Treatment strategies for premenstrual syndrome

Premenstrual syndrome (PMS) refers to a group of menstrually related disorders. Premenstrual symptoms sufficient to impair daily activity and relationships are estimated to occur in up to 40 percent of women of reproductive age, with 5 percent of these women having severe impairment. Although no single causative factor has been identified, PMS is related to ovulatory cycles and resolves at menopause. A specific diagnostic test for PMS does not exist. Treatment is based on the symptoms. Oral contraceptive agents, diuretics and antidepressants have been used successfully to relieve symptoms. Cognitive therapy may help the patient develop appropriate ways to cope with the obstacles, frustrations and discomforts of daily life. Although dietary deficiencies may be difficult to demonstrate, nutritional supplementation may result in significant improvement. Various treatments, including progesterone supplementation, vitamin B6 in high doses, alprazolam and gonadotropin-releasing hormone agonists, are generally not recommended. A comprehensive treatment plan that encourages a healthy lifestyle may relieve symptoms in most women.     

Treatment of cloverleaf skull syndrome

Up to a few years ago, patients with cloverleaf skull deformity underwent partial surgery to relieve intracranial hypertension with poor functional and aesthetic results, often leading to relapses and reoperations, both in our own experience and in that of other authors. As of 1990, however, we started to use the technique described by Persing et al. to resolve the complex cloverleaf malformation in a single definitive procedure. Five patients, whose ages ranged from 2 months to 5 years, achieved satisfactory results both as regards relief from intracranial hypertension and preservation of visual acuity, and from the aesthetic viewpoint. Surgical approaches and their modifications are described.     

Treatment of sleep apnea-hypoapnea syndrome

Two patients with chronic myelogenous leukemia are described in whom thrombotic thrombocytopenic purpura (TTP) developed following treatment by interferon-alpha. In one of the patients, a lymphoblastic transformation was diagnosed concomitantly. Prompt institution of plasmapheresis, steroids and vincristine resulted in complete resolution. In the hitherto reported case of TTP complicating interferon-alpha treated chronic myelogenous leukemia, the course was fatal.     

Treatment of hemolytic uremic syndrome

Since the pathogenesis of hemolytic uremic syndrome (HUS) has not been fully understood, it is difficult to establish a therapy protocol for HUS. Until now, there have been no effective treatments of HUS, evaluated by prospective controlled studies. Progress in the management of acute renal failure has improved the prognosis of HUS. Recently, the effectiveness of plasma infusion has been considered to be doubtful. Antiplatelet therapy and vitamin E administration may be recommended to treat typical HUS without severe complications. In addition to these treatments, plasma exchange using fresh plasma or fresh frozen plasma is recommended to treat HUS in the adult, atypical HUS and typical HUS with severe complications in childhood, considering the poor prognosis in these conditions.     

Treatment of post-traumatic stress syndrome

This paper reviews different psychotherapeutic and drug treatments for Post Traumatic Stress Disorder (PTSD). Psychotherapeutic treatments have changed from the abreaction technique to more classical psychodynamic approaches and recently to cognitive and behavioral techniques. Many drugs have been used in the treatment of PTSD but most of the studies were not controlled and included very few patients. More recently, double blind controlled studies have been performed comparing imipramine, desipramine, amitriptyline, phenelzine and placebo. A global efficacy has been found but the improvement was more closely related to associated symptoms, namely anxiety and depression, than to the core symptoms of PTSD.     

Treatment of atypical autism in Martin-Bell syndrome

The paper reports the case of sibs, brother and sister, with Martin-Bell's syndrome confirmed cytogenetically. Mental retardation and autism were the main phenomena in the clinical picture. Positive effect was achieved by means of Skvortsov--Osipenko method (metameric injection of cerebral hydrolysates' preparations, stimulation of visual, acoustic and proprioceptive analyzers). A decline of the signs of intellectual retardation and autism were observed in both children.     

Treatment of urethral syndrome with triamcinolone acetonide

A new method for the treatment of the urethral syndrome is presented. Therapy involves the submucosal injection of triamcinolone acetonide around Skene's glands to decrease inflammation and scarring. It is a simple office procedure, while all other therapeutic modalities are surgical.     

Treatment of overactive bladder syndrome and detrusor overactivity

The overactive bladder syndrome is a relatively new-term defined by the International Continence Society in 2002. Previous definitions were based on urodynamic diagnoses; however, the overactive bladder syndrome is a symptomatic diagnosis with urgency as the cornerstone symptom, thus allowing treatment to be initiated by primary care physicians before embarking on complex investigations. It affects millions of people worldwide and has considerable economic costs. Its aetiology is unknown but some people suggest that it may be a nerve-related problem while others suggest that it may be a muscle-related problem. The true cause probably lies somewhere between the two theories. With this in mind, treatment is aimed at relief of symptoms and improving quality of life. Conservative treatments combined with antimuscarinic drugs are the main treatment for overactive bladders. There are many antimuscarinics available, with several under development, which have different specificities for the muscarinic receptors. Other drugs have also been tried but with limited success.If conservative and oral medical treatments fail, the options include intravesical therapy, neuromodulation or major surgery. However, urodynamics are essential for patients referred for these treatments, which are mainly initiated by specialists rather than primary care physicians. The aim of this review is to give an overview of the overactive bladder and detrusor overactivity, their diagnosis and treatment options.     

Evidence for autonomic nervous system imbalance in women with irritable bowel syndrome

Autonomic nervous system function was assessed in women with and without irritable bowel syndrome using frequency domain measures of heart rate variability. Women were interviewed and placed into the irritable bowel syndrome (N = 25) group based on history of diagnosis and self-report of current gastrointestinal symptoms. Women in the control group denied a history of chronic gastrointestinal symptoms (N = 15). Women were followed for one menstrual cycle with a symptom diary, and during mid-luteal phase they wore a Holter 24-hr electrocardiograph monitor. Women with irritable bowel syndrome demonstrated significantly lower vagal tone as measured by the high frequency spectrum relative to control women. In addition, women with irritable bowel syndrome had a flattened 24-hr pattern of heart rate variability, with significantly lower levels of vagal tone during sleep. These results suggest that systemic sympathovagal balance may be shifted in a subset of women with irritable bowel syndrome.     

Treatment of antecubital pterygium in the nail-patella syndrome

The effects of an aggressive biting response on stress-induced noradrenaline (NA) release in the rat amygdala and gastric ulcer formation were studied with an intracerebral microdialysis technique. Rats were exposed to a 60-min period of cold restraint stress with or without being allowed to bite a wooden stick. They were sacrificed 100 min after release from stress to investigate gastric ulcer formation. Cold-restraint stress increased NA release to 304 +/- 22.3 and 206 +/- 23.8% of basal levels (mean +/- SEM) in the nonbiting and biting groups, respectively. The stress-induced increases in NA release in the nonbiting group were significantly higher than those in the biting group. In the nonbiting group, significant increases in NA release continued for 80 min after release from stress; however, NA levels in the biting group recovered to basal levels immediately after the cessation of stress. Although many severe gastric lesions with bleeding were found in the nonbiting group, fewer gastric lesions without bleeding were found in the biting group. The cumulative length of gastric lesions in the nonbiting group and in the biting group was 26.2 +/- 7.4 and 6.8 +/- 3.9 mm (mean +/- SEM), respectively. The mean number of ulcers in the nonbiting group and the biting group was 11.8 +/- 1.3 and 1.8 +/- 0.7 (mean +/- SEM), respectively. Both the cumulative length of ulcers and the number of ulcers were significantly lower than those seen in the nonbiting group. These findings strongly suggest that expression of aggression during stress exposure attenuates not only stress-induced increases in NA release in the rat amygdala but also gastric ulcer formation consequent to stress.     

Treatment of Frey's syndrome with botulinum A toxin

A 74-year-old woman suffered from severe gustatory sweating and flushing of the preauricular skin following parotidectomy (Frey's syndrome). She was treated with intracutaneous botulinum A toxin injections in the affected skin area. Minor's test was used to determine the extent of the affected area. Within one week, the symptoms disappeared. After three weeks, Minor's test was repeated and showed minimal residual hyperhidrosis. These small areas were treated again. No side effects were noted. At follow-up one year later, the patient was free of symptoms.     

Treatment of hyperandrogenic manifestations in polycystic ovary syndrome

Etiopathogenesis of the polycystic ovarian disease is not clarified. Therefore, optimum therapy of hyperandrogenic syndromes, menstrual and fertility disorders pose a difficult problem. Sequential therapy with estrogens and progestagens is of value in young women, who are not planning to conceive in order to reduce hirsutism and regulate menses. A reduction of hirsutism, acne and seborrhea is produced within 3 months. However, cessation of the treatment produces the symptoms of excessive androgen production. Another method is therapy with antiandrogens, especially cyproterone acetate. This drug inhibits androgens biosynthesis and has also peripheral activity. Spironolactone is another antiandrogen frequently used, but it is known as a primarily diuretic agent. It acts primarily at the androgen receptor sites. Other antiandrogens such as ketoconazole and flutamide are used less frequently. It has been shown, that cimetidine--known H2 receptor inhibitor--also decreases the symptoms of hyperandrogenism. However, cimetidine has not been used for the treatment of polycystic ovarian disease. In cases of enzymatic defects in adrenocortical steroido-synthesis glucocorticoids are used, mainly low doses of triamcinolone and dexamethasone. Other therapies are preferred in case of polycystic ovarian disease in women, who want to conceive. Clomiphene citrate and gonadotropins, mainly FSH, are used to induce ovulation. If pharmacotherapy does not produce ovulation, wedge resection of the ovaries must be performed.     

Treatment with beta-blockers in patients with acute coronary syndrome

BACKGROUND: Immunosuppressive treatment with cyclosporin A (CsA) improves the survival of renal allografts, but is associated with renal vasoconstriction and hypertension. Previous reports suggest that the calcium-channel blockers nifedipine and amlodipine may improve graft function in CsA-treated patients. We have compared the effects of amlodipine (5-10 mg once daily) and nifedipine retard (10-40 mg twice daily) on renal function and blood pressure in renal transplant recipients treated with CsA. METHODS: This was a multicentre, two-way, crossover study in 27 evaluable hypertensive patients with renal insufficiency following renal transplantation, who were maintained on a stable dose of CsA. Patients received either amlodipine (5-10 mg once daily) or nifedipine retard (10-40 mg twice daily) for 8 weeks, and were then crossed over to the other treatment for a further 8 weeks. RESULTS: Trends were seen during amlodipine treatment towards larger improvements, in serum creatinine (by 8% of baseline on amlodipine vs 4% on nifedipine), lithium clearance (13% vs 2%), and glomerular filtration rate 11% vs 7%). Effective renal plasma flow was increased by 11% of baseline on nifedipine vs 9% on amlodipine. There were no significant differences between treatments. Amlodipine and nifedipine lowered systolic blood pressure to a similar extent (21 mmHg vs 15 mmHg respectively, P=0.25), but amlodipine was more effective than nifedipine in lowering diastolic blood pressure (13 mmHg vs 8 mmHg, P=0.006). Both treatments were well tolerated. CONCLUSION: Once-daily amlodipine is at least as effective as twice-daily nifedipine retard in controlling blood pressure and does not adversely affect graft function in hypertensive renal allograft recipients.     

Renin-angiotensin system: involvement in polycystic ovarian syndrome

OBJECTIVE: To investigate the relationship between renin-angiotensin system (RAS) and polycystic ovarian syndrome (PCOS) METHODS: A pituitary-stimulating test with luteinizing hormone releasing hormone (LRH, 100 micrograms) was performed in two PCOS groups with similar mean testosteron (T) levels of luteinizing hormone/follicular stimulating hormone (LH/FSH) (LH/FSH > or = 3, group 1, n = 15; LH/FSH < 3, group 2, n = 15) and the controls (n = 20) of matched body mass index with group 1. The basal level and LRH-evoked responses of LH, plasma renin activity (PRA), angiotensin II (AT II ) and aldosterone (ALD) were measured by RIA with commercially available kits. In the basal state, a positive correlation was found between T and AT II levels (r = 0. 49, P < 0.05) in all PCOS subjects. After LRH administration, susceptible individuals, especially of group 1 had exaggerated responses of LH, PRA, AT II and ALD as compared with the controls, and a positive correlation was also found between peak levels of LH and AT II (r = 0.54, P < 0.01). CONCLUSIONS: There is enhanced RAS function in PCOS especially in group 1. This may contribute to the excess androgen production and high incidence of ovarian hyperstimulation syndrome in this disorder.