Azulfidine
By K. Jack. University of Massachusetts at Lowell. 2018.
Despite impressive technological advances in the development of minimally invasive and endovascular approaches to treat arterial occlusions order 500mg azulfidine with mastercard back pain treatment kansas city, the full benefit of these gains awaits the resolution of this fundamental biologic problem buy cheap azulfidine 500mg line tuomey pain treatment center. Although it is now thought that remodeling may account for the majority of late lumen loss after balloon dilation of atherosclerotic vessels, proliferation has been the predominant target of experimental genetic interventions. Cytostatic and Cytotoxic Approaches There have been two general approaches—cytostatic, in which cells are prevented from progressing through the cell cycle to mitosis, and cytotoxic, in which cell death is induced. A group of molecules known as cell cycle regulatory proteins act at dif- ferent points along the cell cycle (see Chapter 10), mediating progression toward division. To support this hypothesis, near complete inhibition of neointimal hyperplasia after carotid balloon injury has been demonstrated. Arrest of the cell cycle via antisense blockade of either of two proto-oncogenes, c-myb or c-myc, has been found to inhibit neointimal hyperplasia in models of arterial balloon injury. The activity of a number of cell cycle regulatory genes is influenced by a single transcription factor known as E2F. In quiescent cells, E2F is bound to a complex of other proteins, including a protein known as the retinoblastoma (Rb) gene product. In pro- liferating cells, E2F is released, resulting in cell cycle gene activation. A transcrip- tion factor decoy bearing the consensus binding sequence recognized by E2F can be employed as a means to inhibit cellular proliferation. Alternatively, the approach of localized arterial in- fection with a replication-defective adenovirus encoding a nonphosphorylatable, constitutively active form of Rb at the time of balloon angioplasty has been studied. This approach significantly reduces smooth muscle cell proliferation and neointima formation in both the rat carotid and porcine femoral artery models of restenosis. Similar results were also obtained by adenovirus-mediated overexpression, a natural inhibitor of cell cycle progression, the cyclin-dependent kinase inhibitor, p2l. In addition to blockade of cell cycle gene expression, interruption of mitogenic signal transduction has been achieved in experimental models as well. For example, Ras proteins are key trans- ducers of mitogenic signals from membrane to nucleus in many cell types. Nitric oxide mediates a number of biologic processes that are thought to mitigate neointima formation in the vessel wall. Results revealed expression of the transgene in the vessel wall, along with improved vasomotor reactivity and a 70% inhibition of neointima formation (Fig. After one course of gancyclovir treatment, neointimal hyperplasia decreased by about 50% in that model system. It has been clearly established, in a number of animal models, that angiogenic factors can stimulate the growth of capillary networks in vivo. But, it is less certain that these molecules can induce the development of larger, more complex vessels in adult tissues needed for carrying significantly increased bulk blood flow. Nevertheless, the possibility of an improve- ment, even of just the microvascular collateralization as a biological approach to the treatment of tissue ischemia, has sparked the beginning of human clinical trials in neovascularization therapy. These factors either stimulated endothelial cell proliferation or enhanced endothelial cell migra- tion. The list of angiogenic factors includes such diverse molecules as insulinlike growth factor, hepatocyte growth factor, angiopoeitin, and platelet-derived endothelial growth factor. However, much debate persists regarding the optimum agent and the optimum route of delivery for angiogenic therapy in the ischemic human myocardium or lower extremity. Angiogenic Gene Therapy Preclinical studies of angiogenic gene therapy have utilized a number of models of chronic ischemia. These results were shown in a pig model of chronic myocardial ischemia induced via placement of a slowly occlud- ing Ameroid constrictor around the circumflex coronary artery. Thus, the transfer of these genetic sequences is less likely to yield an adequate supply of growth factor to target endothelial cells. Delivery of this plasmid to the femoral artery wall, even at low transfection efficiencies, was found to improve capillary density and reduce vascular resistance in the ischemic 11 rabbit hind limb.
Pubic hair should be described in terms of its coarseness buy azulfidine 500mg jaw pain treatment medications, distribution (Tanner stages 1–5) cheap 500mg azulfidine overnight delivery rush pain treatment center meridian ms, and color. A note should be made if the pubic hair appears to have been plucked (including bleeding hair follicles), shaved, cut, or dyed. Acquired abnormalities, such as circumcision, Peyronie’s disease, balanitis xerotica obliterans, vasectomy scars, phimosis, tattoos, and piercing. Foreign bodies may be worn around the base of the penis, sometimes also encir- cling the scrotum, in an attempt to increase and sustain penile tumescence. Such devices may result in local and distal genital trauma (penile tourniquet syndrome) (157). In several case reports, children have had human hairs wrapped around the penis; these hairs may be virtually invisible because of edema or epithelialization (158). Kerry and Chapman (159) have described the deliberate application of such a ligature by parents who were attempting to prevent enuresis. After consensual sexual intercourse, lacerations of the foreskin and frenulum, meatitis, traumatic urethritis, penile edema, traumatic lymphangitis, paraphimosis, and penile “fractures” have all been described (160– 163). Accidental trauma is more common when there is a pre-existing abnormal- ity, such as phimosis (160). Skin injury may be incurred if the genitals are deliberately bitten during fellatio (160). Although the precise incidence of male genital trauma after sexual activity is unknown, anecdotal accounts suggest that it is rare to find any genital injuries when examining suspects of serious sexual assaults (164). In children the genitalia may be accidentally or deliberately injured, and the latter may be associated with sexual abuse (165). Bruises, abrasions, lac- erations, swelling, and burns of the genitalia of prepubescent males have all been described (165,166). Definitions Buggery is a lay term used to refer to penile penetration of the anus (anal intercourse) of a man, a woman, or an animal (also known as bestiality). Consensual Although anal intercourse among heterosexuals is the least common com- ponent of the sexual repertoire, it has been experienced on at least one occa- sion by 13–25% of heterosexual females surveyed (64,80,167), and it was described as a regular means of sexual gratification for 8% of women attend- ing one gynecologist (80). Among 508 men who reported having had a same- gender sexual experience at some stage in their lives, 33. Inter- estingly, in contrast to a common perception, more men had experienced both practices than had been in exclusively receptive or insertive roles (168). Nonconsensual Anal intercourse was reported by 5–16% of females who described hav- ing been sexually assaulted (6,169). Although it may be the only sexual act performed, it is more frequently combined with vaginal and oral penetration (6,169). Fewer data are available regarding sexual assaults on males, although Hillman et al. Legal Implications Under English common law, the term buggery is defined as anal inter- course by a man with another man or a woman and anal or vaginal inter- course by a man or a woman with an animal (bestiality). Although the 1967 Sexual Offences Act provided that it was not an offense for two consenting men who had attained the age of 21 to commit buggery in private, it remained an offense for a man to commit buggery with a woman, even if both parties consented, until 1994. The Criminal Justice and Public Order Act 1994 expanded the definition of rape, which had previously related to only vaginal intercourse, to include nonconsensual penile penetration of the anus independent of the gender of the recipient. The Sexual Offences (Amendment) Act 2000 reduced the minimum age at which a person, whether male or female, may lawfully consent to bug- gery to 16 years. A recent change in English law has defined nonconsensual penetration of the anus by an object or a body part (excluding the penis) as “assault by penetration,” this new offense has the same maximum sentence as rape. In some other jurisdictions, such as Australia, such acts are included in the legal definition of rape (172). Anatomy and Physiology An understanding of the normal anatomy and physiology of the perianal area and anal canal is important for the reliable description and interpretation of the medical findings after allegations of anal penetrative acts. Unfortunately, varying definitions have resulted in considerable confusion, such that there is no consensus among forensic practitioners about the nomenclature that should be used in describing injuries to this area. Therefore, a brief overview of the relevant information is given in the remaining Subheadings, together with ref- erences to more substantive texts. Anus The anus refers not to an actual anatomical structure but to the external opening of the anal canal.
If the blade is double- edged order azulfidine 500mg otc pain treatment for psoriatic arthritis, such as that of a dagger generic 500mg azulfidine free shipping pain treatment for plantar fasciitis, the extremities of the wound tend to be equally pointed. A stab wound from a single-edged blade, such as a kitchen knife, will usually have one extremity rounded, squared-off, or fish-tailed (caused by the noncutting back of the blade). When blunt weapons are used—a pair of scissors, for example—the wound tends to be more rounded or oval, with bruising of its margins (see Fig. Scissor wounds can sometimes have a cross-shape caused by the blade screws or rivets. Notched wounds are often caused by the blade of the weapon being partially withdrawn and then rein- troduced into the wound or twisted during penetration. It is rarely possible from an inspection of the skin wound alone to com- ment usefully on the width of the blade because the skin retracts and the knife is unlikely to have been introduced and removed perfectly perpendicularly. Deliberate Self-Harm Deliberate self-harm refers to any attempt by an individual to harm him- self or herself. When assessing injuries, it is important to understand which factors may indicate the possibility that an injury was caused by deliberate Injury Assessment 143 Table 4 Indicators of Possible Deliberate Self-Harm Injuries • Must be on an area of body accessible to the person to injure themselves. Individuals injure themselves for numerous reasons, including psy- chiatric illness and others, such as attempting to imply events took place that did not or for motives of gain. Self-inflicted injuries have several characteris- tics, which are not diagnostic but that together may give an indication of self- infliction. Table 4 lists features that may assist in the recognition or suspicion that cuts or other injury, such as scratches, are self-inflicted—all or some may be present—their absence does not preclude self-infliction nor does their pres- ence necessarily imply self-infliction (2). As with all injuries within the forensic setting it is essential in these nonfatal cases that the initial appear- ances of the injuries be accurately described and the wounds photographed. This is particularly important because subsequent surgical treatment may dis- tort or completely obliterate the wound characteristics. Furthermore, any frag- ments, bullets, or pellets found within the wounds must be carefully removed and handed over to the appropriate authorities. Smooth-Bore Weapons Shotguns, which fire a large number of small projectiles, such as lead shot, are the most common type of smooth-bore weapons. They are commonly used in sporting and agricultural activities and may be either single or double- barreled. The ammunition for these weapons consists of a plastic or cardboard cartridge case with a brass base containing a percussion cap. Inside the main part of the cartridge is a layer of propellant, plastic, felt, or cardboard wads and a mass of pellets (lead shot of variable size) (see Fig. In addition to the pellets, the wads and/or cards may contribute to the appearance of the wounds and may be important in estimating range and possible direction. Rifled Weapons Rifled weapons are characterized by having parallel spiral projecting ridges (or lands) extending down the interior of the barrel from the breach to the muzzle. The rifling also leaves characteristic scratches and rifling marks that are unique to that weapon on the bullet surface. There are three common types of rifled weapons: the revolver, the pistol, and the rifle. The Injury Assessment 145 revolver, which tends to have a low muzzle velocity of 150 m/s, is a short- barreled weapon with its ammunition held in a metal drum, which rotates each time the trigger is released. In the self-loading pistol, often called “semi-automatic” or erroneously “automatic,” the ammunition is held in a metal clip-type maga- zine under the breach. Each time the trigger is pulled, the bullet in the breach is fired, the spent cartridge case is ejected from the weapon, and a spring mecha- nism pushes up the next live bullet into the breach ready to be fired. The rifle is a long-barreled shoulder weapon capable of firing bullets with velocities up to 1500 m/s. Most military rifles are “automatic,” allowing the weapon to continue to fire while the trigger is depressed until the magazine is empty; thus, they are capable of discharging multiple rounds within seconds. Shotgun Wounds When a shotgun is discharged, the lead shot emerges from the muzzle as a solid mass and then progressively diverges in a cone shape as the distance from the weapon increases. The pellets are often accompanied by particles of unburned powder, flame, smoke, gases, wads, and cards, which may all affect the appearance of the entrance wound and are dependent on the range of fire.
The recommendations given in the chapter “Diarrhea” are appropriate in most cases buy azulfidine 500 mg on-line a better life pain treatment center golden valley, especially the use of probiotics discount 500mg azulfidine with visa neuropathic pain treatment guidelines 2010. The mechanisms responsible for this syndrome are not well defined, but it is clear that this is a multifactorial process. Contributors to wasting syndrome include inadequate dietary protein intake, malabsorption, increased metabolism, and increased levels of inflammatory compounds, known as cytokines, secreted by the immune system (e. The protein with the highest biological value is found in whey, a natural by-product of the cheesemaking process. Of that protein, 80% is casein (another type of protein), and the remaining 20% is whey protein. Whey protein is collected by filtering off the other components of whey, such as lactose, fats, and minerals. Whey protein is a complete protein, in that it contains all essential and nonessential amino acids. One of the reasons the biological value of whey protein is so high is that it has the highest concentrations of glutamine and branched-chain amino acids found in nature; these substances are critical to cellular health, muscle growth, and protein synthesis. Better options to raise glutathione levels may be vitamin E, beta-carotene, vitamin C, selenium, and alpha-lipoic acid. Alpha-lipoic acid (also known as thioctic acid) is a sulfur-containing vitamin-like substance that plays an important role as the necessary cofactor in two vital energy-producing reactions involved in the production of cellular energy. Alpha-lipoic acid is not considered a vitamin because it is thought that either the body can usually manufacture sufficient levels or the nutrient can be acquired in sufficient quantities from food. However, as with many of the other compounds described in this section, a relative deficiency can occur in certain situations, and alpha-lipoic acid supplementation provides benefits beyond its role in normal metabolism. Alpha-lipoic acid is an effective antioxidant, unique in that it is effective against both water-soluble and fat-soluble free radicals. Increasing the carnitine content of the white blood cells has been shown to strongly improve their function, a finding that highlights the importance of carnitine to the immune system. The research may have been performed as a follow-up to a population study in Trinidad. About 40% of Trinidad’s population is of Indian descent and these Trinidadians use curry extensively in their diet. Another 40% of the population is of African descent; these people rarely use curry. Whether this was due to dietary factors or culturally determined sexual behaviors remains to be shown; however, given the recent antiviral studies with curcumin, a strong case could be made for the former. In addition, curcumin is a powerful antioxidant showing activity as much as 300 times greater than that of vitamin E. For this reason, pure curcumin preparations are preferred to turmeric when medicinal effects are desired. One concern regarding curcumin has been absorption, but there now exist a number of methods and products that enhance the absorption of curcumin. One of those methods is complexing the curcumin with soy phospholipids, as in the product Meriva. Absorption studies in animals indicate that peak plasma levels of curcumin after administration of Meriva were five times higher than those after administration of regular curcumin. Licorice The primary active components of licorice (Glycyrrhiza glabra) root are glycyrrhizin and its backbone structure glycyrrhetinic acid (glycyrrhizin minus a small sugar molecule). Although much of the research has featured intravenous administration, this route of administration may not be necessary, as glycyrrhizin and glycyrrhetinic acid are easily absorbed orally and well tolerated. Helper T cell and total T cell numbers, other immune system indicators, and glycyrrhizin and glycyrrhetinic acid levels in the blood were monitored. The results indicated that orally administered glycyrrhizin was converted into glycyrrhetinic acid without producing any side effects. In contrast, in the group not receiving glycyrrhetinic acid showed decreases in helper and total T cell counts and antibody levels. After 30 days, five of the six showed a reduction or disappearance of the P24 antigen (an indicator of viral load and severity of active disease). The big concern is that licorice root at a dosage of more than 3 g per day or glycyrrhizin at more than 100 mg per day for more than six weeks may cause sodium and water retention, leading to high blood pressure. Monitoring of blood pressure and increasing dietary potassium intake are suggested.
Most fruits cheap 500mg azulfidine otc pain medication for uti, especially berries and dried fruits cheap azulfidine 500 mg amex pain treatment diverticulitis, contains salicylates; raisins and prunes have the highest amounts. Salicylates are also found in appreciable amounts in licorice and peppermint candies. Vegetables, legumes, grains, meat, poultry, fish, eggs, and dairy products typically contain insignificant levels of salicylates. Salicylate levels are especially high in some herbs and condiments, including curry powder, paprika, thyme, dill, oregano, and turmeric. Although intake of these herbs and spices tends to be relatively small, they can make a significant contribution to dietary salicylate intake. Other flavoring agents, such as cinnamon, vanilla, menthol, and other volatile compounds, may produce hives in some individuals. The artificial sweetener aspartame (NutraSweet) has also been shown to induce hives. Although the incidence of adverse reactions to these compounds in the general population is thought to be less than 1%, the frequency of reactions in patients with chronic hives varies from 4 to 44%. This may be one reason adverse reactions to these foods are so common in patients with hives. Like tartrazine, sulfites have been shown to induce asthma, hives, and angioedema in sensitive individuals. They are typically added to processed foods to prevent microbial spoilage and to keep them from browning or changing color. The earliest known use of sulfites was in the treatment of wines with sulfur dioxide by the Romans. Sulfites are used to preserve many foods, especially dried fruit, prepared salads, items at salad bars, wine, and beer. Wine and beer drinkers typically consume up to 10 mg sulfites per day even with moderate drinking (two to three glasses of wine or beer). Normally, the enzyme sulfite oxidase metabolizes sulfites to safer sulfates, which are excreted in the urine. Those with a poorly functioning sulfoxidation system, however, have an increased ratio of sulfite to sulfate in their urine. Although most nutrition textbooks list molybdenum deficiency as uncommon, an Austrian study of 1,750 patients found that 41. Food Emulsifiers and Stabilizers Various compounds are used to emulsify and stabilize many commercial foods to ensure that the solids, oils, and liquids do not separate out. Most of the foods that contain these compounds contain other additives as well, such as preservatives, and dyes. Polysorbate in ice cream has been reported to induce hives, and vegetable gums such as acacia, gum arabic, tragacanth, quince, and carrageenan may also induce hives in susceptible individuals. In adults, immunological tolerance to many microorganisms apparently occurs owing to repeated antigen exposure. The role of bacteria, viruses, and yeast (Candida albicans) in hives is briefly reviewed below. Bacterial Infections Bacterial infections contribute to hives in two major settings: in acute streptococcal tonsillitis in children and in chronic dental infections in adults. In the first setting, acute hives predominate, while in the second, chronic hives predominate. Hives have also been strongly linked to infectious mononucleosis and may develop several weeks before the disease is manifested clinically. Candida The association between Candida albicans and chronic hives has been suggested in several clinical studies. The proportion of patients with chronic hives who react positively to an immediate skin test with candida antigens is 19 to 81%, compared with 10 to 15% of people without hives. Approximately 70% of patients who have a positive skin reaction to Candida albicans also react to oral provocation tests using foods prepared with baker’s or brewer’s yeast. Treatment with the drug nystatin has shown that elimination of the candida organism can achieve a cure in a number of sensitive individuals. However, in one study more patients (18 of 49) responded to nystatin plus a yeast-free diet than to nystatin alone (9 of 49). The yeast-free diet excluded breads, sausages, wine, beer, cider, grapes, raisins, vinegar, tomato, ketchup, pickles, and prepared foods containing yeast. Only 3 patients became symptom-free from taking nystatin alone, compared with 23 who had diet therapy that included avoiding food allergies and yeast following the nystatin therapy.
Habitually azulfidine 500 mg visa back pain treatment yahoo answers, you tie your shoes by either passing the right-hand lace around behind the left-hand lace purchase azulfidine 500mg mastercard pain treatment history, "or vice versa. Tomorrow morning determine which shoe you put on first and how you tie your shoes. Now, consciously decide that for the next 21 days you are going to form a new habit by putting on the other shoe first and tying your laces in a different way. Now, each morning as you decide to put on your shoes in a certain manner, let this simple act serve as a reminder to change other habit- ual ways of thinking, acting and feeling throughout that one day. Say to yourself as you tie your shoes, "I am be- ginning the day in a new and better way. I am going to be a little less critical and a little more tolerant of other people, their faults, failings and mis- takes. Regardless of what happens, I will react as calmly and as intelligently as possible. I will ignore completely and close my mind to all those pessimistic and negative "facts" which I can do noth- ing to change. But each of the above habitual ways of acting, feeling, thinking does have beneficial and con- structive influence on your self-image. I have found one of the most effective means of helping people achieve an adequate or "successful" personality is to first of all give them a graphic picture of what the suc- cessful personality looks like. Remember, the creative guidance mechanism within you is a goal-striving mech- anism, and the first requisite for using it is to have a clear- cut goal or target to shoot for. A great many people want to "improve" themselves, and long for a "better person- ality," who have no clear-cut idea of the direction in which improvement lies, nor what constitutes a "good personality. Time and again, I have seen confused and unhappy people "straighten themselves out," when they were given a goal to shoot for and a straight course to follow. They find themselves in a new role, and are not sure what kind of a person they are supposed to "be" in order to live up to that role. The Picture of Success In this chapter I am going to give you the same "pre- scription" that I would give you should you come to my office. He was like the skipper of a ship who had relinquished his hold upon the wheel, and hoped that he would drift in the right direction. He was like a mountain climber, who as long as he looked upward to the peak he wished to scale, felt and acted courageously and boldly. But when he got to the top, he felt there was nowhere else to go, and began to look down, and became afraid. He was now on the defensive, defending his present position, rather than acting like a goal-striver and going on the offensive to attain his goal. He regained control when he set himself new goals and began to think in terms of, "What do I want out of this job? Your trouble is you are trying to maintain your balance sitting still, with no place to go. When we have no personal goal which we are interested in and which "means something" to us, we are apt to "go around in circles," feel "lost" and find life itself "aimless," and "purposeless. People who say that life is not worthwhile are really saying that they themselves have no personal goals which are worthwhile. Get interested in some project to help your fellow man—not out of a sense of duty, but because you want to. You cannot react appropriately if the information you act upon is faulty or misunderstood. To deal effectively with a problem, you must have some understanding of its true nature. He is merely responding appropriately to what—to him—seems to be the truth about the situation. To give the other person credit for be- ing sincere, if mistaken, rather than willful and malicious, can do much to smooth out human relations and bring about better understanding between people. Opinion Many times we create confusion when we add our own opinion to facts and come up with the wrong con- clusion. When she stopped reacting just as if she had been personally insulted, she was able to pause, analyze the situation, and select an appropriate response. Be Willing to See the Truth Oftentimes, we color incoming sensory data by our own fears, anxieties, or desires.
In younger women who may desire to get pregnant in the future order azulfidine 500mg on-line diagnostic pain treatment center tomball texas, surgical treatment attempts to remove the stray endometrial tissue and preserve the ovaries order 500 mg azulfidine with amex pain treatment in rheumatoid arthritis. The dominant nonsurgical treatment is the use of hormonal medication that suppresses the natural menstrual cycle, plus pain medication to manage the discomfort. On occasions, naturopathic physicians will use natural progesterone therapy (a form of bioidentical hormone therapy) to help relieve the symptoms of endometriosis. Although progesterone creams may be available over the counter, we recommend being treated and monitored by a physician. The natural approach to endometriosis is designed to achieve the following goals: • Reduce inflammation • Enhance detoxification mechanisms • Reduce bothersome symptoms The strategies discussed in the chapter “Silent Inflammation” are extremely important in endometriosis. The consumption of trans-fatty acids appears to increase the risk of endometriosis, while long-chain omega-3 fatty acids from fish oils appear to be protective. Those women who consumed the most trans-fatty acids were 48% more likely to be diagnosed with endometriosis. In contrast, those women with the highest consumption of long-chain omega-3 fatty acids were 22% less likely to be diagnosed with endometriosis. The cell cultures were provided with nutrients and supplemented with various ratios of omega-3 polyunsaturated fatty acids and omega-6 polyunsaturated fatty acids (found in meat and dairy products, and in soy, safflower, corn, and sunflower oil). They found that the higher the ratio of omega-6 to omega-3 fatty acids, the greater the secretion of an inflammatory compound, interleukin-8, in cells from women both with and without endometriosis, with the cells from women with endometriosis secreting significantly higher levels. Foods high in fiber are associated with the growth of friendly microorganisms within the large intestine. Studies show that a high intake of fiber and a predominantly vegetarian diet lead to a decrease of biologically active free estrogens in blood plasma. Foods that are particularly helpful in this regard are vegetables in the brassica family, such as broccoli, brussels sprouts, cabbage, and cauliflower. Onions, garlic, and leeks contain organosulfur and flavonoid compounds, which enhance the immune system and encourage the production of liver enzymes that have a role in detoxification. Last, the isoflavones in soy products and the lignans in flaxseed may also be important in a dietary approach to endometriosis. A Japanese study demonstrated that moderate soy intake was associated with a decreased risk of premenopausal hysterectomy. Since some of the surgeries were due to endometriosis, these results led the authors to conclude that moderate soy intake may decrease the risk for endometriosis. The Environmental Protection Agency estimates that 90% of human pesticide exposure occurs through food, primarily meat and dairy products. In a two-month study of 50 women with endometriosis, a significant reduction in symptoms occurred when the intake of higher-glycemic carbohydrates and caffeine was decreased and the intake of omega-3 and omega-9 fatty acids (e. In one study, women consuming an average of more than 150 to 225 mg of caffeine per day (about the amount in 1 to 11/2 cups of coffee) had a 20% increased risk of endometriosis, while those consuming more than 225 mg had a 60% increase. Lipotropic supplements usually are a combination of vitamins and herbs designed to support the liver’s functions of removing fat, detoxifying the body’s wastes, detoxifying external toxins, and metabolizing and excreting estrogens. These lipotropic products vary in formulation depending on the manufacturer, but they are all similar. Research has shown that these compounds help to break down cancer-causing forms of estrogens to non-cancer-causing forms, making them especially important for women with endometriosis. Because Pycnogenol was shown to inhibit inflammation in a test tube study, researchers sought to evaluate its role in a study of 58 women with endometriosis. The women were randomly assigned to receive either Pycnogenol 30 mg twice per day for 48 weeks or an antihormonal drug, leuprorelin acetate, given by intramuscular injection every four weeks for 24 weeks. After four weeks on Pycnogenol, patients slowly but steadily improved, with their symptoms decreasing from severe to moderate. The leuprorelin group had a greater response within the treatment period but relapsed after 24 weeks. The Pycnogenol group maintained regular menses and normal estrogen levels during treatment; in contrast, the leuprorelin group had suppressed menstruation and drastically lowered estrogen levels (which were expected). However, their activity is certainly less that the effects of dietary phytoestrogens such as soy and flax. Vitex or chasteberry (Vitex agnus-castus) has traditionally been used as a treatment for hormone imbalances in women. Through action on the pituitary gland, it increases progesterone production by means of an increase in luteinizing hormone, with the effect of making estrogen less available.
