20. Nlsen C, Vessby B, Berglund L, Uusitupa M, Hermansen K, Riccardi G, Rivellese A, Storlien L, Erkkil A, Herttuala SY, Tapsell L, Basu S. N-3 ; fatty acids reduce plasma F2-isoprostanes but not prostaglandin F2 formation in healthy humans. J. Nutr. In press ; . 21. Basu S. Novel cyclooxygenase-catalysed bioactive and luteolytic prostaglandin F2 with a new dogma in inflammation. 2006. 22. Granstrm E, Kumlin M. Kindahl M. Radioimmunoassay of eicosanoids. 1987 ; In Prostaglandins and related substances. A practical approach. Eds. Benedetto, McDonald-Gibson, Nigam and Slater, IRL press, UK, 167-195. 23. Basu S. 1998 ; Radioimmunoassay of 15-keto13, 14-dihydro-prostaglandin F2. An index for inflammation via cyclooxygenase catalysed lipid peroxidation. Prost. Leuk. Ess. Fatty Acids, 58: 347352. 24. Goff AK, Basu S, Kindahl H. 1984 ; Measurement of 11-ketotetranor PGF metabolites: An approach for monitoring prostaglandin F2release in the mare. Theriogenology, 21: 887-896. 25. Basu, S. 1985 ; Maternal Recognition of Pregnancy. Nord. Vet.-Med. 37: 57-79. 26. Vane JR. 1976 ; Prostaglandins as mediators of inflammation. Adv Prostaglandin Thromboxane Res., 2: 791-801. 27. Takayama K, et al., 2005 ; Thromboxane A2 and prostaglandin F2mediate inflammatory tachcardia. Nature Medicine, 11: 562-566. 28. Basu S. 1989 ; Endogenous inhibition of arachidonic acid metabolism in the endometrium of the sheep. Pros. Leuk. & Ess. Fatty Acids, 35: 147-152. 29. Odensvik K, Cort N, Basu S, Kindahl H. 1989 ; Effect of flunixin meglumine on prostaglandin F2synthesis and metabolism in the pig. J. Vet. Pharmacol. Therap., 12: 307-311. 30. Vane JR. 1971 ; Inhibition of prostaglandins synthesis as a mechanism of action for aspirin-like drugs. Nature, 231: 232-235. 31. Helmersson J, Vessby B, Larsson A, Basu S. 2005 ; Cyclooxygenase-mediated prostaglandin F2 is decreased in an elderly population treated with low-dose aspirin. Prost. Leuk. Ess. Fatty Acids, 72: 227-233. 32. Liu XL, Wiklund L, Nozari A, Basu S. 2003 ; Differences in cerebral reperfusion and oxidative injury after cardiac arrest in pigs. Acta Anaesthesiol. Scand., 47: 958-967. 33. Wiklund L, Sharma HS, Basu S. 2005 ; Circulatory arrest as a model for studies of global ischemic injury and reperfusion. Ann. NY Acad. Sci., 1053: 205-219. 34. Basu S, Larsson A, Vessby J, Vessby B, Berne C. 2005 ; Type 1 diabetes is associated with increased cyclooxygenase- and cytokine-mediated inflammation. Diabetes Care, 28: 1371-1375. 35. Helmersson J, Vessby B, Larsson A, Basu S. 2004 ; Association of type 2 diabetes with cyclooxygenase-mediated inflammation and oxidative stress in an elderly population. Circulation, 109: 1729-1734. 36. Basu S, Steffen LM, Vessby B, Steinberger J, Moran A, Jacobs DR, Hong C-R, Sinaiko A. 2005 ; Obesity in 15-year-old adolescent is relates to oxidative stress and inflammation. Diabetologia, Supplement 48, Abs. 366. 37. Helmersson J, Larsson A, Vessby B, Basu S. 2005 ; Active smoking and a history of smoking are associated with enhanced prostaglandin F2, interleukin-6 and F2-isoprostane in elderly men. Atheroscelerosis, 181: 201-207. 38. Wohlin M, Helmersson J, Sundstrm J, rnlv J, Vessby B, Larsso A, Andrn B, Lind L, Basu S. 2006 ; Prostaglandin F2 and C-reactive protein are independently associated with carotid intima-media thickness. A potential link between different inflammatory pathways and atherosclerosis. Submitted.
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Most viruses that affect humans may cause severe disease in the HSCT recipient; this list includes relatively uncommon infections with rhinoviruses, enteroviruses, measles, and papovaviruses. A key aspect of the prevention of viral infections involves risk assessment based on viral and host factors, as well as recognition of risk according to the time after transplantation. Endogenous viral infections typified by the human herpesviruses--CMV, HSV, EBV, VZV, and human herpes virus-6 [HHV-6] ; are characterized by reactivation from latency, which usually occurs during periods of maximal T-cell suppression. As a result, the timing of these infections is often predictable: during therapy for GVHD or earlier among recipients of T celldepleted transplants. Infection with the "episodic" or community acquired viruses such as respiratory syncytial virus or parainfluenza ; is determined primarily by exposure, rather than the level of immunosuppression. However, the level of immunosuppression does determine the disease severity for many of these viruses; unrelated transplantation and or high doses of steroids to treat GVHD are associated with higher rates of severe disease pneumonia, dissemination, etc ; for many of the CRVs [39] and adenovirus [80]. CMV infection. CMV, which primarily causes pneumonitis and gastrointestinal disease after HSCT, continues to be one of the most feared complications of stem cell transplantation. CMV seropositive patients are at highest risk approximately 70% reactivate latent CMV, with 35% to 40% developing disease without preemptive ganciclovir ; , followed by seronegative recipients with a seropositive donor 20% develop primary infection and 10% disease ; , seropositive autograft recipients 25% to 40% reactivate endogenous infection and 5% to 7% develop disease ; , and seronegative autograft recipients and seronegative allograft recipients with a.
Transplant. 2000; 6: 659-734. Institute of Medicine. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: National Academy Press, 1992 or : books.nap books 0309047412 html index 3. Centers for Disease Control and Prevention. Addressing Emerging Infectious Disease Threats: a Prevention Strategy for the United States. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, 1994, or : cdc.gov ncidod publications eid plan home 4. USPHS IDSA Prevention of Opportunistic Infections Working Group. USPHS IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: a summary. MMWR 1995; 44 No. RR-8 ; : 1-34, or : cdc.gov epo mmwr preview mmwrhtml 00038328 5. Centers for Disease Control and Prevention. 1997 USPHS IDSA and clozaril.
Oligozoospermic males, whose sperm concentraranged between 5 x 106 and 20 x 106 mi, were treated with 25 mg of clomiphene citrate for 3 months. The hCG test was performed before the treatment, as follows. Ten thousand.
The history of the detection of H. pylori is a prime example of how a medical dogma can lead to scientific observations being neglected. This dogma maintained that the stomach is sterile due to its gastric acid content. Another dictum which governed former pathophysiological concepts was that of K. Schwartz, who stated in 1910 that ulcers occur when too much acid damages the gastric mucosa `no acid, no ulcer' ; . Nevertheless, evidence for bacterial involvement had been found as early as the latter half of the 19th century. Bacteria in the human stomach had already been reported by G. Bttcher in 1874. In 1893, G. Bizzozero described spiral organisms in the stomach of dogs, and in 1906, W. Krienitz found `spirochaetes' in the stomach of a patient with stomach cancer. J.M. Luck and T.N. Seth isolated the enzyme urease from gastric mucus in 1924. In a larger series in 1939, J.L. Doenges found bacterial colonization of the gastric mucosa in 43% of the patients. But it was not until 1979 that the pathologist J. Robin War and clozapine, for instance, clomiphene in men.
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References the paediatric clinics of north america: adolescent gynaecologypart i, volume 46, number-i, june 199 review of medical physiology and mebeverine.
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Medicine, the case for IUI with or without COH as the first-line treatment for unexplained and mild or moderate male factor infertility appears to be strong. Even in the presence of severe semen defects, IUI improves pregnancy rates and is an option for the couple who wish to avoid IVF ICSI. Although pregnancy may not occur as quickly, a policy of initial treatment by IUI will probably save 20% of couples from moving on to IVF, which is universally accepted as being more invasive and expensive both financially and emotionally. There are still questions to be answered, however, such as the optimuni dose regimen of gonadotrophins and the place of clomiphene for COH. These issues will only be resolved by high-quality prospective trials with adequate power, preferably with standardised reporting of success and complication rates and combivir.
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Newborn infants. Fentanyl buccal should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.1 Fentanyl is excreted in human milk. Fentanyl buccal should not be used in breast-feeding women because of the potential for sedation and respiratory depression in the infant.1 ADVERSE REACTIONS The most common adverse reactions were typical of opioid therapy eg, nausea, vomiting, dizziness, constipation, fatigue, somnolence, headache ; and are dose-related see Tables 5 and 6 ; .1, 9, 12, Local application-site reactions included pain, irritation, ulceration, and vesicles.1, 12 A complete list of the adverse reactions reported with fentanyl buccal can be found in the product labeling. DRUG INTERACTIONS Drugs that inhibit CYP-450 3A4 may increase fentanyl levels, while drugs that induce CYP-450 3A4 may reduce the efficacy of fentanyl.1 Administration of ritonavir with intravenous fentanyl resulted in a 67% reduction in fentanyl clearance and a 174% increase in the fentanyl AUC. Coadministration of ritonavir with buccal fentanyl has not been studied; however, an increase in the fentanyl AUC.
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1. Aromatase inhibitors including, but not limited to, anastrozole, letrozole, aminoglutethimide, exemestane, formestane, testolactone. 2. Selective Estrogen Receptor Modulators SERMs ; including, but not limited to, raloxifene, tamoxifen, toremifene. 3. Other anti-estrogenic substances including, but not limited to, clomiphene, cyclofenil, fulvestrant.
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Where is SARS now?, 650 severity assessment, Assessment of illness severity in community acquired pneumonia: a useful new prediction tool?, 371 Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study, 377 sickle cell anaemia, The pulmonary physician in critical care N Illustrative case 6: Acute chest syndrome of sickle cell anaemia, 726 skeletal muscle strength, Non-volitional assessment of skeletal muscle strength in patients with chronic obstructive pulmonary disease, 665 smokeless tobacco, Health effects associated with smokeless tobacco: a systematic review, 435 smoking, Association of CYP2A6 deletion polymorphism with smoking habit and development of pulmonary emphysema, 623 Lack of association of group specific component haplotypes with lung function in smokers, 790 Passive smoking and lung function in c1-antitrypsin heterozygote schoolchildren, 237 Relationship between inflammatory cells and structural changes in the lungs of asymptomatic and never smokers: a biopsy study, 135 smoking cessation, Chronic obstructive pulmonary disease N 8: Nonpharmacological management of COPD, 453 Clinical trial comparing nicotine replacement therapy NRT ; plus brief counselling, brief counselling alone, and minimal intervention on smoking cessation in hospital inpatients, 484 Nicotine replacement therapy in smoking cessation, 464 spirometric testing, Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease COPD ; , 861 spontaneous pneumothorax, BTS guidelines for the management of spontaneous pneumothorax, ii39 sputum, Sputum T lymphocytes in asthma, COPD and healthy subjects have the phenotype of activated intraepithelial T cells CD69 + CD103 + ; , 23 sputum macrophages, Nuclear localisation of p65 in sputum macrophages but not in sputum neutrophils during COPD exacerbations, 348 sputum neutrophils, Nuclear localisation of p65 in sputum macrophages but not in sputum neutrophils during COPD exacerbations, 348 starvation, Atypical mycobacterial infection, starvation and effect of BCG vaccination on tuberculin skin test, 367 streptokinase, Successful treatment of empyema thoracis with human recombinant deoxyribonuclease, 365 superoxide, Role of the endothelium and nitric oxide synthases in modulating superoxide formation induced by endotoxin and cytokines in porcine pulmonary arteries, 598 surfactant protein A, Relationship of anti-GM-CSF antibody concentration, surfactant protein A and B levels, and serum LDH to pulmonary parameters and response to GM-CSF therapy in patients with idiopathic alveolar proteinosis, 252 surfactant protein B, Relationship of anti-GM-CSF antibody concentration, surfactant protein A and B levels, and serum LDH to pulmonary parameters and response to GM-CSF therapy in patients with idiopathic alveolar proteinosis, 252 surfactant system, Impaired recycling of surfactant-like liposomes in type II pneumocytes from injured lungs, 127 surfactant-like liposomes, Impaired recycling of surfactant-like liposomes in type II pneumocytes from injured lungs, 127 surgery, Lung cancer patterns of care in south western Sydney, Australia, 690 surgical resection, Lung cancer N 6: The case for limited surgical resection in non-small cell lung cancer, 639 surgical resection rate, Improving surgical resection rates in lung cancer without a two stop service, 368 survival, Lung cancer patterns of care in south western Sydney, Australia, 690 systematic review, Health effects associated with smokeless tobacco: a systematic review, 435 systemic inflammatory response syndrome, Association of IL-10 polymorphism with severity of illness in community acquired pneumonia, 154 systemic lupus erythematosus, Unusual lung consolidation in SLE, 367 thoracic endometriosis, Catamenial haemoptysis and clomiphene citrate therapy, 89 Thorax, Pulmonary physicians, intensive care medicine and Thorax: an evolving relationship, 829.
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I. Whyte L, Brooker C. Working with a multidisciplinary team in secure psychiatric environments. Journal of Psychosocial Nursing & Mental Health Services 2001; 39 9 ; : 26-34 Type IV evidence quantitative and qualitative study. 233 staff from 20 multidisciplinary teams in the UK prison health care n 4, low secure sites n 6, medium secure sites n 5, high secure sites n 5 ; completed 29-item questionnaires and 4 teams from each level of secure care were interviewed in focus groups. Teams were chosen based on questionnaire scores for the highest levels of clarity related to the five aspects of team functioning and compazine.
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Serono In-Training Award for first place oral presentation; "A randomized trial comparing clomiphene citrate with tamoxifen for ovulation induction in obese anovulatory women". Presented at the 47th Annual meeting of the Pacific Coast Reproductive Society, La Costa, California, April 1999. American Society for Reproductive Medicine, Wyeth-Ayerst Resident Fellow Report "The conservative management of uterine leiomyomata". San Francisco, California, September 1999 and prochlorperazine.
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66. Ibanez L et al. 2001 ; Sensitization to insulin induces ovulation in nonobese adolescents with anovulatory hyperandrogenism. J Clin Endocrinol Metab 86: 3595 67. Jacobs HS et al. 1999 ; Leptin, polycystic ovaries and polycystic ovary syndrome. Hum Reprod Update 5 2 ; : 166 68. Jayagopal V et al. 2003 ; The biological variation of testosterone and sex hormone-binding globulin SHBG ; in polycystic ovarian syndrome: implications for SHBG as a surrogate marker of insulin resistance. J Clin Endocrinol Metab 88: 1528 69. Katsuki A et al. 1996 ; Acute and chronic regulation of serum sex hormonebinding globulin levels by plasma insulin concentrations in male noninsulindependent diabetes mellitus patients. J Clin Endocrinol Metab 81: 2515 70. Kazerooni T et al. 2003 ; Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome. Gynecol Endocrinol 17 1 ; : 71. Kiddy DS et al. 1992 ; Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol Oxf. ; 36: 105 72. Kirchengast S, Huber J 2001 ; Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod 16 6 ; : 1255 73. Kocak M et al. 2002 ; Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome. Fertil Steril 77 1 ; : 101 74. Kolodziejczyk B et al. 2000 ; Metformin therapy decreases hyperandrogenism and hyperinsulinemia in women with polycystic ovary syndrome. Fertil Steril 73 6 ; : 1149 75. Kowalska I et al. 2001 ; Insulin, leptin, IGF-I and insulin-dependent protein concentrations after insulin-sensitizing therapy in obese women with polycystic ovary syndrome. Eur J Endocrinol 144 5 ; : 509 and coreg and clomiphene.
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Since the progesterone has a pulsatile secretion pattern, low level in a single study may not always imply ovulatory disturbance. It is important to avoid measuring progesterone level in serum too late when the level might have risen due to the effect of chorionic gonadotrophin from the implanted embryo. If measured too early, the level may be low. So timing of measurement of progesterone level in the luteal phase is important. Many of the reference value guidelines were developed in women with supposedly normal ovulation and these measurements were not always in actual conception cycles. While a general ideal range for mid-luteal phase progesterone level is known, the mid-luteal progesterone level which is compatible with conception in a woman is not known and more so in a woman undergoing induction of ovulation with clomiphene citrate CC.
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TABLE OF CONTENTS Introduction 560 Clinical evidence of the sonographic appearance of the endometrium 561 Relationship between endometrial oestrogen and progesterone receptors and sonographic endometrial appearance 562 Effect of clomiphene citrate stimulation on endometrial oestrogen and progesterone receptors 563 References 564 The rapid development of ultrasonographic equipment now permits instantaneous assessment of follicles and endometrium. The sonographic appearance of the endometrium has been discussed in relation to in-vitro fertilization IVF ; cycles. However, a generally agreed view of the relationship of the sonographic appearance to fecundity in IVF cycles has not emerged. We have studied the relationship between steroid receptors and the sonographic appearance of the preovulatory endometrium in natural cycles and ovulation induction cycles. Preovulatory endometrial thickness was not found to be indicative of fecundity, although a preovulatory endometrial thickness of 9 mm related to an elevated miscarriage rate. The preovulatory endometrial echo pattern did not predict fecundity. No relationships were found among endometrial appearance, endometrial steroid receptors and steroid hormone concentrations in serum. Oestrogen or progesterone receptor concentrations were not related to endometrial thickness or to concentrations of serum oestradiol, the only significant correlation being found between the endometrial concentrations of oestrogen and progesterone receptors. The ratio of progesterone: oestrogen receptor concentration was and losartan.
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Spironolactone, cyproterone acetate and finasteride are androgen blocking agents block the action of testosterone ; and can also be beneficial if hirsutism or other signs of androgen excess that persist despite oral contraceptives. Electrolosis or laser hair removal can be beneficial in PCOS women with severe hirsutism. Waxing, pulling and dying although not permanent can help with the promotion of a better self-image. Treatment to Promote a Pregnancy Clomiphene citrate is used to induce ovulation when infertility is a complaint. Approximately 80% of patients with PCOS will ovulate on clomiphene. However, only 50% of those that ovulate will get pregnant. Clomiphene is indicated for six ovulatory cycles. It is important to demonstrate ovulation on clomiphene and this is done using a luteal phase progesterone level. A complete description of clomiphene is available on the clomiphene information sheet. A newer medication sometimes used in a similar fashion to clomiphene is letrozol femara ; . The initial results with this drug have been very exciting. We use it at S.O.F.T. when clomiphene has not produced a pregnancy with six cycles, when clomiphene causes excessive thinning of the endometrium or when higher doses of clomiphene have been necessary to induce ovulation. Metformin can be beneficial to treat insulin resistance. When insulin resistance is present, use of metformin will sometimes allow the resumption of normal ovulatory cycles and sometimes a spontaneous pregnancy. Three such pregnancies occurred in the first year of operation of S.O.F.T. It is also very helpful in PCOS, which is resistant to ovulation induction with clomiphene. Early results of a clinical trial demonstrated that in 19 consecutive patients with infertility, PCOS and insulin resistance who did not ovulate with clomiphene citrate in a dose of up to 150 mg., metformin 500 mg. p.o. t.i.d. allowed 4 patients to ovulate at 100 mg and 2 patients at 150 mg. 31.6% ; . Two pregnancies occurred. Since then many more pregnancies have occurred in the same circumstances.
160; once ovulation has been established, each course of clomiphene citrate therapy should be started on or about the 5th day of the cycle.
Manee Raksakietisak, Shusee Visalyaputra, Pichaya Ophasanond, Kasana Raksamani Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Objectives: This study aimed to assess 1 ; Postoperative recovery between 2 groups of patients accepting minimal hematocrit levels at 30% and 27% 2 ; Intraoperative blood loss and blood tranfusion in gynecologic surgery Patients and Methods: Sixty ASA 1 and 2 patients, aged 18-60, scheduled for elective gynecologic surgery and had intraoperative blood loss more than 10 ml kg more than the allowable blood losses were enrolled in this study. The patients were randomly assigned to accept minimal hematocrit level at 30% or 27% before receiving blood transfusion while the anesthesiologist maintained normovolumic status with crystalloid and or colloid. The intraoperative complication were monitored and corrected, whereas the patients were also monitored postoperatively to determine recovery outcome and any complication might occur. Results: The two groups showed no difference in postoperative recovery. There were neither significant hemodynamic effects nor serious complications in this study. Conclusion: There was no difference in postoperative outcome between two accepting minimal hematocrit levels 30% and 27% ; . However, this study had rather small sample size, further larger sample size study would be very valuable, for example, clomiphene multiple births.
CLOMIPHENE CITRATE 50 mg CLONAZEPAM 2 mg CYCLOPHOSPHAMIDE 50 mg CYCLOSPORINE 100 mg Soft Caps. Neoral DEXTROSE 4.3% + SALINE 0.18% .BAG OF 500 mL DILTIAZEM 60 mg ENSURE LIQUID 240ml and clozaril.
Appendix F will be retained for poisons only other than agricultural or veterinary chemicals or chemicals packed and sold solely for industrial use ; . The requirements for medicines are to be removed from the Appendix accordingly and transferred to the ANZTPA `Required Advisory Statements for Medicine Labels' RASML ; - see KEY CHANGE 4 at Attachment 1.
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54. Lerner, L. J., and Jordan, V. C. The development of antiestrogens for the treatment of breast cancer. Cancer Res., 50: 4177 4189, Beall, P. T., Misra, K. L., Young, R. L., Spjut, H. J., Evan, H. J., and LeBlanc, A. Clomiphene protects against osteoporosis in the mature ovariectomized rat. Calcif. Tissue Int., 36: 123125, 1985. Schulz, K-D., Haselmayer, B., and Holzel, F. The influence of clomid and its isomers on dimethylbenzanthracene-induced rat mammary tumours. In: Basic Actions of Sex Steroids on Target Organs, pp. 274 279. Basel: Karger, 1971. 57. Jordan, V. C., Phelps, E., and Lindgren, J. U. Effects of antiestrogens on bone in castrated and intact female rats. Breast Cancer Res. Treat., 10: 3135, 1987. Gottardis, M. M., and Jordan, V. C. Antitumor actions of keoxifene and tamoxifen in the N-nitrosomethylurea-induced rat mammary carcinoma model. Cancer Res., 47: 4020 4024, Turner, R. T., Wakley, G. K., Hannon, K. S., and Bell, N. H. Tamoxifen inhibits osteoclast-mediated resorption of trabecular bone in ovarian hormone-deficient rats. Endocrinology, 122: 1146 1150, Black, L. J., Sato, M., Rowley, E. R., Magee, D. E., Bekele, A., Williams, D. C., Cullinan, G. J., Bendele, R., Kauffman, R. F., Bensch, W. R., et al. Raloxifene LY139481 HCI ; prevents bone loss and reduces serum cholesterol without causing uterine hypertrophy in ovariectomized rats. J. Clin. Investig., 93: 63 69, Gottardis, M. M., Robinson, S. P., Satyaswaroop, P. G., and Jordan, V. C. Contrasting actions of tamoxifen on endometrial and breast tumor growth in the athymic mouse. Cancer Res., 48: 812 815, Fornander, T., Rutqvist, L. E., Cedermark, B., Glas, U., Mattsson, A., Silfversward, C., Skoog, L., Somell, A., Theve, T., Wilking, N., et al. Adjuvant tamoxifen in early breast cancer: occurrence of new primary cancers. Lancet, 1: 117120, 1989. Black, L. J., Jones, C. D., and Falcone, J. F. Antagonism of estrogen action with a new benzothiophene derived antiestrogen. Life Sci., 32: 10311036, 1983. Buzdar, A. U., Marcus, C., Holmes, F., Hug, V., and Hortobagyi, G. Phase II evaluation of Ly156758 in metastatic breast cancer. Oncology, 45: 344 345, Turken, S., Siris, E., Seldin, D., Flaster, E., Hyman, G., and Lindsay, R. Effects of tamoxifen on spinal bone density in women with breast cancer. J. Natl. Cancer Inst. Bethesda ; , 81: 1086 1088, Love, R. R., Mazess, R. B., Barden, H. S., Epstein, S., Newcomb, P. A., Jordan, V. C., Carbone, P. P., and Demets, D. L. Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer [see comments]. N. Engl. J. Med., 326: 852 856, Greaves, P., Goonetilleke, R., Nunn, G., Topham, J., and Orton, T. Two-year carcinogenicity study of tamoxifen in Alderley Park Wistarderived rats. Cancer Res., 53: 3919 3924, Phillips, D. H. Understanding the genotoxicity of tamoxifen? Carcinogenesis Lond. ; , 22: 839 849, Ettinger, B., Black, D. M., Mitlak, B. H., Knickerbocker, R. K., Nickelsen, T., Genant, H. K., Christiansen, C., Delmas, P. D., Zanchetta, J. R., Stakkestad, J., Gluer, C. C., Krueger, K., Cohen, F. J., Eckert, S., Ensrud, K. E., Avioli, L. V., Lips, P., and Cummings, S. R. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation MORE ; Investigators [see comments]. J. Am. Med. Assoc., 282: 637 645, Cummings, S. R., Eckert, S., Krueger, K. A., Grady, D., Powles, T. J., Cauley, J. A., Norton, L., Nickelsen, T., Bjarnason, N. H., Morrow, M., Lippman, M. E., Black, D., Glusman, J. E., Costa, A., and Jordan, V. C. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. J. Am. Med. Assoc., 281: 2189 2197, Cauley, J. A., Norton, L., Lippman, M. E., Eckert, S., Krueger, K. A., Purdie, D. W., Farrerons, J., Karasik, A., Mellstrom, D., Ng, K. W., Stephan, J. J., Powles, T. J., Morrow, M., Costa, A., Silfen, S. L., Walls, E. L., Schmitt, H., Muchmore, D. B., and Jordan, V. C. Contin.
By Yuki Asai University of Saskatchewan Preceptor: Dr. L. Clein ABSTRACT The idea of sickness as a punishment has been powerful in Western society, influencing approaches toward the ill in areas such as public health policy and patient treatment. Within this paradigm, illness is viewed as punishment for individual or collective sins. These transgressions can be either moral or lifestyle choices. This attitude can lead to the stigmatization of the ill and the targeting of certain groups, or has been used to justify existing biases within society. The practice of healing has always been closely tied to religion and moral obligations, and subsequently the battle to reduce the stigma of sickness has been difficult, within the general population and within medicine itself. Even today, modern society is still shaped by this attitude, which is especially apparent with regards to such illnesses as AIDS. This paper will discuss the concept of sickness as punishment throughout the history of medicine. Introduction When faced with severe illness, people often reflect on why they have become ill; "Why me?" or "What have I done to deserve this?" One could propose that these questions are due to an underlying notion that one becomes sick because one has earned it as a punishment for some sort of transgression. Now these sins could be on a personal or a collective level; and they could be either moral or lifestyle choices. This attitude can lead to the stigmatization of the ill and the targeting of certain groups, or has been used to justify existing biases within society. Medicine and healing have always been closely tied to religion and moral obligation, and therefore the battle to reduce the stigma of sickness has been difficult, within the general population and within medicine itself. I will be discussing the concept of sickness as punishment throughout the history of Western medicine, concentrating on specific diseases such as the plague, syphilis and cholera, and how this concept of sickness as punishment is relevant in medicine today. Early on there was an establishment of the theme of retribution in sickness. In traditional concepts, sickness is generally viewed as a deliberate, non-random affliction, targeted against a specific person or group of people. If only the sick person hadn't angered their gods or ancestors, then they wouldn't be sick. You can see this in the Bible, where divine wrath is shown by epidemics such as the plagues of Egypt. Epidemics of any sort have been typically interpreted as acts of God, an attitude that can still be found today. The plague is a good.
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