 WORDS)

Interactive effects among porcine somatotropin, the beta-adrenergic agonist salbutamol, and dietary lysine on growth performance and nitrogen balance of finishing swine.

An experiment was conducted to evaluate the interactive effects among porcine somatotropin (pST), salbutamol, and dietary lysine on growth performance, nitrogen balance, and carcass characteristics of finishing barrows (n = 32; 62.8 kg initially). Two replicate 32-d studies were set up in a split-plot design to evaluate singular and combined use of pST (0 or 4 mg/d) and salbutamol (0 or 2.75 ppm of the diet) as whole-plot treatments and diets containing .8, 1.2, 1.6, or 2.0% lysine as subplot treatments. Dietary lysine levels were administered within subplots in a 4 x 4 Latin square with pigs allowed 4 d of adjustment to diets followed by 4 d of urine and feces collection for determination of N retention and apparent digestibility of DM and N. Interactions between lysine and salbutamol were not found (P > .16). A pST x lysine interaction (P < .05) resulted in ADG being maximized at 1.2% lysine for pST-treated pigs (lysine quadratic, P < .02) but decreased linearly (P < .02) with increasing lysine for pigs receiving buffer. Pigs injected with 4 mg/d of pST had improved gain:feed (G:F) up to 1.2% lysine (lysine quadratic, P < .05), but no further increase to 2% lysine, whereas pigs injected with buffer showed no benefit from increased lysine (pST x lysine, P < .06). Pigs receiving buffer had greater increases in plasma urea N (PUN) as lysine increased than those receiving pST (pST x lysine, P < .002), but PUN was reduced by pST (P < .001) regardless of lysine level.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of porcine somatotropin and dietary phosphorus on growth performance and bone properties of gilts.

One hundred eight gilts (initial weight = 58.5 kg) were used to determine the effects of porcine somatotropin (pST) and dietary P on growth performance and bone mechanical properties and mineralization during the finishing phase (58 to 105 kg) and a 35-d postfinishing phase. Gilts were injected daily with placebo (control) or 4 mg of pST and fed diets containing .4, .8, or 1.2% P in a 2 x 3 factorial arrangement. From 58 to 105 kg, administration of pST increased (P < .01) ADG and G/F and decreased (P < .01) ADFI. When mean weight of the gilts in a pen reached 105 kg, half the gilts were slaughtered and first rib, femur, and third and fourth metacarpals were collected for determination of mechanical properties and bone ash. A pST x P interaction was observed (P < .05) for rib bending moment and modulus of elasticity; maximum rib bending moment was attained by control gilts at .8% P and rib modulus of elasticity values remained constant across P levels, whereas rib bending moment and modulus of elasticity increased as dietary P increased from .4 to 1.2% in pST-treated gilts. Administration of pST decreased (P < .05) stress of the rib, femur, and metacarpals compared with control gilts. Increasing dietary P resulted in a linear (P < .10) increase in bending moment, stress, and ash content for rib, femur, and metacarpal bones. The remaining 54 gilts were individually fed 1.8 kg/d of a common diet for 35 d postfinishing.(ABSTRACT TRUNCATED AT 250 WORDS)