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November 2002

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Daily migraine with visual aura associated with an occipital arteriovenous malformation.

A 51-year-old woman with daily attacks of migraine with visual aura is described. The aura always occurred on the right and the headache always on the left side of the head, suggesting a structural lesion in the left occipital lobe. The lesion appeared to be an arteriovenous malformation of which almost full obliteration resulted in a decrease in frequency of the aura and in intensity of the headache. Subsequent treatment of borderline hypothyroidism with levothyroxine brought about a dramatic improvement in frequency of both the aura and the headache. The case is discussed in the light of our present understanding of the pathogenesis of the migraine attack.

Headache 2001 Feb;41(2):193-7

Hypertension in thyroid disorders.

Hypertension is more common in hypothyroidic patients than in euthyroid controls in older age groups. Treatment of the thyroid deficiency alone lowers blood pressure in most patients. Hemodynamically, cardiac output is reduced and total peripheral resistance is elevated. The latter probably is secondary to an increase of sympathetic nervous tone and a relative increase in alpha-adrenergic response. In hyperthyroidism, elevation of diastolic blood pressure is uncommon. Systolic hypertension is more common in younger age groups. Treatment of the hyperthyroidism alone lowers systolic blood pressure in most patients. An increase in cardiac output and a decrease in total peripheral resistance accompany the hyperthyroidism. Potentiation of catecholamine action by an excess of thyroid hormone has been invoked as an explanation, because thyroid hormone excess is accompanied by increased beta-adrenergic receptors in some tissue, including heart.

Endocrinol Metab Clin North Am 1994 Jun;23(2):379-86

Levels of thyroid hormones and thyrotropic hormone in serum of women with perimenopausal arterial hypertension.

Test carried out in 96 women aged between 43 to 55 years (50.46 +/- 4.7), who did not take any drugs during the last three months. The women were divided into two groups: premenopausal and early postmenopausal. Each group was subdivided according to blood pressure: with normal pressure and with arterial hypertension. The concentration of T4, T3 and TSH were measured using a radioimmunologic method. The saturation of carrier proteins was established with the T3/test, the result of which was used to divide T4 and T3 and to obtain FT4I and FT3I respectively. It was found that women with arterial hypertension have significantly higher (p < 0.001) TSH concentration. The concentration of T3 and FT3I were significantly higher (p <0.01) in women with arterial hypertension in the postmenopausal period.

Ginekol Pol 1992;63(3):130-3

Thyroid disease and female reproduction.

OBJECTIVE: To review the menstrual function and fertility in thyroid disease, mainly in hyperthyroidism and hypothyroidism. Also, to register the consequences of (131)I therapy, which is used widely in the treatment of Graves’ disease and thyroid cancer, on subsequent pregnancies and on fertility in these patients. DESIGN: A MEDLINE computer search was used to identify relevant studies. The type of menstrual disturbances and the status of fertility were recorded from all the studies found. Also, the fertility and genetic hazard of female patients with Graves’ disease and thyroid cancer who were treated with (131)I were registered. RESULT(S): Both hyperthyroidism and hypothyroidism may result in menstrual disturbances. Menstrual abnormalities are less common now than in previous series. In a recent study, we found that only 21.5% of 214 thyrotoxic patients had some type of menstrual disturbance, compared to 50% to 60% in some older series. The most common manifestations are hypomenorrhea and oligomenorrhea. According to the results of endometrial biopsies, most thyrotoxic women remain ovulatory. Moreover, the genetic hazard incidence to radioiodine therapy in Graves’ disease and thyroid carcinoma is very small; exposure to (131)I does not cause reduced fecundity, and the risk of loss of fertility is not a contraindication for its use in these patients. In hypothyroidism, the frequency of menstrual irregularities has very recently been reported to be 23.4% among 171 hypothyroid patients studied. This is much less than that reported in previous studies, which showed that 50% to 70% of hypothyroid female patients had menstrual abnormalities. The most common manifestation is oligomenorrhea. Severe hypothyroidism is commonly associated with failure of ovulation. Ovulation and conception can occur in mild hypothyroidism. These pregnancies are, however, often associated with abortions, stillbirths or prematurity. The latter may be of greater clinical importance in infertile women with unexplained infertility. CONCLUSION(S): These new data, mainly concerning menstrual abnormalities in hyperthyroidism and hypothyroidism, are inconsistent with what is generally believed and written in the classic thyroid textbooks and indicate that such opinions should be revised.

Fertil Steril 2000 Dec;74(6):1063-70

Screening for hypothyroidism in infertile women.

OBJECTIVE: To determine the frequency of an elevated thyroid-stimulating hormone (TSH) level in 704 patients seeking treatment for infertility. STUDY DESIGN: Sera from 704 women evaluated for infertility were assayed for TSH levels using radioimmunoassay (normal, 0.45-4.09 mIU/mL). All women had at least one year of infertility. Women with a known history of thyroid disease were excluded from the review. RESULTS: Sixteen of 704 patients (2.3%) had elevated TSH levels and were treated with levothyroxine to normalize TSH. None of these women had overt clinical signs or symptoms of hypothyroidism. Of these women, 11 of 16, or 69%, had ovulatory dysfunction, and 7 (64%) later became pregnant while on thyroid replacement. Five of 704 (0.7%) women with infertility who presented without a history of ovulatory dysfunction had elevated TSH levels, and none became pregnant with treatment. CONCLUSION: The prevalence of elevated TSH in 704 women with at least one year of infertility was 2.3%. The majority of women diagnosed with hypothyroidism (11 of 16, or 69%) had ovulatory dysfunction. With treatment for hypothyroidism, successful pregnancies resulted in 7 of 11 (64%) of patients. Women with infertility and ovulatory dysfunction should be screened for hypothyroidism. Screening for hypothyroidism as part of a routine infertility workup in women with normal ovulatory function will yield few abnormal tests.

J Reprod Med 1999 May;44(5):455-7

Breast cancer

Nutrition and survival after the diagnosis of breast cancer: a review of the evidence.

PURPOSE: To review and summarize evidence from clinical and epidemiologic studies that have examined the relationship between nutritional factors, survival and recurrence after the diagnosis of breast cancer. MATERIALS AND METHODS: Relevant clinical and epidemiologic studies were identified through a Medline search. References of identified reports also were used to identify additional published articles for critical review. RESULTS: Several nutritional factors modify the progression of disease and prognosis after the diagnosis of breast cancer. Overweight or obesity is associated with poorer prognosis in the majority of the studies that have examined this relationship. Treatment-related weight gain also may influence disease-free survival, reduce quality of life and increase risk for comorbid conditions. Five of 12 studies that examined the relationship between dietary fat and survival found an inverse association, which was not evident on energy adjustment in most of these studies. The majority of the studies that examined intakes of vegetables or nutrients provided by vegetables and fruit found an inverse relationship with survival. Alcohol intake was not associated with survival in the majority of the studies that examined this relationship. CONCLUSION: Much remains to be learned about the role of nutritional factors in survival after the diagnosis of breast cancer. Healthy weight control with an emphasis on exercise to preserve or increase lean muscle mass and a diet that includes nutrient-rich vegetables can be recommended. Diets that have adequate vegetables, fruit, whole grains and low-fat dairy foods and that are low in saturated fat may help to lower overall disease risk in this population.

J Clin Oncol 2002 Aug 1;20(15):3302-16

Exercise counseling and programming preferences of cancer survivors.

PURPOSE: Exercise has emerged as an important quality-of-life intervention for cancer survivors, but exercise motivation is a challenge. The purpose of this study was to provide a comprehensive assessment of the exercise preferences of cancer survivors. DESCRIPTION OF STUDY: A mailed, self-administered survey was completed by 307 survivors of prostate, breast, colorectal or lung cancer. The survey contained questions on demographic and medical variables, past exercise and various exercise counseling and programming preferences. RESULTS: For exercise counseling, 84% of participants said they preferred or maybe preferred to receive exercise counseling at some point during their cancer experience. Moreover, 85% preferred to receive exercise counseling face to face, and 77% preferred to receive it from an exercise specialist affiliated with a cancer center. For exercise programming, 98% preferred recreational exercises, 81% preferred walking, 57% preferred unsupervised exercise (57%), and 56% preferred moderate-intensity exercise. In addition, 48% preferred to exercise in the morning, 44% preferred to exercise alone, 40% preferred to exercise at home and 32% preferred to start their exercise program before treatment. Chi-square analyses revealed that a small number of exercise preferences were moderated by demographic, medical and exercise variables. CLINICAL IMPLICATIONS: The results of this study indicate that cancer survivors have unique and varied exercise counseling and programming preferences. Fifty-six percent of cancer survivors preferred to exercise at moderate intensity rather than at high intensity. Moderate-intensity exercise has been shown previously to be relatively safe even for cancer survivors who are advanced in age. The key to success for inactive cancer survivors may be to provide reassurance that exercise is a safe and beneficial modality for cancer survivors and to prescribe an exercise program that builds their confidence by slowly increasing the level of exercise intensity.

Cancer Pract 2002 Jul-Aug;10(4):208-15

Effects of weight control and physical activity in cancer prevention: role of endogenous hormone metabolism.

Excess body weight and/or lack of physical activity are increasingly recognized as major risk factors for cancer of the colon, breast, endometrium and prostate. This paper reviews the effects of excess body weight and physical inactivity on endogenous hormone metabolism (insulin, the IGF-I/IGFBP system and sex steroids) and of endocrine alterations with risk of cancer of the endometrium, breast, prostate and colon.

Ann N Y Acad Sci 2002 Jun;963:268-81

Effect of exercise on the rat mammary gland: implications for carcinogenesis.

Physical activity has been associated with decreased risk for developing breast cancer yet to date, the mechanism remains unknown. The purpose of this investigation was to evaluate the effects of moderate exercise training on the normal mammary gland in an attempt to identify alterations or differences that might be associated with tumor inhibition. A total of 170 female Sprague-Dawley rats were randomized to baseline (n=10), exercise (EX; n=80) or sham-exercise groups (SHAM; n=80). Treadmill training (20-25 m min-1, 15% grade, 30 min day-1, 5 days week-1) was started at 28 days of age (DOA). Animals were killed at 28, 42, 56, 70 and 84 DOA. Mammary glands were evaluated by histology and immunohistochemistry. Terminal end buds (TEB), structures susceptible to carcinogenesis were counted. Sexual maturation, estradiol and progesterone, and organ and muscle weights were also evaluated. No differences in growth, sexual maturation or steroid hormones were observed in response to training. No difference in the number of TEBs was observed at any timepoint between EX and SHAM. Proliferation was significantly increased at 56 DOA and tended to be increased at 42 and 70 DOA in the EX animals whereas cell death was significantly increased at 70 DOA and tended to be increased at 84 DOA in the EX animals. These data suggest no difference in the number of carcinogen-susceptible structures as a result of moderate exercise. The changes in cell proliferation and apoptosis with exercise training suggest altered cell turnover that will necessitate future study particularly with relevance to carcinogenesis.

Acta Physiol Scand 2002 Jun;175(2):147-56

Social stress and state-to-state differences in smoking and smoking related mortality in the United States.

This paper reports on the relationship between the stressfulness of the social environment, smoking and mortality rates for malignant neoplasms of the respiratory system and chronic obstructive pulmonary disease (COPD). A macro-social approach was employed with the 50 states of the United States serving as the units of analysis....The results show that populations that experience higher levels of stressful events smoke more heavily and eventually experience higher mortality from lung cancer and COPD. These relationships are robust: they are replicated for different time periods, for different measures of the independent and dependent variables, and with different analytic methods.

Soc Sci Med 1994 Jan;38(2):373-81

Influence of war circumstances on tumor morphological characteristics in patients with breast cancer.

The influence of war circumstances on tumor morphological characteristics in patients with breast cancer has not been studied up to now. The aim of this study is to investigate if war circumstances have influenced breast cancer incidence. The study covered both the patients in which during a period of observation a breast cancer was diagnosed as well as those who died of the same disease in the same period. Three sources of data were used: 1) The archives of the Oncology and Radiotherapy Center of the University Hospital “Split” (UHS): hospital data of 768 patients were reviewed. The war sample consisted of 380 patients aged 59.4+/-12.1 (31 to 86) (including 5 males), whereas the pre-war sample was made up of 388 patients aged 58.4+/-12.7 (19 to 88) (including three males); 2) Register of death of the Pathology Department of UHS with 162 analyzed persons whose deaths were caused by breast cancer in the six-year period between 1988 and 1993. The list of 162 dead patients included 79 people who died from breast cancer diagnosed in that period (1988 to 1993) and another 83 people that had been diagnosed before that period; 3) The biopsy register of the Pathology Department of UHS with 851 breast biopsies performed between 1988 and 1993. Breast cancer is predominantly a female illness (99.1%). The war circumstances influenced the of T, N and M rate. (TNM system refers to the stages of cancer.) The rate of N2, N3, Ml were conspicuously higher in the war period. There were significantly more malignant histological diagnoses found in new patients and also significantly more patients died due to breast cancer. Stress and other war circumstances undoubtedly have a negative impact on the numerous markers of breast cancer, which we have proved in this study.

Coll Antropol 2002 Jun;26(1):99-106

Glycemic index: overview of implications in health and disease.

The glycemic index concept is an extension of the fiber hypothesis, suggesting that fiber consumption reduces the rate of nutrient influx from the gut. The glycemic index has particular relevance to those chronic Western diseases associated with central obesity and insulin resistance. Early studies showed that starchy carbohydrate foods have very different effects on postprandial blood glucose and insulin responses in healthy and diabetic subjects, depending on the rate of digestion. A range of factors associated with food consumption was later shown to alter the rate of glucose absorption and subsequent glycemia and insulinemia. At this stage, systematic documentation of the differences that exist among carbohydrate foods was considered essential. The resulting glycemic index classification of foods provided a numeric physiologic classification of relevant carbohydrate foods in the prevention and treatment of diseases such as diabetes. Since then, low-glycemic-index diets have been shown to lower urinary C-peptide excretion in healthy subjects, improve glycemic control in diabetic subjects, and reduce serum lipids in hyperlipidemic subjects. Furthermore, consumption of low-glycemic index diets has been associated with higher HDL-cholesterol concentrations and, in large cohort studies, with decreased risk of developing diabetes and cardiovascular disease. Case-control studies have also shown positive associations between dietary glycemic index and the risk of colon and breast cancers. Despite inconsistencies in the data, sufficient, positive findings have emerged to suggest that the dietary glycemic index is of potential importance in the treatment and prevention of chronic diseases.

Am J Clin Nutr 2002 Jul;76(1):266S-73S


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