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Atenolol versus pindolol: side-effects in hypertension unisom 25mg line insomnia 1997 full movie. Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men purchase unisom cheap insomnia yelp. Fogari R order unisom with amex insomnia help, Zoppi A, Corradi L, Mugellini A, Poletti L, Lusardi P. Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study. Fogari R, Zoppi A, Corradi L, Preti P, Mugellini A, Lusardi P. Beta-blocker effects on plasma lipids during prolonged treatment of hypertensive patients with hypercholesterolemia. Fogari R, Zoppi A, Poletti L, Marasi G, Mugellini A, Corradi L. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. The effect of losartan versus atenolol on cardiovascular morbidity and mortality in patients with hypertension taking aspirin: the Beta blockers Page 102 of 122 Final Report Update 4 Drug Effectiveness Review Project Losartan Intervention for Endpoint Reduction in hypertension (LIFE) study. Long-term effects of a losartan- compared with an atenolol-based treatment regimen on carotid artery plaque development in hypertensive patients with left ventricular hypertrophy: ICARUS, a LIFE substudy. Comparison of the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias following myocardial infarction. Effects of atenolol, nifedipine SR and their combination on the exercise test and the total ischaemic burden in 608 patients with stable angina. Effects of beta-blockers on sexual performance in men with coronary heart disease. Freytag F, Schelling A, Meinicke T, Deichsel G, Telmisartan Hypertension Experience in a Randomized European Study Versus Atenolol Study G. Comparison of 26-week efficacy and tolerability of telmisartan and atenolol, in combination with hydrochlorothiazide as required, in the treatment of mild to moderate hypertension: a randomized, multicenter study. Double-blind titrated-dose comparison of metoprolol and propranolol in the treatment of angina pectoris. Quality of life, side effects and efficacy of lisinopril compared with metoprolol in patients with mild to moderate essential hypertension. Double-blind randomized placebo controlled crossover comparison of propranolol and verapamil in patients with angina pectoris and systemic hypertension. Comparison of oral propranolol and verapamil for combined systemic hypertension and angina pectoris. The systolic hypertension in the elderly pilot program: methodological issues. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Galcera-Tomas J, Castillo-Soria FJ, Villegas-Garcia M, et al. Effects of early use of atenolol or captopril on infarct size and ventricular volume: A double-blind comparison in patients with anterior acute myocardial infarction. Comparison of the efficacy and safety of flunarizine to propranolol in the prophylaxis of migraine. Beta blockers Page 103 of 122 Final Report Update 4 Drug Effectiveness Review Project 160. Cyclandelate versus propranolol in the prophylaxis of migraine--a double-blind placebo-controlled study. Antihypertensive regimen and quality of life in a disadvantaged population. Adrenoreceptors, endothelial function, and lipid profile: effects of atenolol, doxazosin, and carvedilol. Stroke after thrombolysis: Mortality and functional outcomes in the GUSTO- I trial. Effect of fluoxetine on carvedilol pharmacokinetics, CYP2D6 activity, and autonomic balance in heart failure patients. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. High blood pressure and diabetes mellitus: are all antihypertensive drugs created equal? Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Guazzi M, Fiorentini C, Polese A, Magrini F, Olivari MT. Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. Effect of oral proporanolol on the extent of acute anterior myocardial infarction [abstract]. Paper presented at: Ninth World Congress on Cardiology1982; Moscow. Reduction of infarct size by early use of oral propranolol and verapamil in acute myocardial infarction. Long-acting beta-blockers in the twenty-fourth hour. Verapamil and propranolol in essential hypertension. Perioperative beta blockade with propranolol: reduction in myocardial oxygen demands and incidence of atrial and ventricular arrhythmias. Beta blockers Page 104 of 122 Final Report Update 4 Drug Effectiveness Review Project 177. Hansson L, Dahlof B, Ekbom T, Lindholm L, Schersten B, Wester PO. Key learning from the STOP-hypertension study: An update on the progress of the ongoing Swedish study of antihypertensive treatment in the elderly. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Permutation distribution estimation applied to the comparison of the profile of the activity of two antianginal drugs.
Rivaroxaban concentrations in the evaluated ● To evaluate existing evidence for the effect of rivaroxaban on samples ranged from 0 to 1000 ng/mL purchase generic unisom insomnia 55. Samples included normal routine coagulation tests (prothrombin time buy cheap unisom 25mg insomnia 2002, international plasma spiked in vitro with rivaroxaban (n 9) buy cheap unisom 25 mg on line insomnia 2 am, ex vivo plasma normalized ratio, and activated partial thromboplastin time) from rivaroxaban-treated patients (n 3), and plasma from healthy volunteers receiving rivaroxaban (n 2). Introduction PT/INR Rivaroxaban is a direct oral anticoagulant that achieves its anticoagu- 1 The effect of rivaroxaban on the PT was evaluated in 14 studies. After oral 2 Only 6 studies reported a correlation coefﬁcient (R ) to describe administration, peak plasma levels are achieved within 2-4 hours. Correlation coefﬁcients hours in healthy elderly subjects. In plasma from inducers of the P-glycoprotein transport protein and CYP3A4 patients receiving rivaroxaban and plasma spiked with rivaroxa- enzyme. However, in patients receiving rivaroxaban, the effect on ng/mL and 25-30 ng/mL, respectively. However, assessment of the amount of rivaroxaban present in signiﬁcant variability with respect to assay sensitivity depending a patient may be desirable in certain clinical situations such as on the thromboplastin reagent used. Although rivaroxaban prolonged the aPTT in a time OR laboratory monitoring OR laboratory measurement). Studies dose-dependent manner, the relationship between rivaroxaban were eligible for inclusion if they reported the relationship between concentration and aPTT was nonlinear. Pediatric studies, animal studies, abstracts, articles concentration ranges over which nonlinearity was most pro- lacking original data, and non-English studies were excluded. Three studies reported correlation coefﬁcients using 334 American Society of Hematology Table 1. Studies evaluating the effect of rivaroxaban on PT or aPTT Range of drug concentration Coagulation Study (ng/mL) Test material Indication N Dose tests R2 Barrett et al, 201014 10– 1000 Spiked normal pooled plasma N/A N/A N/A PT N/R Dinkelaar et al, 201318 0–800 Spiked normal pooled plasma N/A N/A N/A PT 1. Similar to the PT, correlation coefﬁcients appeared rivaroxaban concentrations (grade 2C). There Disclosures was signiﬁcant variability in results by reagents used and 10,15,17 Conﬂict-of-interest disclosures: The authors declare no competing between individual laboratories. Taken together, these results demonstrate that rivaroxaban can Correspondence prolong the PT, but assay results vary markedly with different Dr. Konkle, Director, Clinical and Translational Re- thromboplastin reagents. Assay methodology, including data analy- search, Medical Director, Hemostasis Reference Laboratory, Puget sis, and instrumentation may also affect results. In vitro and in vivo studies monitoring reduced sensitivity and increased variability, making it of the novel antithrombotic agent BAY 59-7939–an oral, direct Factor unsuitable for assessment of rivaroxaban anticoagulant effect. Finally, the nonlinear relationship of aPTT with rivaroxaban 2. Kubitza D, Becka M, Wensing G, Voith B, Zuehlsdorf M. Safety, concentration, poor sensitivity, and signiﬁcant variability between pharmacodynamics, and pharmacokinetics of BAY 59-7939–an oral, reagents makes it unsuitable for assessing the presence of direct Factor Xa inhibitor–after multiple dosing in healthy male rivaroxaban. Kubitza D, Becka M, Voith B, Zuehlsdorf M, Wensing G. Safety, Our results suggest that dose-response studies using calibration pharmacodynamics, and pharmacokinetics of single doses of BAY standards should be conducted by individual laboratories to deter- 59-7939, an oral, direct factor Xa inhibitor. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti communicated to clinicians. Oral anticoagulant therapy: Antithrombotic Therapy and Prevention preted by practicing physicians with attention to timing of last of Thrombosis, 9th ed: American College of Chest Physicians Evidence- administration, advanced age, renal insufﬁciency, and concomitant Based Clinical Practice Guidelines. Target-speciﬁc oral anticoagulants in atrial ﬁbrillation: would recommend against the use of the neuraxial anesthesia 12 results of phase III trials and comments on sub-analyses. J Thromb hours after a dose of rivaroxaban because signiﬁcant amounts of Thrombolysis. Metabolism and Hematology 2014 335 excretion of rivaroxaban, an oral, direct factor Xa inhibitor, in rats, dogs, time for measuring rivaroxaban plasma concentrations using calibrators and humans. Clinical laboratory measure- embolism in 106 patients, who have undergone major orthopedic ment of direct factor Xa inhibitors: anti-Xa assay is preferable to surgery: an observational study. Mueck W, Lensing AW, Agnelli G, Decousus H, Prandoni P, Missel- factor Xa inhibitor rivaroxaban on commonly used coagulation assays. Rivaroxaban: population pharmacokinetic analyses in patients J Thromb Haemost. Determination of an patients with atrial ﬁbrillation treated for stroke prevention. Clin Pharmacoki- thromboplastin as calibrator for plasma spiked with rivaroxaban. Measuring Rivaroxaban in a clinical and pharmacodynamics of rivaroxaban–an oral, direct factor Xa inhibi- laboratory setting, using common coagulation assays, Xa inhibition and tor in patients undergoing major orthopaedic surgery. Dinkelaar J, Molenaar PJ, Ninivaggi M, de Laat B, Brinkman HJ, Leyte 10. In vitro assessment, using thrombin generation, of the applicability of assessment of novel oral anticoagulants: method suitability and variabil- prothrombin complex concentrate as an antidote for Rivaroxaban. Comparison of calibrated assays to measure rivaroxaban–an oral, direct factor Xa inhibitor. Normalized Ratio calibrated for rivaroxaban has the potential to 20. Coagulation normalize prothrombin time results for rivaroxaban-treated patients: parameters in patients receiving dabigatran etexilate or rivaroxaban: two results of an in vitro study. Bates1,2 1Department of Medicine, McMaster University and 2Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada Assisted reproductive technology is widely used to treat couples affected by infertility. Complications associated with assisted reproduction include venous thromboembolism, ovarian hyperstimulation syndrome, and recurrent implanta- tion failure. It has also been proposed that thrombophilia may be associated with an increased likelihood of these events. Although data are limited, antithrombotic therapy is frequently used to enhance the likelihood of successful assisted reproduction. This chapter reviews the risks of venous and arterial thromboembolism associated with assisted reproduction, as well as available data regarding the impact of thrombophilia on the risks of thromboembo- lism and failure of implantation. The role of antithrombotic therapy in reducing the likelihood of these events, along with recommendations from various guidelines, are also discussed. It antithrombotic therapy in women undergoing assisted repro- has been proposed that thrombophilia leads to an increased risk of duction microthrombosis at the implantation site, impairing initial invasion of maternal vessels by the syncytiotrophoblast. Most were case-control procedures involving in vitro handling of human oocytes and sperm studies and the overall methodologic quality was thought to be poor or embryos for the purpose of achieving pregnancy, is widely used 1,2 because only a few of the case-control studies used a representative to treat the 1 in 6 couples affected by infertility. Techniques control and consecutive patient sampling was used in 1/2 of the used include not only in vitro fertilization, but also intracytoplasmic cohort studies, several of which were retrospective.
After a BEP5 in intermediate- and high-risk patients median follow-up of 56 purchase unisom us insomnia one-liners. There is no useful the follow-up of ovarian cancer patients unisom 25 mg visa insomnia relaxation techniques. The gold REFERENCES standard of treatment is complete debulking surgery 1 order unisom discount insomnia relaxation techniques. Global cancer either at primary surgery or after neoadjuvant statistics. CA Cancer J Clin 2005;55;74–108 chemotherapy followed by platinum-based com- 2. In: Global status report on noncommunicable dis- eases. A prognostic chemotherapy and difficult access to healthcare for model for ovarian cancer. National Cancer Insti- available for the management of cancers make it tute. Ovarian cancer: epidemi- very difficult for low-resourced settings to develop ology, biology, and prognostic factors. Newer, afford- 2000;19:3–10 able drugs focusing on maximal clinical benefit 6. Merck Manual of Diagnosis and Therapy, 2008 It may also be possible that the outcomes from 7. Sensiti- vity and specificity of multimodal and ultrasound use of chemotherapeutic agents researched in clini- screening for ovarian cancer, and stage distribution of cal trials in affluent societies may differ significantly detected cancers: results of the prevalence screen of the in less-developed countries due to differences in UK Collaborative Trial of Ovarian Cancer Screening genetic, environmental, lifestyle and nutritional (UKCTOKS). Lancet Oncol 2009;10:327–40 factors and health service infrastructure in the 8. Ultrasound charac- teristics of different types of adnexal malignancies. Quality of life studies col Oncol 2006;102:41–8 assessing treatment effects in low-resourced com- 9. Prolonged hospi- statements on the management of ovarian cancer: final tal stay, treatment side-effects, lack of post-treatment document of the 3rd International Gynecologic Cancer support, for a disease with limited survival may be Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Neoadjuvant chemo- ACKNOWLEDGEMENT therapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943–53 Dr MEL van der Burg, PhD, medical oncologist, 11. Gynecol Oncol 1992;47:159–66 Guideline for staging surgery early-stage ovarian 12. Role of primary surgery in cancer stage FIGO IA–IIA advanced ovarian cancer. Impact of adjuvant • Inspection, palpation and resection chemotherapy and surgical staging in early-stage ovarian N Median abdominal laparotomy carcinoma: European Organisation for Research and N Cytologic whashing of ascites Treatment of Cancer-Adjuvant ChemoTherapy in Ovar- N Inspection and palpation of abdomen and ian Neoplasm trial. International pelvis Collaborative Ovarian Neoplasm trial 1: a randomized N Uterus and adnexal extirpation trial of adjuvant chemotherapy in women with early- N Omentectomy stage ovarian cancer. J Natl Cancer Inst 2003;95:125–32 N (Appendectomy at mucinous adenocarcino- 15. International ma) Collaborative Ovarian Neoplasm trial 1 and Adjuvant ChemoTherapy In Ovarian Neoplasm trial: two parallel • Staging biopsies randomized phase III trials of adjuvant chemotherapy in N Biopsy of all sites where the ovary was adhe- patients with early-stage ovarian carcinoma. J Natl sive Cancer Inst 2003;95:105–12 N Biopsy every lesion suspicious for tumor 16. Surgical stag- N ‘Blind’ biopsy of the peritoneum from: ing and treatment of early ovarian cancer: long-term analysis from a randomized trial. J Natl Cancer Inst 2010; • Bladder 102:982–7 • Pouch of Douglas 17. Protocol • Lateral pelvic sidewalls (fossa ovarica) development for ovarian cancer treatment in Kenya: a • Left and right paracolic grooves brief report. Int J Gynecol Cancer 2011;21:424–7 • Right diaphragmatic site 18. High dose cisplatin compared with high dose cyclophosphamide in the management • Lymph node dissection, or sampling of at least 2 of advanced epithelial ovarian cancer (FIGO stages III lymph nodes from the following sites: and IV): report from the North Thames Cooperative N Para-aortic lymph nodes Group. BMJ 1985;290:889–93 N Lymph nodes at the common iliac vessels 19. Randomized N Lymph nodes at the internal iliac vessels intergroup trial of cisplatin–paclitaxel versus cisplatin– cyclophosphamide in women with advanced epithelial N Lymph nodes at the external iliac vessels ovarian cancer: three-year results. J Natl Cancer Inst N Lymph nodes at the obturator fossa 2000;92:699–708 20. The International Collaborative Ovarian Neoplasm NOTE: In young patients with ovarian cancer lim- Group (ICON) Group. Paclitaxel plus carboplatin ver- ited to one ovary and who want to preserve their sus standard chemotherapy with either single agent fertility, tumor resection can be limited to one carboplatin or cyclophosphamide, doxorubicin, and cis- ovary + omentectomy and optimal surgical staging. Long-term follow-up confirms a survival advantage of the paclitaxel–cisplatin regimen over the cyclophospha- mide–cisplatin combination in advanced ovarian cancer. Intraperitoneal chemotherapy in patients with advanced ovarian cancer: the con view. The effect of debulking surgery after induction chemo- therapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet 2010;376:1155–63 353 GYNECOLOGY FOR LESS-RESOURCED LOCATIONS APPENDIX 2 Antiemetics in patients with chemotherapy for ovarian cancer Medicine Day 1 Day 2 Day 3 Day 4 and if necessary the of the chemotherapy following days Dexamethasone (1. Daily 1 × 150 mg ranitidine; 3 times daily 1 or 2 tablets magnesium oxide to prevent constipation. APPENDIX 3 Three-weekly carbotaxol/paclitaxel for epithelial ovarian cancer Hour Time Infusion fluid + medication Initial Control initial T = –0 h 30 min 50 ml NaCl 0. ENDOMETRIAL ADENOCARCINOMA Endometrial adenocarcinoma is the most common gynecological malignancy in industrialized coun- tries. In industrialized countries the incidence maybe four to six times higher than in low-resourced countries. A Figure 1 Number of new patients with uterine cancer at number of reasons may explain this discrepancy. In Groote Schuur Hospital, Cape Town industrialized countries there has been a sharp in- crease of the life expectancy and a subsequent risk of tuberculosis and malnutrition is in a worse state exposure to causative factors of endometrial cancer. Although Secondly, it has been shown that obesity is reaching exact figures are not known, it may well be that epidemic levels in industrialized areas.