LE Magazine November 2002
Page 4 of 4
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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