ABSTRACT
The purpose of this review was to consider the Reappraisal of European guidelines on hypertension management published in 2009 in the light of 2005 French national guidelines and of recently published large randomized trials. We analyzed successively the recommendations dealing with assessment of global cardiovascular risk, hypertension treatment and blood pressure goals; we focused on patients at high cardiovascular risk: diabetic patients and patients with coronary disease and elderly population.
Subject(s)
Hypertension/therapy , Practice Guidelines as Topic , Humans , Randomized Controlled Trials as TopicABSTRACT
First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.
Subject(s)
Endometriosis/drug therapy , Gynecology , Obstetrics , Practice Guidelines as Topic , Societies, Medical , Endometriosis/diagnosis , Endometriosis/surgery , Female , France , Gynecology/standards , Humans , Obstetrics/standards , Practice Guidelines as Topic/standards , Societies, Medical/standardsABSTRACT
First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.
Subject(s)
Endometriosis/diagnosis , Endometriosis/therapy , Complementary Therapies , Contraceptives, Oral, Hormonal , Diagnostic Imaging , Female , Gynecological Examination , Humans , Infertility, Female/etiology , Infertility, Female/therapy , Patient Education as Topic , Pelvic Pain/drug therapy , Pelvic Pain/etiologyABSTRACT
The aim of the study was to evaluate pulse wave velocity (PWV) and carotid intima-media thickness (IMT) in type 2 diabetics with microalbuminuria (mualb). The study concerned 37 patients type 2 diabetics, age: 53.4 +/- 6.6, years free of cardiovascular complications. HbA1C was 7.73 +/- 1.39%, waist circumference 104.2 +/- 11.7 cm. 19 patients with BP > 130/85 mmHg were identified as mild hypertensives (17/19 under treatment). All patients underwent ABPM, PWV and IMT measurements. The study population was separated into 2 subgroups according to median of mualb (mg/24 h): 18.9. [table: see text] In patients with mualb > 18.9 mg/24, IMT and PWV were significantly increased (p = 0.06; p < 0.01). After adjustment to BP and age, there was no significant difference in IMT and PWV in the subgroups. In this selected population of type 2 diabetics, microalbuminuria appears associated to a pressure-dependant vascular remodeling.
Subject(s)
Albuminuria/etiology , Carotid Arteries/anatomy & histology , Diabetes Mellitus, Type 2/complications , Hypertension/etiology , Tunica Intima/anatomy & histology , Albuminuria/pathology , Female , Humans , Hypertension/complications , Male , Middle Aged , Tunica Intima/pathology , Ventricular RemodelingABSTRACT
Insulin resistance manifested by hyperinsulinism is an important risk factor for the development of cardiovascular diseases. When associated with characteristic disorders of the lipid metabolism and arterial hypertension it is regarded today as a metabolic syndrome X. To detect hyperinsulinism in patients with arterial hypertension in everyday practice, it is advisable to determine the rations "circumference of the waist, circumference of the hips", while its abnormal values necessitate a carbohydrate challenge. Hyperinsulinism in AH patients should be born in mind when devising therapeutic measures, the mainstay of which is dietary therapy, with Calcium antagonists and inhibitors of the converting enzyme being used as hypotensive agents.
Subject(s)
Hypertension/etiology , Insulin Resistance , Antihypertensive Agents/therapeutic use , Blood Pressure , Glucose Tolerance Test , Humans , Hyperinsulinism/blood , Hyperinsulinism/drug therapy , Hypertension/blood , Hypertension/drug therapy , Lipids/blood , Risk FactorsABSTRACT
OBJECTIVE: To assess the safety of planned home birth compared to hospital birth, in low-risk pregnancies. METHOD: An international literature review was conducted. Mortality, adverse outcomes and medical interventions were compared. RESULTS: Home birth was not associated with higher mortality rates, but with lower maternal adverse outcomes. Perinatal adverse outcomes are not significantly different at home and in hospital. Medical interventions are more frequent in hospital births. CONCLUSION: Home birth attended by a well-trained midwife is not associated with increased mortality and morbidity rates, but with less medical interventions.