Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity.

OBJECTIVE: To assess the role of insulin resistance, independent of obesity, in determining cardiovascular risk among women with the polycystic ovarian syndrome (PCOS). DESIGN: Cross-sectional study examining the relationships between hyperinsulinemia, composite cardiovascular risk scores, and prevalence of individual risk factors among lean and obese women with PCOS and healthy controls. SETTING: University-based tertiary care outpatient endocrinology clinic. PATIENT(S): 57 women with clinically defined PCOS and 45 unselected healthy age-matched controls. INTERVENTION(S): Clinical and anthropomorphic measurements and laboratory determinations of insulin and lipid levels. MAIN OUTCOME MEASURE(S): Fasting serum insulin and a cardiovascular risk score. RESULTS: Hyperinsulinemic women with PCOS carried more cardiovascular risk than their normoinsulinemic counterparts, who in turn had more risk than the control women (P=.004 by analysis of covariance). In addition to the lipid changes expected with insulin resistance (high triglyceride and low HDL cholesterol levels), there was an excess of LDL cholesterol among the women with PCOS (P=.006 by analysis of covariance). Across the range of body mass index, women with PCOS had greater insulin resistance than controls, suggesting that PCOS itself and body mass index both contribute to the observed insulin resistance. CONCLUSIONS: Our data support the hypothesis that insulin resistance in PCOS is a determinant of overall cardiovascular risk independent of obesity. The mechanism of this relationship remains uncertain and is the subject of ongoing research.

Is Medicaid pronatalist? The effect of eligibility expansions on abortions and births.

CONTEXT: Income thresholds for Medicaid eligibility for pregnant women were raised in two phases between 1987 and 1991. During roughly the same period, the U.S. fertility rate rose and the abortion rate declined; changes were particularly marked among young women, raising the possibility that fertility increases were related to Medicaid expansions. METHODS: Pooled time-series cross-section regressions were used to examine the effects of the Medicaid eligibility expansions in 15 states on rates of abortions and births among unmarried women aged 19-27 with 12 or fewer years of schooling. Abortion data came from the National Center for Health Statistics or state health departments and were aggregated by women's age, race, marital status and schooling; data on births were from national natality tapes. RESULTS: The Medicaid expansions were associated with a 5% increase in the birthrate among white women, but did not influence the rate among black women. Overall, no effect on the abortion rate was evident, but in analyses restricted to a subsample of eight states with the most complete abortion data, the rate among white women showed a significant decline after the second phase of expansions. CONCLUSIONS: Subsidized health care for low-income pregnant women in these 15 states may have encouraged white women to have more children than they would have without coverage.

PIP: From 1987 to 1991, Medicaid eligibility standards were expanded dramatically, expanding the proportion of Medicaid-financed births from 15% in 1985 to 32% in 1991. During this same period, the US fertility rate rose from 65.4/1000 women of reproductive age in 1986 to 69.6/1000 in 1991, and the abortion rate fell from 28.0 in 1985 to 25.9 in 1992. This study examines trends in US birth and abortion rates in 15 states between 1986 and 1992 to determine the effect of changes in Medicaid eligibility on abortion and birth rates among unmarried women aged 19-27 with 12 or less years of schooling. The study is introduced with a literature review that reveals a mixed effect of welfare payments on fertility and a description of the methodology, which is based on data gathered between 1986 and 1992 by the National Center for Health Statistics and on vital statistics from Georgia and Mississippi. Data analysis involved pooled time-series cross-section regressions using the natural logarithm of the state-specific annualized quarterly birth or abortion rate as the dependent variable, with all regressions run separately for race in states with a sufficiently large Black population. The Medicaid expansions were associated with a 5% increase in the birth rate among White women. No effect was found on the birth rate in Black women or on the overall abortion rate. Analysis of a subsample of eight states with the most complete abortion data showed a decline in the abortion rate after the second phase of Medicaid expansions. It is concluded that the Medicaid expansion may have encouraged While women to have more children.

An unusually-formed appearance epidermoid cyst of the plantar region--a case report.

A rare site for an epidermoid cyst is herein reported. A 40-year-old female was admitted for treatment of a right plantar tumor. The tumor was multiloculated, soft, nodular and in the range of about seven by seven centimeters. We initially diagnosed it as a saccular hemangioma, but it was finally diagnosed as an epidermoid cyst with foreign body reaction from the surgical specimen. Epidermoid cysts can occur in various parts of the body. Trauma is regarded to be the chief cause of them. Due to their various locations and appearance, they are sometimes difficult to diagnose. In such cases, however, it is generally agreed that pathological study is mandatory for a correct diagnosis.