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Other possible risk - with estrogen therapy increases gallbladder disease,
bronchial spasms , ovarian cancer, systemic lupus erythematosus , Raynaud's
phenomenon and the associated . These data are insufficient epilepsy.
Incontinence - estrogen can relieve pain during intercourse , recurrent
cystitis, women after vaginal / urethral atrophy and inflammation in
postmenopausal women. However, both the Heart and Estrogen / progestin
Replacement Study (HERS) and the Women's Health Initiative (WHI) trial showed
that oral hormone therapy worsen incontinence. Therefore , oral estrogen or
progestin should not be prescribed for this indication no . Notably , low
-dose transdermal unopposed estrogens ( 0.014 mg / day ) does not seem to
increase urinary incontinence [ 99 ] risk. ( See " treatment of female
urinary incontinence and prevention " in the " other drugs " one ) . Use of
topical vaginal estrogen therapy of urogenital atrophy symptoms are discussed
separately . ( See " Treatment of vaginal atrophy ." ) Bronchospasm -
Estrogen therapy may be associated with asthma related. In the Nurses' Health
Study , for example , the relative risk of new-onset 36,094 postmenopausal
women followed for 10 years with asthma remarkable women serving larger
Estrogen compared with those who did not ( relative risk 1.5 ) [ 100 ] a .
This increased risk is dose-related , it was statistically significant only
in the dose , because of the small number of women , may be greater than
0.625 mg / day of conjugated estrogens study . Conflicting data after
estrogen therapy in postmenopausal women will lead to deterioration of the
asthmatic airway function . A study conducted in 15 postmenopausal women with
mild to moderate asthma showed that estrogen therapy for women with
subclinical deterioration of disease activity ( eg by peak expiratory flow
and spirometry ) [ 101 ]
. By contrast, a second study of women with asthma with measures of airway
obstruction in 20 postmenopausal women , there was no difference stopping and
restarting estrogen therapy [ 102 ] after . Thus, although estrogen in women
is not taboo obstructive pulmonary disease , clinicians should be aware of
the possibility of worsening of bronchial spasm . In addition , estrogen can
be considered as etiological factors in women who suffer from asthma during
treatment . Systemic lupus erythematosus - estrogen appears to increase
developing systemic lupus erythematosus [ 103 ] risk. A report from the
Nurses' Health Study found that the relative risk of 2.5 current estrogen
therapy for the past 1.8 estrogen therapy had no significant risk and who had
never received estrogen [ 104 ] compared to women . The duration of exposure
is associated with estrogen therapy .
( See " Epidemiology and pathogenesis of systemic lupus erythematosus ." )
Use of estrogen in postmenopausal women may increase the risk of lupus flares
established , but these flares tend to be mild to moderate , moderate and
severe . This is discussed in detail elsewhere . ( See " menstrual function ,
menopausal hormonal contraceptives and women with systemic lupus
erythematosus ," in " Menopause " section. ) Uterine fibroids - the use of
postmenopausal hormone therapy after childbearing age may lead some women
continue to have uterine fibroids after menopause symptoms. Symptoms may vary
depending on the risk , in part, on the location of uterine fibroids (if
higher mucosa [ 105 ] ) and type ( high estrogen transdermal estrogen
preparations in some studies [ 106, 107 ] , but not others [ 108 ] ) . A
systematic review of randomized controlled trials , including five found that
postmenopausal hormone therapy -induced growth of uterine fibroids , but this
usually occurs without clinical symptoms [ 109 ] . These findings confirmed
in subsequent prospective study [ 110 ] . Therefore, there is a hormonal
treatment of fibroids after menopause is not a contraindication , nor with
new symptoms related to uterine fibroids most women .
Epilepsy - 42 menopausal women with epilepsy report , hormone therapy (HT)
and increase the frequency of seizures [ 111 ] related. Although these data
are not sufficient to recommend that women disappear seizures serotonin can
not provide indications of hormone replacement has shrunk dramatically since
the publication of the WHI . Women who are treating epilepsy should be
carefully monitored. Dry eye - a large observational study of postmenopausal
dry eye syndrome confirmed in unopposed estrogen or estrogen for women -
increases the risk of progestin therapy compared with non- users ( relative
risk [RR] 1.69 , and 1.29 , 95% CI 1.49-1.91 and 1.13 - 1.48 , respectively )
[ 112 ] . This may reflect the effects of estrogen on the tear film . ( See
"dry eye ." ) Kidney stones - menopause may increase urinary calcium
excretion, an important risk factor for the development of calcium kidney
stones [ 1
13 ] . However , the rate of increase is unclear . In contrast , exogenous
estrogen therapy may reduce urinary calcium excretion. Although the risk that
people might expect an increase in kidney stones and menopause and reduce the
risks associated with estrogen therapy , data, to solve this problem is
inconsistent : ● In the Nurses' Health Study , a prospective cohort study ,
the risk of natural menopause is not associated with an increased related
kidney stones [ 114 ]
. In addition , postmenopausal estrogen users, compared with nonusers , did
not lower the risk of kidney stones. ● Data from the WHI , the only
randomized trial to address this problem , we recommend that estrogen therapy
may increase kidney stones [ 115 ] risk. In the post- analysis of two trials
of hormone therapy , kidney stones by the patient self-report data is
obtained . After adjusting for age, body mass index, hormone therapy before ,
with coffee or diuretics, have kidney stones small excess risk of hormone
group compared with placebo ( 39 vs. 34 / 10,000 person-years ; ? ? Hazard
ratio 1.21 ) . The reason , the results of these differences is unclear .
However , the incidence of kidney stones in the WHI were compared Nurses'
Health Study ( includes only symptomatic stone cases ) [ 114 ] at nearly
three times higher . In addition, women taking estrogen are more likely to
develop gallstones [ 61 ] , and imaging studies to assess the gallbladder
will identify asymptomatic kidney stones. Given the present study the small
absolute risk ( five cases per 10,000 person-years of additional lower ) , we
do not think of kidney stones is an important factor to consider in deciding
whether to take short-term hormone therapy for menopausal symptoms ( see "
gallbladder disease ' above) the weight of other issues - although women are
often concerned that, after taking postmenopausal hormone therapy will
increase, weight gain occurs in middle age , a meta-analysis of 28 trials of
28,559 women found no evidence that the anti-estrogen effect, or physical the
combination of estrogen and progesterone body weight or body mass index
[ 116 ]
. Women with primary ovarian insufficiency ( premature ovarian failure ) -
data from the Women's Health Initiative (WHI) should not be generalized to
women with primary ovarian insufficiency ( premature ovarian failure ,
menopause before age 40 years ) , after which postmenopausal hormone therapy
generally start at a young age . In healthy women with primary ovarian
insufficiency , we continue until their postmenopausal hormone therapy after
menopause , with an average age of about 50 years old to 51 years old. At
this point, the benefits of the potential risk of postmenopausal hormone
therapy and how should the same discussion . Androgen therapy - after
perimenopausal and postmenopausal women using exogenous androgen therapy is
examined separately . ( See " androgen production and treatment of women "
and " female sexual dysfunction : management," in part " androgens ." )
Expert group - the group most experts agree that hormone therapy is indicated
for the management of menopausal symptoms , instead of cardiovascular disease
or dementia [ 7,117-119 ] primary or secondary prevention. Some groups
believe that hormone therapy may be reasonable for women with osteoporosis
who can not take non- estrogen therapy [ 5,117 ] . Patient Information -
current offers two types of patient education materials , " Basics" and "
Beyond the Basics " on the basis of patient education pieces are in plain
language , at the 5th to 6th grade reading level , and they answer the four
or five patients may be the key issues for a given condition. These products
are our people who want a general overview of the patient , who prefers short
, easy-to -read materials. In addition to basic patient education sheet for
longer , more complex and detailed. These articles are written in grades 10
to 12, and the most appropriate reading level who want in-depth information
and customary use of some medical terminology patients. The following
articles are related to this topic patient education. We encourage you to
print or e-mail these topics to your patients. ( You can also locate a wide
variety of topics in patient education articles by searching for " Patient
Information" and interested keywords. )
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