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The Cochrane Database of Systematic... Sep 2012Various pharmacologic and non-pharmacologic interventions have been used to suppress lactation after childbirth and relieve associated symptoms. Despite the large volume... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various pharmacologic and non-pharmacologic interventions have been used to suppress lactation after childbirth and relieve associated symptoms. Despite the large volume of literature on the subject, there is currently no universal guideline on the most appropriate approach for suppressing lactation in postpartum women.
OBJECTIVES
To evaluate the effectiveness and safety of interventions used for suppression of lactation in postpartum women (who have not breastfed or expressed breastmilk) to determine which approach has the greatest comparative benefits with least risk.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2012).
SELECTION CRITERIA
Randomised trials evaluating the effectiveness of treatments used for suppression of postpartum lactation.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data.
MAIN RESULTS
We included 62 trials (6428 women). Twenty-two trials did not contribute data to the meta-analyses. The trials were generally small and of limited quality. Three trials (107 women) indicated that bromocriptine significantly reduced the proportion of women lactating compared with no treatment at or within seven days postpartum (three trials, 107 women; risk ratio (RR) 0.36, 95% confidence interval (CI) 0.24 to 0.54). Seven trials involving oestrogen preparations (diethylstilbestrol, quinestrol, chlorotrianisene, hexestrol) suggested that they significantly reduced the proportion of lactating women compared with no treatment at or within seven days postpartum (RR 0.40, 95% CI 0.29 to 0.56). We found no trials comparing non-pharmacologic methods with no treatment. Trials comparing bromocriptine with other pharmacologic agents such as methergoline, prostaglandins, pyridoxine, carbegoline, diethylstilbestrol and cyclofenil suggested similarity in their effectiveness. Side effects were poorly reported in the trials and no case of thromboembolism was recorded in the four trials that reported it as an outcome.
AUTHORS' CONCLUSIONS
There is weak evidence that some pharmacologic treatments (most of which are currently unavailable to the public) are better than no treatment for suppressing lactation symptoms in the first postpartum week. No evidence currently exists to indicate whether non-pharmacologic approaches are more effective than no treatment. Presently, there is insufficient evidence to address the side effects of methods employed for suppressing lactation. When women desire treatment, bromocriptine may be considered where it is registered for lactation suppression in those without predisposition to its major side effects of public concerns. Many trials did not contribute data that could be included in analyses. Large randomised trials are needed to compare the effectiveness of pharmacologic (especially bromocriptine) and non-pharmacologic methods with no treatment. Such trials should consider the acceptability of the intervention and lactation symptoms of concern to women and be large enough to detect clinically important differences in major side effects between comparison groups.
Topics: Bromocriptine; Estrogens; Female; Hormone Antagonists; Humans; Lactation; Milk Ejection; Randomized Controlled Trials as Topic
PubMed: 22972088
DOI: 10.1002/14651858.CD005937.pub3 -
British Medical Journal Apr 1971
Topics: Adult; Aged; Anxiety; Chlorotrianisene; Coronary Disease; Curettage; Depression; Diethylstilbestrol; Estrogens; Ethinyl Estradiol; Female; Humans; Menopause; Menstruation; Middle Aged; Sleep Initiation and Maintenance Disorders; Testosterone; Vasomotor System
PubMed: 5575954
DOI: 10.1136/bmj.2.5755.208 -
Journal of Ayub Medical College,... 2023The global burden of patients affected by chronic liver disease (CLD) has shown a steady rise over the last few decades and is now considered the 11th most frequent... (Review)
Review
BACKGROUND
The global burden of patients affected by chronic liver disease (CLD) has shown a steady rise over the last few decades and is now considered the 11th most frequent cause of death globally. In addition, as the world population is facing increased obesity rates coupled with alcohol consumption, these rates are predicted to continue to rise. The Objective was to assess the appearance of Lipiodol retention upon different MRI sequences with a special focus on non-contrast sequences. Lipiodol Trans-arterial chemoembolization (TACE) has become the standard treatment for unresectable hepatocellular carcinoma (HCC) without vascular invasion. However, data regarding Lipiodol TACE imaging via MRI is limited and results are not familiar to radiologists for regular assessment of treatment response.
METHODS
After IRB and EC approval, we included all those patients who underwent TACE treatment with Lipiodol and chemotherapeutic agent; having both 4-6-week post-treatment CT and MRI imaging. This criterion was fulfilled by a total of 25 patients. Only lipiodol-containing areas within the lesion were noted for signal intensities on all MRI sequences and labelled as hyperintense, isointense, hypointense and mixed intensity. Data was entered and analyzed by SPSS v27. Frequencies and percentages were calculated for qualitative data.
RESULTS
The most sensitive sequence in detecting Lipiodol retention was Fat suppressed T1 imaging sequence, with low signal intensity seen on T1 weighted fat-suppressed sequences in up to 76% of lesions. While on non-fat suppressed T1 weighted images, 60% of Lipiodol retention areas appeared hyperintense. 52% of lesions showed a hypointense appearance on the T2 weighted sequence. A much more variable appearance was seen in Diffusion-weighted imaging sequences demanding cautious interpretation. MR patterns were clearer in patients having more than 50% lipiodol retention on CT and lesion size more than 2 cm. .
CONCLUSION
While MRI is deemed as a reliable and most useful imaging modality for assessing HCC's following lipiodol TACE it requires cautious interpretation with knowledge of variable signal appearance seen on different imaging sequences.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Ethiodized Oil; Chemoembolization, Therapeutic; Magnetic Resonance Imaging; Chlorotrianisene
PubMed: 38406903
DOI: 10.55519/JAMC-S4-11966 -
The Journal of Biological Chemistry Jun 1982The effects of estrogens on ovarian aromatase activity were investigated in vitro using granulosa cells from immature hypophysectomized estrogen-primed rats. The cells...
The effects of estrogens on ovarian aromatase activity were investigated in vitro using granulosa cells from immature hypophysectomized estrogen-primed rats. The cells were cultured for 3 days in an androgen-free medium in the presence of follicle-stimulating hormone (FSH), with or without the specified estrogen. After washing, the cells were reincubated for 5 h with 10(-7) M androstenedione, and the formation of estrogens was measured. Estrogen production by control and diethylstilbestrol-treated cells was negligible, while FSH stimulated aromatase activity. Furthermore, concomitant treatment with diethylstilbestrol led to dose-dependent increases in the FSH-induced aromatase activity with an ED50 value of 4 X 10(-9) M and an apparent Vmax value 12- to 16-fold higher than those induced by FSH alone. The direct stimulatory effect of estrogens was time-dependent and was not accounted for by increases in cell protein. Various native and synthetic estrogens also augmented the FSH induction of aromatases (native estrogens: estradiol-17 beta = estrone greater than estradiol-17 alpha greater than estriol; synthetic estrogens: hexestrol greater than moxestrol greater than ethinyl estradiol much greater than chlorotrianisene and mestranol). The effect of estradiol-17 beta was dose-dependent with an ED50 value of 9 X 10(-9) M, which is within the physiological levels of follicular estradiol-17 beta. Although treatment with androgens also enhanced the FSH-induced aromatases, treatment with a progestin (R5020) or a mineralocorticoid (aldosterone) was without effect. Thus, estrogens directly augment the stimulation of granulosa cell aromatase activity by FSH. Follicular estrogens may activate intraovarian autoregulatory positive feedback mechanisms to enhance their own production, resulting in selective follicle maturation and the preovulatory estrogen surge.
Topics: Aldosterone; Animals; Aromatase; Diethylstilbestrol; Enzyme Induction; Estradiol; Estrogens; Estrone; Female; Follicle Stimulating Hormone; Granulosa Cells; Ovary; Oxidoreductases; Rats; Rats, Inbred Strains
PubMed: 6804461
DOI: No ID Found -
Nature Jun 2012Discovering the unintended 'off-targets' that predict adverse drug reactions is daunting by empirical methods alone. Drugs can act on several protein targets, some of...
Discovering the unintended 'off-targets' that predict adverse drug reactions is daunting by empirical methods alone. Drugs can act on several protein targets, some of which can be unrelated by conventional molecular metrics, and hundreds of proteins have been implicated in side effects. Here we use a computational strategy to predict the activity of 656 marketed drugs on 73 unintended 'side-effect' targets. Approximately half of the predictions were confirmed, either from proprietary databases unknown to the method or by new experimental assays. Affinities for these new off-targets ranged from 1 nM to 30 μM. To explore relevance, we developed an association metric to prioritize those new off-targets that explained side effects better than any known target of a given drug, creating a drug-target-adverse drug reaction network. Among these new associations was the prediction that the abdominal pain side effect of the synthetic oestrogen chlorotrianisene was mediated through its newly discovered inhibition of the enzyme cyclooxygenase-1. The clinical relevance of this inhibition was borne out in whole human blood platelet aggregation assays. This approach may have wide application to de-risking toxicological liabilities in drug discovery.
Topics: Blood Platelets; Chlorotrianisene; Cyclooxygenase 1; Cyclooxygenase Inhibitors; Databases, Factual; Drug Evaluation, Preclinical; Drug-Related Side Effects and Adverse Reactions; Estrogens, Non-Steroidal; Forecasting; Humans; Models, Biological; Molecular Targeted Therapy; Platelet Aggregation; Reproducibility of Results; Substrate Specificity; Toxicity Tests
PubMed: 22722194
DOI: 10.1038/nature11159 -
Canadian Medical Association Journal Nov 1975A total of 154 patients with carcinoma of the prostate received estrogen therapy with diethylstillbestrol (DES), chlorotrianisene or ethinyl estradiol. During a mean... (Comparative Study)
Comparative Study
A total of 154 patients with carcinoma of the prostate received estrogen therapy with diethylstillbestrol (DES), chlorotrianisene or ethinyl estradiol. During a mean follow-up period of 26 months the incidence of complications -- thromboembolic episodes, fluid retention and gynecomastia -- was recorded. Although the incidence of cardiovascular complications was significantly higher in the DES group, the differences in mortality between the groups were not significant. The differences in incidence of fluid retention and gynecomastia also lacked significance. All three compounds produced adrenal cortical hyperplasia as indicated by the increased serum cortisol values.
Topics: Aged; Diethylstilbestrol; Estrogens; Humans; Male; Prostatic Neoplasms; Thromboembolism
PubMed: 1182631
DOI: No ID Found -
British Medical Journal Feb 1966
Topics: Aged; Alcoholism; Chlorotrianisene; Diethylstilbestrol; Humans; Liver Diseases; Male; Pancreatic Neoplasms; Porphyrias; Porphyrins; Prostatectomy; Urine
PubMed: 5902684
DOI: 10.1136/bmj.1.5485.461 -
Canadian Medical Association Journal Oct 1977
Clinical Trial
Topics: Administration, Oral; Bromocriptine; Chlorotrianisene; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Female; Humans; Lactation; Pregnancy; Prolactin; Puerperal Disorders; Uterine Contraction
PubMed: 334356
DOI: No ID Found -
FEBS Letters Feb 1990Chlorotrianisene (TACE) exhibits in vitro little or no binding to the uterine estrogen receptor (ER) but demonstrates potent estrogenic activity in vivo, indicating that...
Inactivation of the uterine estrogen receptor binding of estradiol during P-450 catalyzed metabolism of chlorotrianisene (TACE). Speculation that TACE antiestrogenic activity involves covalent binding to the estrogen receptor.
Chlorotrianisene (TACE) exhibits in vitro little or no binding to the uterine estrogen receptor (ER) but demonstrates potent estrogenic activity in vivo, indicating that TACE is a proestrogen/proantiestrogen. Our earlier studies demonstrated that the incubation of TACE with rat liver microsomes and NADPH generates a reactive intermediate (T*) which binds covalently to proteins. The current study examined the possibility that T* may inactivate the uterine ER. The incubation of TACE with rat liver microsomes and NADPH in the presence of rat uteri, under conditions which generate T*, markedly decreased the binding capacity of the ER for [3H]estradiol (E2). The evidence indicates that ER inactivation was probably due to irreversible (covalent) binding of T* to the E2 binding site. The possibility that the antiestrogenic action of TACE and of other triphenylethylenes involves such a novel mechanism is discussed.
Topics: Animals; Chlorotrianisene; Cytochrome P-450 Enzyme System; Estradiol; Estrogen Antagonists; Female; Male; Microsomes, Liver; NADP; Prodrugs; Rats; Rats, Inbred Strains; Receptors, Estrogen; Uterus
PubMed: 2307235
DOI: 10.1016/0014-5793(90)80636-w -
British Medical Journal Nov 1970
Topics: Animals; Castration; Chlorotrianisene; Diethylstilbestrol; Estradiol; Estrogens; Feminization; Humans; Hypophysectomy; Libido; Lymphatic Metastasis; Male; Neoplasm Metastasis; Pituitary Irradiation; Prostatic Neoplasms
PubMed: 5483325
DOI: 10.1136/bmj.4.5734.539