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Non-clinical data reveal no special hazard for humans based on conventional studies of repeated dose toxicity, genotoxicity, and carcinogenic potential. Reproduction toxicology studies in male rats have demonstrated reduced prostate and seminal vesicular weights, reduced secretion from accessory genital glands and reduced fertility index caused by the primary pharmacological effect of finasteride ; . The clinical relevance of these findings is unclear. As with other 5-alpha-reductase inhibitors, femininisation of male rat foetuses has been seen with administration of finasteride in the gestation period. Intravenous administration of finasteride to pregnant rhesus monkeys at doses as high as 800 ng day during the entire period of embryonic and foetal development resulted in no abnormalities in male fetuses. This represents at least 750 times the highest estimated exposure of pregnant women to finasteride from semen. In confirmation of the relevance of the Rhesus model for human fetal development, oral administration of finasteride 2mg kg day 100 times the recommended human dose or approximately 12 million times the highest estimated exposure to finasteride from semen ; to pregnant monkeys resulted in external genital abnormalities in male fetuses. No other abnormalities were observed in male fetuses and no finasteride-related abnormalities were observed in female fetuses at any dose.
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Cisapride and Food and Drug Administration regulatory actions. J Gastroenterol. 2001; 96: 1698-1703. Wysowski DK, Talarico L, Bacsanyi J, Botstein P. Spinal and epidural hematoma and low-molecular-weight heparin [letter]. N Engl J Med. 1998; 338: 1774-1775. Green L, Wysowski DK, Fourcroy JL. Gynecomastia and breast cancer during finasteride therapy [letter]. N Engl J Med. 1996; 335: 823. Wysowski DK, Fourcroy JL. Flutamide hepatotoxicity. J Urol. 1996; 155: 209-212. Pierce LR, Wysowski DK, Gross TP. Myopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy. JAMA. 1990; 264: 71-75. Wysowski DK, Green L. Serious adverse events in Norplant users reported to the Food and Drug Administration's MedWatch Spontaneous Reporting System. Obstet Gynecol. 1995; 85: 538-542. Malozowski S, Tanner LA, Wysowski DK, Fleming GA, Stadel BV. Benign intracranial hypertension in children with growth hormone deficiency treated with growth hormone. J Pediatr. 1995; 126: 996-999. Blum MD, Graham DJ, McCloskey CA. Temafloxacin syndrome: review of 95 cases. Clin Infect Dis. 1994; 18: 946-950. Graham DJ, Green L. Further cases of valvular heart disease associated with fenfluramine-phentermine [letter]. N Engl J Med. 1997; 337: 635. Rosa FW, Bosco LA, Graham CF, Milstien JB, Dreis M, Creamer J. Neonatal anuria with maternal angiotensin-converting enzyme inhibition. Obstet Gynecol. 1989; 74: 371-374. Arrowsmith JB, Creamer JI, Bosco L. Severe dermatologic reactions reported after treatment with tocainide. Ann Intern Med. 1987; 107: 693-696. Rossi AC, Bosco L, Faich GA, Tanner A, Temple R. The importance of adverse reaction reporting by physicians: suprofen and flank pain syndrome. JAMA. 1988; 259: 1203-1204. Wysowski DK, Barash D. Adverse behavioral reactions attributed to triazolam in the Food and Drug Administration's Spontaneous Reporting System. Arch Intern Med. 1991; 151: 2003-2008. Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis [letter]. N Engl J Med. 2002; 346: 539-540. Ahmad SR, Kortepeter C, Brinker A, Chen M, Beitz J. Renal failure associated with the use of celecoxib and rofecoxib. Drug Saf. 2002; 25: 537-544. Kahn LH, Alderfer RJ, Graham DJ. Seizures reported with tramadol [letter]. JAMA. 1997; 278: 1661. Faich GA, Moseley RH. Troglitazone Rezulin ; and hepatic injury. Pharmacoepidemiol Drug Saf. 2001; 10: 537-547. Zitelli BJ, Alexander J, Taylor S, et al. Fatal hepatic necrosis due to pyrimethaminesulfadoxine Fansidar ; . Ann Intern Med. 1987; 106: 393-395. La Grenade L, Graham D, Trontell A. Myocarditis and cardiomyopathy associated with clozapine use in the United States [letter]. N Engl J Med. 2001; 345: 224-225. Koller EA, Doraiswamy PM. Olanzapine-associated diabetes mellitus. Pharmacotherapy. 2002; 22: 841-852. Wysowski DK, Honig SF, Beitz J. Uterine sarcoma associated with tamoxifen use [letter]. N Engl J Med. 2002; 346: 1832-1833. Wysowski DK, Pitts M, Beitz J. An analysis of reports of depression and suicide in patients treated with isotretinoin. J Acad Dermatol. 2001; 45: 515-519. Lasser KE, Allen PD, Woolhandler SJ, Himmelstein DU, Wolfe SM, Bor DH. Timing of new black box warnings and withdrawals for prescription medications. JAMA. 2002; 287: 2215-2220. Temple RJ, Himmel MH. Safety of newly approved drugs: implications for prescribing [comment]. JAMA. 2002; 287: 2273-2275. US Food and Drug Administration. Risk management. Available at: : www .fda.gov oc mcclellan riskmngt . Accessed May 3, 2004. US Food and Drug Administration. FDA Talk Paper: November 23, 2004: FDA announces enhancement to isotretinoin risk management program. Available at: : fda.gov bbs topics ANSWERS 2004 ANS01328 . Accessed November 23, 2004. US Food amd Drug Administration. Drug products for the treatment and or prevention of nocturnal leg muscle cramps for over-the-counter human use: FDA: final rule. Fed Regist. 1994; 59: 43234-43252. US Food and Drug Administration. Drug products containing quinine for the treatment and or prevention of malaria for over-the-counter human use: FDA: final rule. Fed Regist. 1998; 63: 13526-13529.
He growing population of elderly persons in the United States has spawned the development of professional societies, medical subspecialties, and governmental institutions aimed at promoting health and wellbeing as well as scientifically exploring the aging process.1-3 Pain is common in the elderly, particularly in those over the age of 75 years.2 The incidence of pain rises from 34% in people aged 75-79 to 50% in those over 90 years old. The incidence of severe pain also increases with age, from 15% in those 7579 years old to 28% in individuals over 90 years old. Persistent pain is associated with depression and anxiety and other psychosocial comorbidities, impaired ability to perform activities of daily living and engage in social activities, and increased health care utilization and costs.1 Because of functional limitations and the overall lower quality of life in individuals with pain, the inadequate management of pain in the elderly can have very broad personal, health care, and societal consequences.
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In sum, the conditions that trigger stage-one entoptic percepts include certain pathologies including migraine ; , stroboscopic stimulation, hypnosis, hypnagogia, and, especially damaging for Helvenston and Bahn's argument, sensory deprivation. There is therefore no point in insisting, as they do, on finding traces of certain hallucinogens in site deposits. Is this a 'debate'? It needs to be emphasized that this conclusion is not a matter of 'interpretation' or 'opinion'. On the contrary, it is an empirical issue: the literature reports research showing that the full range of hallucinations, as encompassed by the three-stage model, call be experienced in circumstances that do not include drug ingestion, and, moreover, that the experiences derive from the structure of the human cortex. The way in which the three-stage model may be used or misused ; in research is another matter altogether. As I have argued, it is certainly no 'quick-fix' tool that can simply and by itself demonstrate the shamanistic context of an art Lewis-Williams 1991; 2001; 2002 ; . Acknowledgements I thank colleagues who kindly commented on drafts of this article. I also thank Etzel Cardefta and Dominic ffytche who provided indispensable information. The Rock Art Research Institute is funded by the University of the Witwatersrand, the National Research Foundation Grant numbers: 2053693 and 2053470 ; , and Anglo-American. David Leewis-Williams Rock Art Research Institute School of Geography, Archaeology and Environmental Studies University of tie Witwoatersrand Johannesburg 2050 South Africa E-mail: david rockart.woits.ac.za.
In fact minoxidil, finasteride and nizoral are often known as the big it is quite expensive but does not need to be used every day to have an effect and fluconazole.
The fat-soluble part of these berries has been shown to inhibit the conversion of testosterone into the active form, much like finasteride.
Finasteride is a 5 alpha-reductase inhibitor and inhibits the conversion of testosterone to the active dht and galantamine.
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Finasteride predictably reduces total serum prostatespecific antigen psa ; , an effect that appears to plateau after approximately 6 months of therapy and glibenclamide.
To establish normal values, we measured ZPP in 130 healthy individuals without iron deficiency. The mean SD ; ZPP in whole blood was 50.9 7.8 ; mol mol heme. In washed erythrocytes, the mean ZPP was 32.8 6.7 ; unol mol heme. There was no significant difference between male and female subjects. In 181 patients without anemia and without iron deficiency Figure 1 ; , ZPP concentrations were above normal in whole-blood samples but returned to normal when the erythrocytes were washed before the assay. These 181 patients included patients with leukemia n 34 ; , carcinomas n 29 ; , diseases associated with immune hemolysis n 15 ; , acute inflammatory diseases n 39 ; , inflammatory and degenerative liver diseases n 31 ; , and biliary tract diseases n 19 ; . dialysis patients with kidney disease, ZPP concentrations measured before dialysis were above normal in CLINICAL CHEMISTRY, Vol. 38, No. 1 1992.
Ahlawat R.K., Bhandari M, Kumar A, Kapoor R.K., Tewari A. Factors affecting success of Eswl of ureteric calculi. Abstracted International Journal of Endourology, 1991. Tewari A, Khan A, Krishna R, Mantri M, And Bhandari M, Color Doppler: Noninvasive modality for diagnosis and follow-up of vesicoureteric reflux. Abstracted American Society of Nephrology, Baltimore. Abstracted Am. J. of Nephrology 1992. Ward RG, Tewari A, Bone GM, Sells RA, Roberts N., Cyclosporin absorption profiles: need of luxury in routine transplant monitoring. Abstracted British Transplant Society Meeting, October 1992. Ahlawat RK, Bhandari M, Kumar A, Kapoor RK, Tewari A. Factors affecting success of ESWL of ureteric calculi. Abstracted International Journal of Endourology, 1991. Tewari A, Wolf A, Mahmood L, Jacob G, Gajendran V, Narayan P: Differential suppression of serum prostatic acid phosphatase PAP ; and prostate specific antigen PSA ; By Finasteride. Abstract, AUA Western Section 1994. Tewari A, Jacob G, Narayan P. Differential suppression of serum prostatic acid phosphatase and prostate specific antigen by finasteride. # 287, UAU, 1995, Las Vegas, NV. Narayan P, Gajenderan, V, Tewari A.: Use of systemic biopsy, gleason score, and preoperative serum Psa in prediction of final pathology of prostate cancer. # 799, AUA 1994, Las Vegas, NV. Narayan P, Tewari A: Impact of prostate size on the out come of laser and randomized study comparing TUEP and VLAP. # 11, AUA, Las Vegas, NV. Perinchery N, Viswanathan G, Tewari A, Fournier G: PSA progression following radical prostatectomy. AUA Western Section, Seattle, WA 1994. Gajenderan V, Tewari A, Narayan P: The role of PSA velocity as a predictive determinant of response to radiotherapy for recurrent prostate cancer after radical prostatectomy. # 890, AUA, 1995, Las Vegas, NV. Gajenderan V, Tewari A, Narayan P: Racial difference in preoperative assessment of prostate cancer. AUA SE Section, April 2, Orlando, 1995. Rehman J, Gajendran V, Tewari A, Jacob G, Narayan P: The role of radical prostatectomy in the incidence of local and systemic recurrence in patients with d1 prostatic cancer. Abstract, AUA Western Section 1994. Narayan P, Indudhara R, Fournier G, Tewari A, Jacob G: Randomized study comparing coagulation and evaporation techniques of laser prostatectomy using nd: yag laser. Preliminary results. Abstract, AUA Western Section, 1994. Shinohara K, Tewari A, Jacob G, Indudhara R, Narayan P: Prostatic transition zone ratio TZR ; : a better predictor for peak urinary flow rate improvement following finasteride therapy in BPH patients. Abstract AUA Western Section 1994. 31 and glucovance.
Thigpen, A.E., Cala, K.M., Russell, D.W., 1993. Characterization of Chinese hamster on vary cell lines expressing human steroid 5 reductase isozymes. Journal of Biological Chemistry 268, 17404 17412. Thompson, I.M., Phyllis, J., Goodman, P.J., Tangen, C.M., Scott Lucia, M., Miller, G.J., Ford, L.G., Lieber, M.M., Duane Cespedes, R., 2003. The influence of finasteride on the development of prostate cancer. The New England Journal of Medicine 349, 215224.
Anderson and Baird Male Contraception iniferous tubules and interstitial tissue. J Clin Endocrinol Metab 37: 454 460 Rivarola MA, Podesta EJ, Chemes HE, Calandra RS 1975 Andro gen metabolism and concentration in the seminiferous tubules at different stages of development. J Steroid Biochem 6: 365369 Thigpen AE, Silver RI, Guileyardo JM, Casey ML, McConnell JD, Russell DW 1993 Tissue distribution and ontogeny of steroid 5 -reductase isoenzyme expression. J Clin Invest 92: 903910 Viger RS, Robaire B 1995 Steady state steroid 5 -reductase messenger ribonucleic acid levels and immunocytochemical localization of the type 1 protein in the rat testis during postnatal development. Endocrinology 136: 5409 5415 Pratis K, O'Donnell L, Ooi GT, McLachlan RI, Robertson DM 2000 Enzyme assay for 5 -reductase type 2 activity in the presence of 5 -reductase type 1 activity in rat testis. J Steroid Biochem Mol Biol 75: 82 Ahmad N, Haltmeyer GC, Eik-Nes KB 1973 Maintenance of spermatogenesis in rats with intratesticular implants containing testosterone or dihydrotestosterone DHT ; . Biol Reprod 8: 411 419 Chen H, Chandrashekar V, Zirkin BR 1994 Can spermatogenesis be maintained quantitatively in intact adult rats with exogenously administered dihydrotestosterone? J Androl 15: 132138 O'Donnell L, Stanton P, Wreford NG, Robertson DM, McLachlan RI 1996 Inhibition of 5 -reductase activity impairs the testosteronedependent restoration of spermiogenesis in adult rats. Endocrinology 137: 27032710 Pratis K, O'Donnell L, Ooi GT, McLachlan RI, Robertson DM, Differential regulation of 5 -reductase type 1 and type 2 activity in rat testis. 11th International Congress of Endocrinology, Sydney, Australia, 2000, Abstract P197 McLachlan RI, McDonald J, Rushford D, Robertson DM, Garrett C, Baker HWG 2000 Efficacy and acceptability of testosterone implants, alone or in combination with a 5 -reductase inhibitor, for male contraception. Contraception 62: 7378 Kinniburgh D, Anderson RA, Baird DT 2001 Suppression of spermatogenesis with desogestrel and testosterone pellets in not enhanced by addition of finasteride. J Androl 22: 88 95 Dorrington JH, Armstrong DT 1975 Follicle-stimulating hormone stimulated oestradiol-17 synthesis in cultured Sertoli cells. Proc Nat Acad Sci USA 72: 26772681 Tsai-Morris CH, Aquilano DR, Dufau ML 1985 Cellular localization of rat testicular aromatase activity during development. Endocrinology 116: 38 46 O'Donnell L, Robertson KM, Jones ME, Simpson ER 2001 Estrogen and spermatogenesis. Endocr Rev 22: 289 318 Saunders PTK, Millar MR, Macpherson S, Irvine DS, Groome NP, Evans LR, Sharpe RM, Scobie GS 2002 ER 1 and the ER 2 splice variant ER cx 2 ; are expressed in distinct cell populations in the adult human testis J Clin Endocrinol Metab 87: 2706 2715 Cooper TG 1992 Epididymal proteins and sperm maturation. In: Nieschlag E, Habenicht U-F, eds. Spermatogenesisfertilization contraception. Molecular, cellular and endocrine events in male reproduction. Berlin: Springer-Verlag; 285318 Sonnenberg-Riethmacher E, Walter B, Riethmacher D, Godecke S, Birchmeier C 1996 The c-ros tyrosine kinase receptor controls regionalization and differentiation of epithelial cells in the epididymis. Genes Dev 10: 1184 1193 Kirchhoff C 1999 Gene expression in the epididymis. Int Rev Cytol 188: 133202 Shetty J, Diekman AB, Jayes FC, Sherman NE, Naaby-Hansen S, Flickinger CJ, Herr JC 2001 Differential extraction and enrichment of human sperm surface proteins in a proteome: identification of immunocontraceptive candidates. Electrophoresis 22: 30533066 Wolner-Hanssen P, Svensson L, Mardh PA, Westrom L 1985 Laparoscopic findings and contraceptive use in women with signs and symptoms suggestive of acute salpingitis. Obstet Gynecol 66: 233238 Plummer FA, Simonsen JN, Cameron DW, Ndinya-Achola JO, Kreiss JK, Gakinya MN, Waiyaki P, Cheang M, Piot P, Ronald AR 1991 Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis 163: 233239 Baeten JM, Nyange PM, Richardson BA, Lavreys L, Chohan B, Martin Jr HL, Mandaliya K, Ndinya-Achola JO, Bwayo JJ, Kreiss JK 2001 Hormonal contraception and risk of sexually transmitted and inderal.
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Of Natural Products. St. Louis, MO: Facts and Comparisons; 2000. Paubert-Braquet M, et al. Effect of Pygeum africanum extract on A23187-stimulated production of lipoxygenase metabolites from human polymorphonuclear cells. J Lipid Mediat Cell Signal 1994; 9: 285-290. Marcoli M. Anti-inflammatory and antiedemigenic activity of extract of Pygeum africanum. New Trends Androl Sci 1985; 1: 89. McCutcheon AR. Pygeum. In: Chandler F, ed. Herbs: Everyday Reference for Health Professionals. Ottawa: Canadian Pharmacists Association; 2000: 176-178. Math G, et al. The so-called phyto-estrogenic action of Pygeum africanum extract. Biomed Pharmacother 1995; 49: 339-340. Yablonsky F, et al. Antiproliferative effect of Pygeum africanum extract on rat prostatic fibroblasts. J Urol 1997; 157: 2381-2387. Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia. A review of 25 years of published experience. Curr Ther Res 1995; 56: 796-817. Barlet A, et al. Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: Evaluation of objective and subjective parameters. A placebo-controlled double-blind multicenter study [in German]. Wien Klin Wochenschr 1990; 102: 667-673. McQueen CE, Bryant PJ. Pygeum. J Health Syst Pharm 2001; 58: 120-123. Ishani A, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: A systematic review and quantitative meta-analysis. J Med 2000; 109: 654-664. Chatelain C, et al. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: A randomized, double-blind study, with long-term open label extension. Urology 1999; 54: 473-478. Iehl C, et al. Human prostatic steroid 5 alpha-reductase isoforms--a comparative study of selective inhibitors. J Steroid Biochem Mol Biol 1995; 54: 273-279. Strauch G, et al. Comparison of finasteride Proscar ; and Serenoa repens Permixon ; in the inhibition of 5-alpha reductase in healthy male volunteers. Eur Urol 1994: 26: 247-252. Wilt T, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: A systematic review. JAMA 1998; 280: 1604-1609. Descotes JL, et al. Placebo-controlled evaluation of the efficacy and tolerability of Permixon in benign prostatic hyperplasia after exclusion of placebo responders. Clin Drug Invest 1995; 9: 291-297. Bach D, Ebeling L. Long-term drug treatment of benign prostatic hyperplasia--results of a prospective 3-year multi-center study using Sabal extract IDS 89. Phytomedicine 1996; 3: 105-111. Carraro JC, et al. Comparison of phytotherapy Permixon ; with finasteride in the treatment of benign prostate hyperplasia: A randomized international study of 1, 098 patients. Prostate 1996; 29: 231-240.
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Gastrointestinal Antineoplastics Antineoplastics Gastrointestinal Psychotherapeutic Drugs Central Nervous System Agents FELBATOL TABLET Central Nervous System Agents felodipine tab. sr 24h Cardiac Drugs FEMARA TABLET Antineoplastics fenofibrate, micronized capsule Cardiovascular Cardiovascular fenofibrate, micronized tablet fenoprofen calcium tablet Antiarthritics fentanyl citrate pf vial Analgesics Pain Management fentanyl patch td72 Analgesics Pain Management fexofenadine hcl tablet Antihistamines Miscellaneous Products ifnasteride tablet flavoxate hcl tablet Miscellaneous Products Cardiac Drugs flecainide acetate tablet FLOMAX CAP. SR 24H Miscellaneous Products FLOVENT AEROSOL Antiasthmatics FLOVENT HFA AER W ADAP Antiasthmatics FLOVENT ROTADISK DISK W DEV Antiasthmatics FLOXIN DROPERETTE Eye, Ear, Nose & Throat Agents FLOXIN DROPS Eye, Ear, Nose & Throat Agents floxuridine vial Antineoplastics fluconazole susp recon Antiinfectives Antifungal Antiviral fluconazole tablet Antiinfectives Antifungal Antiviral fluconazole Antiinfectives dextrose-water piggyback Antifungal Antiviral fluconazole sodium chloride piggyback Antiinfectives Antifungal Antiviral fludarabine phosphate vial Antineoplastics fludrocortisone acetate tablet Hormones flunisolide spray Eye, Ear, Nose & Throat Agents Effective Date January 1, 2007 and kamagra.
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1. Evidence-based medicine: A new approach to teaching the practice of medicine. Evidence-Based Medicine Working Group. JAMA 1992; 268: 2420 Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. 2nd ed. Boston: Little, Brown, 1991. 3. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ 1995; 310: 1122 Fineberg HV. Clinical evaluation: how does it influence medical practice? Bull Cancer 1987; 74: 333 Chalmers TC. The impact of controlled trials on the practice of medicine. Mt Sinai J Med 1974; 41: 7539. Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA 1998; 279: 8757. Bungard TJ, Ghali WA, Teo KK, McAlister FA, Tsuyuki RT. Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 2000; 160: 41 Lamas GA, Pfeffer MA, Hamm P, Wertheimer J, Rouleau JL, Braunwald E. Do the results of randomized clinical trials of cardiovascular drugs influence medical practice? The SAVE Investigators. N Engl J Med 1992; 327: 2417. Furberg CD. The impact of clinical trials on clinical practice. Arzneimittelforschung 1989; 39: 986 Ayanian JZ, Hauptman PJ, Guadagnoli E, Antman EM, Pashos CL, McNeil BJ. Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med 1994; 331: 1136 Turner B, McKee L, Fanning T, Markson LE. AIDS specialist versus general ambulatory care for advanced HIV infection and impact on hospital use. Med Care 1994; 32: 90216. Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care. Results from the Medical Outcomes Study. JAMA 1992; 267: 1624 Donohoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med 1998; 158: 1596 Garfield E. Which medical journals have the greatest impact? Ann Intern Med 1986; 105: 31320. Garfield E. How can impact factors be improved? BMJ 1996; 313: 4113. Liberman UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995; 333: 1437 De Fronzo RA, Goodman AM. Efficacy of metformin in patients with noninsulin-dependent diabetes mellitus. The Multicenter Metformin Study Group. N Engl J Med 1995; 333: 5419. Lepor H, Williford WO, Barry MJ, et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Stud.
Subgroup or chemical substance Other dermatologicals Minoxidil Vinasteride Tacrolimus Pimecrolimus Diclofenac GENITO URINARY SYSTEM AND SEX HORMONES GYNECOLOGICAL ANTIINFECTIVES AND ANTISEPTICS ANTIINFECTIVES AND ANTISEPTICS, EXCL. COMB. WITH CORTICOSTEROIDS Antibiotics Clindamycin Quinoline derivatives Broxyquinoline Imidazole derivatives Metronidazole Clotrimazole Miconazole Econazole Tioconazole OTHER GYNECOLOGICALS OXYTOCICS Ergot alkaloids Methylergometrine Prostaglandins Dinoprostone CONTRACEPTIVES FOR TOPICAL USE Intrauterine contraceptives Plastic IUD with progestogens Intravaginal contraceptives Vaginal ring with progestogen and estrogen OTHER GYNECOLOGICALS Prolactine inhibitors Bromocriptine Cabergoline Quinagolide Other gynecologicals Atosiban and ketoconazole and finasteride.
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Teride for up to 9 days. At 4 days prostate weight of intact controls ventral prostate weight 24 mg 55% 22 mg 45% in finasteride-treated in castrated from intact intact ventral subsequently the weight each of their ofcontrol ; , of control ; . rats, rats and lamisil.
Finasteride is the first 5-alpha-reductase inhibitor to be used in urological clinical practice. The biological rationale for using this compound in the treatment of BPH came from an early observation that patients with 5alpha-reductase deficiency had non-palpable prostates 1 ; . Today, after the completion of many trials, there is no doubt that finasteride can reduce the size of the prostate gland by 20-30%. It improves symptom scores by approximately 15% and can also cause a moderate improvement in urinary flow rate of 1.3-1.6 ml s 2-4 ; . The efficacy of finasteride, however, was questioned by a study published in 1996 which showed that terazosin monotherapy and terazosin plus finasteride were more effective than finasteride monotherapy or placebo 5 ; . Indeed, finasteride in this study was no more effective than placebo. A meta-analysis of six randomized clinical trials with finasteride was performed because the results of this study conflicted with those of all previous trials 6 ; . The main conclusions of the meta-analysis were that baseline prostate volume was a key predictor of various treatment outcomes and that finasteride was more effective in prostates larger than 40 mL. During the Fourth International Consultation on Benign Prostatic Hyperplasia that took place in Paris in 1997, all the available data on this medical treatment option were analysed and the recommendation was: "Finasteride is less effective in men without enlarged prostates. Given its minimal side-effects finasteride should be considered an acceptable treatment option in men with clinically enlarged prostates" 7 ; . Recently, the Finaster9de Urodynamics Study Group published the results of two studies verifying the above recommendation. In the first study it was shown that improvement in pressure-flow parameters with finasteride was greater in men with large prostates than in those with smaller prostates 8 ; . In the second study, a modest, but statistically significant, correlation between detrusor pressure and prostate size was found, supporting the hypothesis that prostate size is important in deciding between various medical treatment options for BPH 9 ; . Another study by Lepor et al. again questioned the efficacy of finasteride in improving the patient's quality of life, and claimed that baseline prostate volume was not a predictor of response to finasteride. However, the mean prostate volume of the patients included in this trial was less than 40 mL 10 ; Two important trials published since 1996 concluded that finasteride significantly reduced acute urinary retention and the need for surgical treatment in men with BPH 11, 12 ; . As the reduction in prostatectomy and acute urinary retention rates was rather small, the cost of achieving these results has been questioned 13 ; . The long-term effects of finasteride have also been examined. The North American Ginasteride Study Group recently reported that patients treated with finasteride maintained a reduction of prostate volume and an improvement in symptom score and maximal urinary flow rate over 5 years 14 ; . The PROWESS Study Group 15 ; also found that finasteride caused long-term symptomatic improvement and verified the results of other reports 11, 12 ; discussed above. The risk of developing acute urinary retention or of needing surgery was also found to be reduced 15 ; . In addition, the Scandinavian Finasteridr Study Group has verified an earlier observation that the maximum efficacy of finasteride action is obtained after 6 months, and has shown that this improvement could be maintained for at least 6 years 16 ; . The mechanism through which finasteride accomplishes its long-term effects has also been examined 17 ; . Finastdride was shown to cause progressive contraction of the prostatic epithelium in the peripheral and transition zones, and this contraction was demonstrated to continue for many months after clinical improvement had been established. The combination of finasteride with an alpha1-blocker has been examined in two clinical trials 5, 18 no additional benefit from combining these two drugs was observed in either study. Another important benefit of finasteride in common clinical urological practice is that it can be used to treat haematuria associated with BPH. Two studies have confirmed this alternative for patients with haematuria due to BPH who, at the same time, had no significant obstruction or adenocarcinoma of the prostate 19, 20 ; . Side-effects: These are mainly related to sexual function. Ejaculation disorders, impotence and decreased libido have been reported in 12% of patients receiving finasteride; these figures were higher than those observed for placebo 7 ; . Such side-effects were considered "minimal" by the World Health Organization WHO.
Validation of animal model. The implants of testosterone were validated for constant delivery. Rats n 30 ; were castrated and implanted with 5 mg testosterone pellets and killed on days 0, 2, 4, 8, and 11. Serum testosterone and prostate weight were stable for at least 11 d and maintained in the range 349 18 ng dl and 0.447 0.015 g, respectively. There was no significant variation over time for either serum testosterone or prostate weight. Intraprostatic androgen dose responses. Mean intraprostatic testosterone and DHT concentrations were 0.62 0.23 and 17.8 1.8 ng g n intact animals, 0.84 0.29 and 0.42 0.18 ng g in castrated animals n 8 ; , and 19 0.61 and 0.98 0.17 ng g in intact animals given finasteride n 5; 40 mg kg d ; . In castrated rats given testosterone pellets in the presence or absence of treatment with finasteride, the relationship between intraprostatic androgen concentration and serum testosterone is illustrated in Fig. 1. The two curves appear to have a biphasic relationship with a more rapid rise in intraprostatic androgen concentration at low concentrations of serum testosterone. In the intraprostatic DHT dose response, the maximum intraprostatic testosterone concentration was 1.29 ng g Fig. 1 ; . In the intraprostatic testosterone dose response, the maximum intraprostatic DHT was also 1.29 ng g Fig. 1 ; . There was no significant increase in these concentrations with increasing dose of testosterone pellets. Prostate weight. Prostate weight varied linearly with intraprostatic DHT r 0.971, P 0.006 ; and testosterone r 0.975, P 0.001 ; concentrations Fig. 2 ; . The slopes derived for the two dose responses were significantly different from each other P 0.01 ; . Analysis of the slopes demonstrated that within the prostate, DHT was 2.4 times as potent as tes2559.
T is estimated that 24% to 90% of US men older than the age of 40 have enlarged prostate EP ; , also known as benign prostatic hyperplasia BPH ; .1 However, the majority of these men are undiagnosed due to the fact that men often seek care for acute medical problems rather than conditions that are chronic or preventive in nature.2, 3 Even with this lack of formal diagnosis, almost 14% of men will seek care for EP.1, 4 Although these numbers are certainly promising, a recent study indicated that men aged 50 years or older who initiate treatment for EP have a 19.2% chance of having acute urinary retention AUR ; or prostate surgery within 1 year after treatment initiation.4 These high rates of AUR and prostate surgery should not be surprising given that more than 85% of men treated for EP are treated with alpha blocker therapy, 4 which does not reduce the size of the prostate even though urinary symptoms are improved.5 In contrast, the 5-alpha reductase inhibitors 5ARIs ; , dutasteride and finasteride, have been shown to reduce prostate size, thereby reducing the likelihood of AUR and prostate surgery.5-7 Although the different rationales for initiating alpha blocker or 5ARI therapy are well known, differences within the 2 therapeutic classes may be less clear, especially when comparing dutasteride and finasteride, the only two 5ARIs in the US market. Although both products are classified as 5ARIs, they have different mechanisms of action. Dutasteride blocks both the type-1 and type-2 5-alpha reductase isozymes, whereas finasteride inhibits type-2 5-alpha reductase isozymes only.6, 7 The dual mechanism of action of dutasteride results in 50% more dihydrotestosterone DHT ; suppression. Additionally, dutasteride has a longer half-life than finasteride. As discussed by Issa et al and Naslund et al in this supplement, in retrospective, real-world outcome studies, patients taking dutasteride had a lower likelihood of AUR and discontinued alpha blocker therapy earlier than finasteride patients. These data suggest that patients who initiate dutasteride rather than finasteride might require less resource utilization. However, no studies have directly compared the economic differences between the 2 drugs. The.
Vaccination to strengthen immune responses to eliminate tumor development and infectious diseases. Strong focus within the 3 research lines is on the study of antigen presenting cells such as dendritic cells DC ; and macrophages MQ ; , how they are suppressed by the tumor microenvironment e.g. stromal cells, chemokines, secretion of inhibitory factors ; and pathogens, to silence their immune stimulating immune responses, and induce regulatory T cells. Tumor antigens, such as CEA, MUC1 and virally derived antigens, and post-translational modifications of tumors and pathogens form major focus elements employing proteomics and glycomics. To come towards pre-clinical immune strategies studies on in vitro and in vivo targeting of tumor antigens to DC and MQ is fully explored as well as adoptive transfer of tumor-specific T cells. Both innate and adaptive components of the immune system in the relation with their microenvironment such as stromal cells, that may steer immune responses during infectious diseases as well as tumor development, are therefore studied. Perspectives Within the next five years we aim to have identified immunological parameters on molecular and cellular basis that have immune suppressive activity due to modifications in pathological situations, such as tumor development and invading pathogens. These immune regulatory parameters may lie in the field of tumor micro-environment, altered glycosylation, altered DC MQ function, understanding the induction of regulatory T cells preceding and during tumor development and infectious diseases. We envisage that a good combination of basic research that forms the basis of understanding escape mechanisms for immune activation will help to create innovative pre-clinical strategies to come to a better treatment of cancer and infectious diseases. The following keys were identified in program 2: 1. Strong DC biology and preclinical knowledge and experimental setting 2. Strong expertise in glycobiology and related tools for research 3. Excellent setting for performing human immunology based research 4. Presence of unique murine tumor-models as well as tolerance induction models 5. Strong expertise in lymph node development 6. Well developed adoptive transfer technology and tetramer technology 7. Unique setting of various pathogen related research and technology Summary of the research aims for the coming 5 years: 1. Within the next five years we envisage setting out strategic ways to target DC in vivo with tumor antigens receptor-targeting, adeno-viral targeting, altered-glycan-targeting ; with a special focus on improving treatment of colon carcinoma, breast, melanoma and virally induced malignancies. Focus will lay in targeting DC in vivo in such a way that both tumor specific CTL and T-helper cells are induced. For adoptive transfer purposes, we aim at generating and redirecting high avidity cytotoxic and helper T cells against virally induced malignancies such as anogenital cancers, head and neck cancers and lymphomas, as well as against non-virally induced malignancies. 2. In the field of infection inflammation due to invading pathogens we will especially focus on the role of stromal cells in regulating the defence mechanisms by innate cells and how this influx may be suppressed for instance in peritoneal dialysis-patients and rheumatoid arthritis patients, and the crucial role of chemokines in this process. Collaboration in VUmc: Projectleaders with projects in program 2 are based at the departments of Molecular Cell Biology, Medical Microbiology and Infection, Dermatology, Hematology, Medical Oncology and Pathology. We will further define and strengthen the different sub-themes within our program. We aim at achieving synergy by combining know-how and technical skills. Collaboration outside VUmc: We will set up monthly immunology seminars in which we invite top-researchers within the field of immunology and tumor immunology to give a seminar, and visit senior scientists within program 2 to discuss their work. This will give the scientist within program 2 an opportunity to present their work to leaders in the field which may improve their quality as well as their international exposure. We aim at promoting the PhD students to actively participate in the after- ; seminar discussions, in order to improve their skills in questioning and answering. We think this will be an excellent opportunity and learning process for the junior and senior scientists, for example, cheapest finasteride.
If patients have asthma that is quickly getting worse, the use of the drug combination should be avoided and flagyl.
With minoxidil: studies have shown that combining oral finasteride tablets ; and topical minoxidil lotion ; produces better results than just taking the tablets or using the topical medication alone.
APPENDIX 1: LIST OF SINGLE INGREDIENT AND LIQUID PRODUCTS a. Capsule b. Tablet c. Liquid * Homeopathic.
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Finasteride is a potent inhibitor of 5-alpha reductase and can be given orally as a 5mg once-daily dose.
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