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The primary route of excretion of all three drugs is from testosterone and is referred to as the 19-nortestos- in the feces discount cipro 750 mg with visa. These compounds have progestational activity yet of these SERMs are increased frequency of hot flashes retain some androgenic activity discount cipro 1000mg with amex. Both effects nor generic 1000mg cipro mastercard, Nor-QD) and norethindrone acetate (Aygestin) are are attributable to their estrogenic activity generic 250mg cipro with visa. In phase III clinical trials faslodex tivity of norethindrone and norethindrone acetate be- showed good activity against advanced breast cancer 750 mg cipro free shipping. Norethindrone is metabolized by hydroxylation and conjugation, just as are the natural CLINICAL USES progestins. The chief therapeutic uses of estrogens and progestins A second chemical class of synthetic progestins con- are as oral contraceptives and hormone replacement tains the pregnane nucleus structure of progesterone therapy. Alkyl chain agents in the treatment of osteoporosis, breast cancer, additions to the C17 position increase the biological endometrial cancer, and infertility. These preparations are designed to more Oral contraceptives are among the most effective forms closely simulate estrogen-to-progestin ratios that occur of birth control (Table 61. Ethinyl of oral contraceptive in the United States today is the estradiol and mestranol are the only two estrogen con- combination preparation, that is, a combination of es- stituents used for oral contraception in the United States. Mestranol is in- daily that contains both an estrogen and a progestin for active until it is metabolized to ethinyl estradiol. Withdrawal bleeding occurs 2 to 3 days after dis- active enantiomers; levonorgestrel (Norplant) is the ac- continuation of this regimen. Levonorgestrel and norethindrone are vary in the dose of synthetic estrogen and progestin the most potent synthetic progestins in oral contracep- they contain. Inhibition of ovulation is the primary mechanism of the contraceptive action of sequential and combination birth control preparations. Contraceptive Method Estrogens are most active in inhibiting FSH release, but at high enough doses, they also inhibit LH release. In Method Pregnancies (%)a low-dose combination products, the progestin causes LH Male sterilization 0. In certain combinations (Ortho-Novum 7/7/7, Tri-Norinyl, Tri-Levlen, Triphasil), the estrogen-to-progestin ratio is TABLE 61. An example of the Untied States, with the estrogen and progestin doses found in this type of Estrogen–Progestin Content oral contraceptive is shown in Table 61. Progestin-only oral contraceptive formulations con- Estrogen Progestin Trade name sist of a low dose of either norethindrone or norgestrel Ethinyl estradiol Norethindrone ac- Loestrin (20 g) etate (1 mg) Ethinyl estradiol Norgestrel (300 g) Lo-Ovral Estrogen and Progestin TABLE 61. Because of an increased incidence of cer- tion and reduced synthesis of estrogens and proges- tain side effects and slightly decreased contraceptive ac- terone. Estrogen production in postmenopausal women tivity, progestin-only oral contraceptives are not exten- is usually only about 10% of that in premenopausal sively used. Almost no progesterone is synthesized in post- progestin-only contraceptives are irregular bleeding menopausal women. Estrogen replacement therapy Norplant System for contraception consists of a series of (ERT) consists of the use of an estrogen alone, usually levonorgestrel-filled pliable plastic tubes that are im- in the form of conjugated equine estrogens or an estro- planted subcutaneously on the inside of the upper arm gen transdermal patch. While one set of six tubes can remain ef- The four most common symptoms associated with fective for up to 5 years, the contraceptive effects are menopause are vasomotor disorders, or hot flashes; uro- readily reversible with removal of the implant. Adverse genital atrophy; osteoporosis; and psychological distur- effects are similar to those seen with other progestin- bances. A varying proportion of women may have one only contraceptives; however, accidental pregnancy is or more of these symptoms. Mirena is a relatively new intrauterine contraceptive Osteoporosis device that releases levonorgestrel into the uterine cav- ity for 5 years. It has been estimated that following cessation of ovarian function, the loss of bone mass proceeds at a rate of 2 to 5% per year. As a Abortifacients and Emergency Contraceptives result of osteoporosis, as many as 50% of women de- Progesterone is a hormone required for the mainte- velop spinal compression fractures by age 75, and 20% nance of pregnancy. Estrogen treatment is the most effective therapy RU486 followed by a single dose of a prostaglandin for osteoporosis and significantly reduces the incidence (Misoprostol) 48 hours later is 90 to 95% effective in of bone fractures in postmenopausal women. Alternatively, a complications have occurred and may be due to the transdermal estrogen patch can be used. The use of Endometrial cancer is not a concern in women who RU486 is therefore contraindicated in women at risk for have undergone hysterectomy. However, in women with cardiovascular disease, including smokers and women an intact uterus, there is a risk of endometrial cancer over 35 years of age.

The mushroom must be washed and soaked in sible loose bowels and stomach upset if the whole mush- water until it turns soft buy cipro 500 mg cheap. Maitake mush- rooms will keep from five to 10 days if properly stored Interactions in a paper bag in the refrigerator trusted 500mg cipro. As of 2002 buy 500 mg cipro amex, no interactions between maitake and Dried maitake pieces may be made into a tea by using prescription medications have been reported buy cipro 750 mg low price. To make the tea discount 1000 mg cipro visa, it is first required to grind the BOOKS dried maitake in a coffee grinder, then it is added to water, American Cancer Society (ACS). Capsules are available in 150-500 mg with a stan- dardized D-fraction powder extract of 10 mg. They may PERIODICALS be taken twice a day between meals or first thing in the Haugen, Jerry and George B. Cap- fola frondosa) D-Fraction on the Control of the T Lymph sules should be stored in a cool dry place. A recent gov- ORGANIZATIONS ernment panel warned that disaster looms over Africa Mushroom Council. It is predicted that OTHER within five years, malaria will kill about as many people “Maitake (Grifola frondosa). The spread of malaria is becoming even more serious as the Sharon Crawford parasites that cause malaria develop resistance to the Rebecca J. In late 2002, a group of public health researchers in Thailand reported that a combination treatment regimen involving two drugs known as dihydroartemisinin and azithromycin shows promises in treating multidrug-resistant malaria in south- east Asia. Malaria Definition Causes & symptoms Malaria is a serious infectious disease spread by cer- Human malaria is caused by four different species tain mosquitoes. Many animals can get malar- (occurs frequently in a particular locality) in many third ia, but human malaria does not spread to animals. Isolated, small outbreaks sometimes turn, animal malaria does not spread to humans. The parasites enter the blood stream and travel to the liver, where they multiply. By the time a patient shows symptoms, the parasites have reproduced very rapidly, Malaria is a growing problem in the United States. Although only about 1400 new cases were reported in Malaria cannot be casually transmitted directly from the United States and its territories in 2000, many in- one person to another. In addition, locally transmit- fected person and then passes the infection on to the next ted malaria has occurred in California, Florida, Texas, human it bites. It is also possible to spread malaria via Michigan, New Jersey, and New York City. This is ia can be transmitted in blood, the American blood sup- why all blood donors are carefully screened with ques- ply is not screened for malaria. Nevertheless, at least being advised to screen returning travelers with fever for 89 cases of so-called airport malaria, in which travelers malaria, and a team of public health doctors in Minneso- contract malaria while passing through crowded airport ta is recommending screening immigrants, refugees, and terminals, have been identified since 1969. The incubation period is not appear until eight to 10 months after the mosquito usually between eight and 12 days for falciparum bite occurred. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1279 The primary symptom of all types of malaria is the (45–60 min) in making the malaria parasites visible “malaria ague” (chills and fever), which corresponds to under a microscope. The second is a bioassay technique the “birth” of the new generation of the parasite. It al- trollable shivering for an hour or two, followed by a lows for a very accurate estimation of parasite develop- rapid spike in temperature (as high as 106°F [41. A dip strip that tests for the presence of HRP2 in which lasts three to six hours. Then, just as suddenly, the blood samples appears to be more accurate in diagnosing patient begins to sweat profusely, which will quickly malaria than standard microscopic analysis. Other symptoms may include fa- Anyone who becomes ill with chills and fever after tigue, severe headache, or nausea and vomiting. As the being in an area where malaria exists must see a doctor sweating subsides, the patient typically feels exhausted and mention their recent travel to endemic areas. In many cases, this cycle of chills, fever, son with the above symptoms who has been in a high- and sweating occurs every other day, or every third day, risk area should insist on a blood test for malaria. Those doctor may believe the symptoms are just the common with the chronic form of malaria may have a relapse as flu virus.

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Ten women with normal menstrual cycles were known to contain significant amounts of the mineral discount cipro 250 mg with amex. The women received 587 or Manganese-rich foods and drinks include peanuts buy cipro 1000mg on line, 1 buy discount cipro 500 mg online,336 mg of calcium a day with 1 cheap cipro 500mg with visa. Other good sources tionnaire during each cycle and the results were ana- include rice generic cipro 750mg fast delivery, sweet potatoes, spinach, whole wheat lyzed. Getting more calcium improved mood, concentra- bread, and lima, pinto, and navy beans. Meat, poultry, tion, and behavior, and also reduced menstrual pain and fish, and dairy products are considered poor sources. This study ganese for several weeks to help treat muscle sprains or suggests that getting adequate amounts of calcium and strains, but the safety and effectiveness of taking dosages manganese can help to reduce the pain and other symp- this high are unknown. Recent studies indicate that high this theory, a handful of animal studies indicate that levels of manganese alter the blood-brain barrier, lower- manganese may play a role in controlling seizures and ing the iron content of blood plasma while allowing the blood sugar levels. These cases of risk of colon cancer by raising levels of the SOD en- manganese-induced parkinsonism are usually limited to zyme, which has antioxidant effects. People Some people take manganese to help treat muscle who eat a manganese-rich diet are not considered at risk strains or sprains, as well as rheumatoid arthritis, though for these types of side effects. In fact, most foods high in there is no convincing scientific evidence to support manganese are believed to contribute to good health. Theoretically, manganese may act as an anti- inflammatory agent by boosting the activity of SOD. Side effects When taken in recommended dosages, manganese is not Preparations associated with any bothersome or significant side effects. People who take oral contraceptives or antacids age 11 and over, the ESADDI for manganese is 2–5 mg a may require higher intake of manganese. More of the miner- GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1287 Manic depression see Bipolar disorder KEY TERMS. Marigold see Calendula Calcium—A mineral necessary for strong bones and the proper functioning of organs and muscles. Osteoporosis—An age-related disease in which bones become fragile and prone to debilitating Marijuana fractures. Description Pancreas—An organ behind the stomach that pro- Marijuana (marihuana), Cannabis sativa L. The term hashish, is derived from the BOOKS name for the Saracen soldiers, called hashashins, who Murray, Michael T. Indian hemp cal Significance of Reduced Manganese and Zinc Levels grows to a height of about 4 ft (1. The hairy leaves are arranged Loss in Postmenopausal Women Supplemented with Cal- opposite one another on the erect and branching stem. The resinous blossoms have five NIH Osteoporosis and Related Bone Diseases National Re- sepals and five petals. Commerce in hemp, which was primarily valued for the Marijuana has been cultivated for thousands of years. By 1621, the British pharmacopoeia is a book containing a list of medicinal were growing cannabis in Virginia where cultivation of drugs, and their descriptions of preparation and use. In 1776, the Declaration of Inde- Cannabis was called a “superior” herb by the Emperor pendence was drafted on hemp paper. Cannabis was recommended as a treat- were advocates of hemp as a valuable cash crop. By period in Egypt, cannabis was used as a treatment for the 1850s, hemp had become the third largest agricultur- sore eyes. Census of that gious ceremonies, and recorded in Sanskrit scriptural year recorded 8,327 hemp plantations, each with 2,000 texts around 1,400 B. Restric- cannabis as a remedy to treat inflammation, earache, and tions on the personal use of cannabis as a mood-altering, edema (swelling of a body part due to collection of flu- psychoactive herb, were soon to come. They called the herb Controversy kannabis and inhaled the “intoxicating vapor” that result- The 1856 edition of the Encyclopedia Britannica, in its ed when it was burned. Utah was the first state to criminalize it, then Emperor Nero, named the herb Cannabis sativa and California and Texas. New York ry, the Chinese physician Hoa-Tho, used cannabis in sur- prohibited cannabis use in 1927.

The result is a accompanied by a cleft palate (an opening in the roof of cleft palate order 750 mg cipro with mastercard, which is an opening in the roof of the mouth cheap cipro 1000 mg. The term sequence is used to describe the The size of the cleft palate varies as well as its position cipro 1000mg mastercard. Babies born with Pierre-Robin have difficulty feed- ing and breathing because the tongue—pushed back- Description wards by the lower jaw—obstructs the throat buy cipro 250mg lowest price. Feeding and breathing difficulties may be very mild or very Children born with Pierre-Robin sequence are severe buy cipro 750mg without prescription. Prenatal ultrasonic examination may show findings Genetic profile to indicate the possibility of Pierre-Robin sequence alert- ing the physician to be prepared at birth for the possibil- Pierre-Robin sequence can occur in association with ity of the baby having breathing and feeding problems. Heredity has not been proven to be a factor in the cause The type of treatment varies according to the sever- of isolated Pierre-Robin sequence. Babies may not sequence found in association with numerous syndromes require any therapy if they have no symptoms of breath- may have a mode of inheritance that is related to the ing difficulties and no feeding difficulties syndrome itself. The mode of inheritance includes single If breathing difficulties are mild, the easiest manage- gene as well as chromosomal abnormalities. This posi- The cause of the abnormal lower jaw in Pierre-Robin tion causes the tongue to fall forward, relieving the syndrome may be mechanical, genetic, teratogenic, or obstruction. A thorough evaluation of these patients must 924 GALE ENCYCLOPEDIA OF GENETIC DISORDERS be conducted, which includes endoscopy of the airways sequence. Close monitoring must be type will achieve near normal jaw size within a few maintained because the prone position may obscure years of birth. If positioning the patient prone fails, a nasopharyn- geal airway may be used but only for a short time. The Resources airway is a tube passed through the nose into the upper airway, which the baby can breath through. Surgical procedures include glossopexy, in which the tongue is sutured to the lower Cohen, N. Glossopexy and tracheotomy are tempo- Otolaryngology–Head and Neck Surgery 118, no. If the child has a cleft palate, it is usually surgically repaired between the ages of nine and 18 months. Gulli, MD Prognosis The prognosis for individuals with Pierre-Robin Pierre-Robin syndrome see Pierre-Robin sequence varies with the severity of symptoms and if it is sequence associated with other congenital abnormalities. The more severe the symptoms and associated congenital abnor- malities, the greater the risk of complications. Pierre-Robin syndrome with fetal The rate at which the lower jaw starts to catch up chrondrodysplasia see Weissenbacher- in growth depends on the cause of Pierre-Robin Zweymuller syndrome GALE ENCYCLOPEDIA OF GENETIC DISORDERS 925 IPituitary dwarfism KEY TERMS Definition Adrenocorticotropin (corticotrophin)—A hor- Dwarfism is a condition in which the growth of the mone that acts on cells of the adrenal cortex, caus- individual is very slow or delayed. The word pituitary is in reference to the hormones that control water and mineral balance pituitary gland in the body. Therefore, pituitary Antidiuretic hormone (vasopressin)—A hormone dwarfism is decreased bodily growth due to hormonal that acts on the kidneys to regulate water balance. The end result is a proportionate little person, because the height as well as the growth of all other Craniopharyngioma—A tumor near the pituitary structures of the individual are decreased. Description Deprivational dwarfism—A condition where emotional disturbances are associated with growth Pituitary dwarfism is caused by problems arising failure and abnormalities of pituitary function. The pituitary gland is also called Follicle-stimulating hormone (FSH)—A hormone the hypophysis. The pituitary gland is divided into two that in females stimulates estrogen and in males halves: the anterior (front) and posterior (back) halves. The anterior half produces six hormones: growth hor- mone, adrenocorticotropin (corticotropin), thyroid Growth hormone—A hormone that eventually stimulating homone (thyrotropin), prolactin, follicle stimulates growth. The Hormone—A chemical messenger produced by posterior pituitary gland only produces two hormones. Most forms of dwarfism are a result of decreased Lutenizing hormone—A hormone secreted by the production of hormones from the anterior half of the pitu- pituitary gland that regulates the menstrual cycle itary gland. When all of the hormones of the anterior pituitary Panhypopituitarism—Generalized decrease of all gland are not produced, this is called panhypopituitarism. Dwarfism can also result from a Prolactin—A hormone that helps the breast pre- lack of somatomedin C (also called insulin like growth pare for milk production during pregnancy. Somatomedin C is a hormone Puberty—Point in development when the gonads produced in the liver that increases bone growth when begin to function and secondary sexual character- growth hormone is present. Levi-Lorain dwarfs lack the ability to produce Thyroid stimulating hormone (thyrotropin)—A somatomedin C in response to growth hormone. All hormone that stimulates the thyroid gland to pro- causes of dwarfism lead to a proportionate little person.

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