2012년 7월 29일 일요일

가열식 화침


가열식 화침요법은 오승규 원장이 기존의 온침요법을 변형 개발하여, 인대, 건질환에 대해 사용됨.

<신용승, 화침요법에 관한 문헌적 고찰, 2003>


손상된 인대의 회복에 대한 온침의 효과, 2006

허동석

우측 뒷발 족관절 염좌를 유발한 쥐들을 4주와 8주 후 각각에 대하여 매주 1회 6주간 환측 족관절 전외측 부위에 온침을 시행함.
인대조직을 박리하여 western blotting and immunofluorescence, RT-PCR에 의하여 단백을 분석하기 위해 사용함. Hoechst 염색법은 각 세포수를 측정하고, Masson's trichrome 염색법은 콜라겐 섬유를 시각화 하는데 사용함.

섬유아세포 핵의 수 증가.
type III 콜라겐 mRNA와 단백질 발현 증가.
콜라겐 섬유의 시각적 강도 증가.
건에서도 유의성 있는 회복 정도를 보였으나, 인대에 비해 그 변화폭이 적어 건보다는 인대에 더욱 효과적으로 보임.




No injury 군(n=6)
only injury 군(n=6)
prolotherapy 군(n=14)
 0.1ml(12.5% 포도당 용액)
warming acupuncture(n=20)


















내측 측부인대 손상 환자의 가열식 화침 치험 1례, 2009

고경모, 김재수, 이봉효, 정태영, 임성철, 이경민

大邱韓醫大學校 濟韓東醫學術院

여자 77세. 좌측 슬부동통 호소. 퇴행성 관절염 치료 당시로부터 10년전 진단.
초진 당시 내측 측부인대 부위 자발통, 압통, 부종, 열감, 내슬안 부위 동통, 보행시 통증 악화, 관절 불안정성 보임.


치료방법
측부인대 기시부위는 관절면과 평행하게 선을 긋고 4개 침시술, 그 상방으로 3개의 침 시술을 한다.
종지 부위를 관절면과 수평으로 표시하고 4개 침시술, 하방으로 3개의 침 시술을 한다.
0.7mm * 10cm 침 사용.
가스 토치를 사용하여 피부로부터 2cm 가량 떨어진 지점을 가열하며 각 침체 당 약 30초 가량이 필요하다.
가열 과정은 2회 이상 반복하지 않는다.
가열시 따끔하거나 뜨겁다는 느낌을 호소하면 해당 침체의 가열을 중지하고 그 옆의 침체를 가열한다.
2일 간격으로 3회 시술함.

일주일 입원동안 가열식 화침, 한약치료, 물리치료 모두 적용됨. VAS 5로 감소되었다고 보고함.




가열식 화침을 이용한 외상성 내측측부인대 손상 치험 5례, 2010

이광호, 유영진, 선승호, 권기록

大韓鍼灸學會誌

외상에 의한 슬관절 통증 호소하는 환자 중 valgus stress test 양성, tenderness 양성 환자 5명

0.40mm * 40mm 침을 사용하여 0.8-1.0cm 간격으로 침을 자입하여 환자마다 15~20개의 침을 사용
침첨이 골막에 닿도록 자입함
가열 전 주변 부위가 화상 입지 않도록 반창고로 보호한 후 피부에서 1.3~1.5cm 떨어진 지점의 침체를 가열하고, 침체를 번갈아 가열하되, 각각 2-3회 정도 가열함



가열식 화침 이외에 다른 치료는 병행하지 않음.






요통에 대한 추나요법과 가열식 화침 병행 치료의 효과, 2011

장동호, 배우열, 정종훈, 이인선

韓方再活醫學科學會誌




3회 이상의 시술을 받은 43명(실험군 20명, 대조군 23명)을 대상
실험군 - 장골 후방회전변위 교정법과 천장관절 가열식 화침 요법을 병행
대조군 - 장골 후방회전변위 교정법으로만 치료

실험군으로 분류된 20명의 환자에게는 일반적인 침치료를 먼저 시행한 후, 장골 후방회전변위 교정법과 천장관절 가열식 화침 시술을 하였다.
하지길이 비교를 통하여 장골 후방회전변위, 장골 후방회전 & 천골 측굴변위로 나누어 교정법을 시행하였고,
교정 이후 양측의 하지길이가 일치된 상황에서 천장관절에 0.50x60mm의 1회용 호침을 후상장골극 내측 20 mm 및 하부 10 mm 정도에 35mm의 심도로 환자가 뻐근한 느낌을 호소할 때 까지 자침한 이후
피부에서 10mm 떨어진 침체 부위를 가스라이터를 이용하여 열을 가하여 환자가 뜨겁거나 따끔거림을 호소하거나, 침 주위의 피부에 수포가 보이면 가열을 중단하고 5~6초 경과 후에 열감이 소설됨을 확인하고 재차 가열하여 총 3회 정도 가열하였다.
치료는 3일에 1회씩 시행하여 주 2회 치료하였다.

대조군은 23명의 환자를 대상으로 일반적으로 사용하는 체침 치료를 하였다. 침치료 방법은 실험군과 동일.
장골 후방회전변위 교정법도 동일하게 시행하였다.
대조군 역시 다른 치료법은 본 연구의 치료효과 검증을 위하여 배제하였다.







슬개건 및 후방십자인대 손상을 동반한 슬내장증 환자에 대한 치험 1례 - 가열식 화침 치료 및 운동 치료를 중심으로 -, 2011

김민철, 주원상, 박가영, 박은영, 박진수, 김에스더, 김성호

韓方再活醫學科學會誌

교통사고로 인한 슬개건 및 후방 십자인대 손상을 동반한 슬내장증 호소하는 남성 22세.
MRI 상 R/O) partial tear of prox. PCL, Lt.
post. drawer test 양성

환자를 앙와굴슬위를 취하게 한 후 슬개골(patella) 하연으로 촉진을 통하여 병소의 위치를 확인하고 표시를 하였다.
시술 전 해당부위를 소독한 후 표시 된 부위에 0.40x40 mm 1회용 호침을 사용하였으며,
1 回/7-10 日(총 3회) 시술로
침 배열 간격은 0.8-1.0 cm로 하였고
자침 후 10분간 유침 하였으며,
자침 심도 는 0.8-1.2 cm로 하였다.
가열 시간은 10-15초로 자침 부위에서 약 1.3-1.5 cm 떨어진 부위의 침체를 3회씩 가열하였으며
가열 도구는 byte GAS IRON(KT-2001, Kovea Ltd., Korea) 을 이용하였다
가열 전후로 환부를 소독 및 보호하였다,

3회의 가열식 화침 시술
4주가 매일 정경침 시술
한방물리요법 시행
안정가료(1주)-체중 부하운동(2주)-능동운동, 수동운동, 등척성 저항운동, 등장성 운동(3주 이후) 시행
한약 투여


하슬개건에만 가열식 화침을 적용한 것으로 보임.

표시한 부분은 가열식 화침 시술일



가열식 화침(火鍼)을 이용한 방아쇠수지 치험 2례, 2011

이철휘, 박민규, 강일아, 신민근, 서상경, 윤광식, 이창희, 이재민

大韓鍼灸學會誌

침은 0.40 * 40mm 호침 사용
자침 부위는 palmar lig. of MCP jt. 주위 압통, 경결처 4군데 선혈.
침첨이 골막에 닿도록 자침한 후 침체 가열. 1회 열자극.

74세 여성, 우측 4th MCP 관절부위 통증, 방아쇠 현상
12일간 매일 시술함
이후 외래 진료 중 7회 시술하여 양호한 결과(tanaka score 0)를 얻음

52세 남성, 좌측 3rd MCP 관절부위 통증, 방아쇠 현상
약 2달동안 화침치료 16회 시술 후 양호한 결과(tanaka score 2)를 얻음




2012년 7월 28일 토요일

전열침

전열침

溫鍵이나 뜸을 이용한 열자극 치료가 인대나 건 병변에 효과가 있는 것을 착안하여 스테인리스 침을 자침한 후 침체를 직접 가열하여 병소에 열자극을 전달하는 방법이다.
뜸보다 심부조직에 열자극을 가할 수 있고 溫鍵보다 높은 온도로 자극하고 가열하는 화력의 세기로 침체의 온도를 조절할 수 있다.

전열침은 화침요법과 온침요법을 결합한 것으로 치밀결합조직의 심부 병소에 침을 자입한 후 가열하는 치료법

섬유-골막 연접부는 침끝이 골막에 닿도록, 근-건 연접부 병변은 침 끝이 건조직의 60-70%를 관통할 정도로 자입하며, 이후 침체를 가열하는 방법이다.(오승규, 심부 가열침을 이용한 인대, 건 손상의 치료, 2009)

온침은 발목의 손상 인대 조직에서 type III 콜라겐 mRNA와 단백질의 발현 증가 및 콜라겐 섬유를 증가시키는 등 손상인대 회복에 유효함을 보였다.(Dong-Seok Heo, Effects of warming acupuncture on ligament recovery in injury-induced rats, 2006)


전열침을 적용한 산후 요통환자 치험 3례, 2012

임광묵, 위대용, 고연석, 이은희, 반지혜, 이아영

척추신경추나학회지

산후 골반통 - 척추 전만의 증가, 인대의 이완, 천장관절의 상방활주

산후 요통을 호소하며 입원한 환자 3례.
복와위로 요천추부 후면을 촉진을 통하여 압통을 호소하는 병소의 위치를 확인하고 0.40*60mm의 호침으로 15~20초, 2-3회 가열. 가열 방향은 체표면에서 30도 위를 향하도록 하였으며, 화상 등의 부작용을 방지하기 위하여 환부를 소독 및 보호함. 3일에 1회 시술.

전열침요법 외에 침치료, 약물치료, 물리치료 병행함.
평가척도는 SF-MPQ, VAS, ODI 를 사용하여 감소의 여부를 확인함.

전열침(가칭)이 급성 족관절 염좌로 인한 전거비 인대 손상에 미치는 임상적 효과, 2009

안순선, 장효길, 허동석

한방재활의학과학회


전거비 인대 2도 손상 환자군 79명.

0.25 mmx40 mm 호침 사용.
볼펜으로 섬유-골막 연접부에서부터 인대 부분을 압박하여 심한 통증이나 jump sign이 나타나는 곳을 표시한 후 골막에 닿을 때까지 자침하였다.
자침시 환자가 짜릿한 느낌이나 통증을 호소하면 이를 피하여 다시 자침하여 말초신경이나 혈관에 자침하는 것을 피하였다.
피부에 1 cm 떨어진 침체 부위를 가스라이터로 5~7초 정도 가열하며 환자가 뜨겁거나 따끔거림을 호소하면 1초 후 가열을 중단하였다. 침체를 가열할 때 불꽃이 피부를 향하여 화장을 입는 것을 방지하기 위해 자체 제작한 방열판(60 mmx90 mm, 열경화성 수지)을 사용하였다.
치료 후 화상 방지 를 위해 silver sulfadiazine 10 mg 성분의 연고로 처치하였으며 치료 기간은 주 1회를 원칙으로 하였다.

pressure algometer(AT-1114, J.TECH,USA)를 이용하여 pain threshold를 측정하였다.








전열침 요법이 pain threshold 및 VAS score 상에서 일반적언 2도 염좌의 치료기간보다 짧은 기간내에 효과를나타낸 것은 족관절 염좌의 조기치료를 가능하게 하여 치료 기간의 단축 및 만성불안정성을 조기에 막을 수 있다는 장점을 보여주는 것이라 하겠다.

전열침은 급 만성 족관절 2도 염좌에 효과가 있으며 이환 기간에 관계없이 치료 횟수에 대하여 유효하다고 사료된다.



전열침이 장요인대 염좌로 인한 요통에 미치는 임상적 효과, 2010

장효길, 안순선, 허동석, 홍권의

한방재활의학과학회

요통을 주소로 내원한 환자 중 8명(방사선 검사 상 요추부의 염좌 진단을 받았으며, 이학적 검사 상 belt test, goldthwait's test의 양성 소견을 나타내는 자)

양측의 관원수에 0.30mm * 75mm 일회용 스테인레스 호침으로 환자의 체격에 따라 2-3개를 40-50mm의 심도로 환자가 뻐근한 느낌을 호소할 때까지 자침하였다.
자침 시 환자가 찌릿한 느낌이나 통증으로 호소하면 이를 피하여 다시 자침하여 말초신경이나 혈관에 자침하는 것을 피하였다.
자침 후 1cm 떨어진 침체 부위를 가스라이터를 이용하여 열을 가하여 환자가 뜨겁거나 따끔거림을 호소하거나, 침 주위의 피부에 수포가 보이면 1초 후 가열을 중단하고 2-3초 정도 경과 후 다시 한 번 더 5-7초 정도 가열하였다. 침체를 가열할 때 불꽃이 피부를 향하여 화상이 입는 것을 방지하기 위해 자체 제작한 방열판(60mm*90mm, 열경화성 수지)을 사용하였고, 치료 후 화상 방지를 위해 silver sulfadiazine 10mg 성분의 연고로 후처치하였고 7일 간격으로 주 1회 치료하였다.





장요인대 염좌로 인한 요통환자의 전열침을 통한 호전은 요추와 천골, 천골과 장골, 추체와 추체간의 안정성을 정상으로 유지하여 관절의 과가동성을 방지함으로써 통증의 경감을 가져온다고 생각된다.

요추에서 주로 문제를 일으키는 인대들로는 극간인대, 장요인대, 천장인대, 천극인대, 천결절인대, 천미인대 등의 척추 뒤쪽의 인대와 골반의 인대, 그리고 고관절과 기타 하지의 큰 관절 주변의 인대들이다.(George Stuart Hackett, 프로로테라피를 이용한 인대와 건의 이완에 대한 치료, 2004)
장요인대가 만성 요통의 중요한 원인이 될 수 있다.(Sims JA, The role of the iliolumbar ligament in low back pain, 1996)
제5요추-제1천추 접합부의 굴곡시에 장요인대의 후방섬유는 요-천추의 전방굴곡을, 전방섬유는 외측굴곡을 조절한다.(leong JC, The biomechanical functions of the iliolumbar ligament in maintaining stability of the lumbosacral junction, 1987)
장요인대가 요-천추부에서 회전력에 대한 안정성을 제공한다.(Chow DH, Torsional stability of the lumbosacral junction, significance of the iliolumbar ligament, 1989)
양측의 장요인대를 제거한 뒤 운동범위의 증가를 확인하여 요천추부의 안정성은 편측 인대만으로는 제공되지 못한다.(Yamamoto, The role of the iliolumbar ligament in the lumbosacral junction, 1990)



전열침(傳熱鍼)과 일반 침의 병행치료가 발목 염좌로 인한 외측인대 2도 손상에 미치는 임상적 효과,2011

장선정, 장효길, 허동석

한방재활의학과학회

외측인대 2도 손상 환자군 67명

침은 0.25 mmx40 mm
볼펜으로 섬유-골막 연접부에서부터 인대 부분을 압박하여 심한 통증이나 jump sign이 나타나는 곳을 표시 한 후 골막에 닿을 때까지 자침하였다.자침 시 환자가 찌릿한 느낌이나 통증을 호소하면 이를 피하여 다시 자침하여 말초신경이나 혈관에 자침하는 것을 피하였다.
pressure algometer(AT-1114, J.TECH, USA)를 이용하여 pain threshold를 측정하였다. 대상 환자가 누운 상태에서 시술자가 손상 인대의 최압통점 부위에 pressure algometer를 1kg/sec의 속도로 피부와 수직방향으로 압력을 가하여, 환자가 통증을 느끼는 시점에서 통증을 호소하거나 '아'라고 말할 때의 pressure algometer의 수치를 kgf단위로 측정하여 3회 측정한 후 평균 수치를 반영하였다.




통증 감소 효과를 보임. 통계적 방법은 잘못 적용되어 볼 필요 없음.




전열침(傳熱鍼)이 급·만성 족관절 염좌로 인한 전거비 인대 손상에 미치는 임상적 효과, 2011

장효길, 허동석

한방재활의학과학회


전거비 인대 2도 손상 환자군 79명

침은 0.25 mm x 40 mm stainless steel 멸균호침
기타는 위의 논문과 동일







전열침(傳熱鍼)이 급성 족관절 염좌로 인한 전거비·종비 인대 손상에 미치는 임상적 효과, 2010

안순선, 허동석

한방재활의학과학회

CFL 손상 12명(2차 치료 5명), ATFL 손상 16명(2차 치료 6명)

나머지는 상동







2012년 7월 27일 금요일

유방울혈


Treatments for breast engorgement during lactation (Review), 2010

Mangesi L, Dowswell T

Main results

We included eight studies with 744 women. Trials examined a range of different treatments for breast engorgement: acupuncture (two studies), cabbage leaves (two studies), cold gel packs (one study), pharmacological treatments (two studies) and ultrasound (one study). For several interventions (ultrasound, cabbage leaves, and oxytocin) there was no statistically significant evidence that interventions were associated with amore rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment. There was evidence from one study that, compared with women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days following treatment, although there was no evidence of a difference between groups by six days, and the study did not have sufficient power to detect meaningful differences for other outcomes (such as breast abscess). A study examining protease complex reported findings favouring intervention groups although it is more than 40 years since the study was carried out, and we are not aware that this preparation is used in current practice. A study looking at cold packs suggested that the application of cold does not cause harm, and may be associated with improvements in symptoms, although differences between control and intervention groups at baseline mean that results are difficult to interpret.

Acupuncture to treat breast engorgement: two studies with 293 women

Primary and secondary outcomes
Two studies examined the effects of acupuncture on breast engorgement(Kvist 2004; Kvist 2007). In both studies there were three treatment groups: advice and usual care (which might include the use of oxytocin nasal spray at the discretion of the midwife); advice and acupuncture (excluding the SP6 acu-point); and advice and acupuncture including the SP6 point. Results for resolution of symptoms were very similar for women in the two acupuncture groups in the Kvist 2007 study, and we have combined them in the data tables. 
We were not able to include data from the Kvist 2004 study in analyses because results were not set out separately for the three randomised groups in the published report and were not available from the author.
Neither study provided information on the review’s primary outcomes(cessation of breastfeeding and mastitis). The number of women prescribed antibiotics may represent a proxy measure of mastitis; results from Kvist 2007 show that, while women in the acupuncture group were less likely to be prescribed antibiotics, the difference between the acupuncture and control group was not statistically significant.
The number of women with breast abscess was reported in Kvist 2007; women in the acupuncture group were less likely to have abscess compared to women receiving routine care, but the difference between groups did not reach statistical significance (risk ratio (RR) 0.20. 95% confidence interval (CI) 0.04 to 1.01, P =0.05).

Non pre-specified outcomes
The amount of time taken for symptoms to resolve was reported by Kvist 2007. Findings favoured the acupuncture group, with fewer women having symptoms at three, four, and five days after commencement of treatment; at four and five days the differences between groups reached statistical significance (RR 0.82, 95% CI 0.69 to 0.96) and (RR 0.84, 95% CI 0.70 to 0.99) respectively. The difference between groups for the numbers of women with symptoms lasting more than six days was not statistically significant.
In the Kvist 2004 study it was reported that at three days after the start of treatment there were no significant differences between groups for severity of symptoms or for satisfaction with breastfeeding.


Cabbage leaves to treat breast engorgement: two studies with 62 women

Primary and secondary outcomes
Two studies by the same author examined cabbage leaves to reduce symptoms of breast engorgement, and collected information on pre- and post-treatment pain scores in randomised groups. In both studies breasts rather than women were randomised, and results were not reported in a way that allowed us to enter data into RevMan 2008. In a study comparing cabbage leaves and gel packs (Roberts 1995a) it was reported that women in both groups had reductions in pain scores following treatment, but that there were no significant differences between groups (data not shown). In a second study comparing chilled versus room temperature cabbage leaves, again authors reported that both groups had less pain following treatment, but that there was no difference between the randomised groups for post-treatment pain scores (Roberts 1995)(data not shown).


Cold packs for breast engorgement: one study with 88 women

Primary and secondary outcomes
In a non-blinded study women who had had caesarean deliveries and who developed symptoms of breast engorgement were randomised to treatment and control groups (breast-shaped cold packs worn in a halter versus routine care) (Robson 1990). Women in the intervention group seemed to experience a reduction in pain intensity at post-test. The author reported a decrease in mean pain intensity score from 1.84 (standard deviation (SD) 0.65) to 1.23 (SD 0.68) compared with an increase in the control group from 1.50 (SD 0.71) to 1.79 (SD 0.72). However, the differences between groups at baseline, and the failure to observe randomisation(women with “heightened distress” were moved into the control group), make results difficult to interpret.

Agreements and disagreements with other studies or reviews

Clinical practice guidelines in the UK (NICE 2006) broadly agree with this review concluding that cabbage leaves and cold packs may be helpful for symptom relief, but that evidence on the effectiveness of these interventions is not strong. In the absence of evidence from trials the guidelines recommend breast massage,
continued breastfeeding and analgesia for symptom relief.




A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation, 2007

Linda J. Kvist, MScN, RM, RGN (Care Development Manager and Postgraduate Student), Marie Louise Hall-Lord, PhD, RN (Associate Professor), Hakan Rydhstroem, PhD, MD (Associate Professor), Bodil Wilde Larsson, PhD, RN (Professor)

to further compare acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation

The hypothesis tested is that acupuncture treatment will hasten recovery from inflammatory symptoms of the breast during lactation.

group 1: essential care and the use of oxytocin spray as deemed necessary by the midwife;
group 2: essential care and treatment by acupuncture needles placed at HT 3 and GB 21;
group 3: essential care and treatment by acupuncture needles placed at HT 3, GB 21 and SP 6.

To help standardise treatments, the midwives were asked to adhere to the following instructions. It was essential that all the participants expressed the sensation of De Qi. If the sensation occurred directly after insertion of the needle, no further manipulation should be carried out. If De Qi did not occur spontaneously, the point should be stimulated by rotation of the needles clockwise to 180° for 30 seconds. This was to be repeated as necessary after 15 mins. Re-positioning of the needle should be carried out if De Qi still did not occur. All treatments were to be terminated after a maximum of 30 mins. A battery-driven acupuncture point localiser was used in conjunction with manual palpation of the points. Marco Polo stainless steel needles with copper handles, gauge 0.25 mm and length 25 mm were used. Insertion was made between 3–5 mm depths, depending on the individual's amount of subcutaneous fat. Needles of gauge 0.2 mm and length 13 mm were available for use for mothers with very little subcutaneous fat. The midwives were at liberty to give daily acupuncture treatments for as long as they and the mothers deemed this necessary.


항생제 처방 비율이 통계적으로 유의성은 없게 나왔으나 의미 있는 감소를 보임.


The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment, 2008

Linda J Kvist, Bodil Wilde Larsson, Marie Louise Hall-Lord, Anita Steen and Claes Schalén


Abstract
Background: The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.

Methods: In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical  statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.

Results: Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 10^7 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).

Conclusion:  Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.


세균 수, 종류와
1) 유선염의 증상,
2) 항생제 처방 유무,
3) 농양의 유무,
4) 증상의 재발 정도
와는 관계없음.




Antibiotics for mastitis in breastfeeding women, 2009

Shayesteh Jahanfar, Chirk-Jenn Ng, Cheong Lieng Teng


One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation.
Older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic.




Interventions for preventing mastitis after childbirth, 2010

Maree A Crepinsek, Linda Crowe, Keryl Michener, Neil A Smart


We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (November 2009), CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to November 2009), EMBASE (1974 to November 2009), CINAHL (1981 to November 2009), MIDIRS (1971 to November 2009), IPA (1970 to November 2009), AMED (1985 to November 2009) and LILACS (1982 to November 2009).

We included five trials (involving 960 women). In three trials of 471 women, we found no significant differences in the incidence of mastitis between use of antibiotics and no antibiotics (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.11 to 1.61; or in one trial of 99 women comparing two doses (RR 0.38; 95% CI 0.02 to 9.18). We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care (one trial); anti-secretory factor cereal (one trial); and mupirocin, fusidic acid ointment or breastfeeding advice (one trial).



Occurrence of lactational mastitis and medical management: A prospective cohort study in Glasgow, 2008

Jane A Scott, Michele Robertson, Julie Fitzpatrick, Christopher Knight and Sally Mulholland.


A longitudinal study of 420 breastfeeding women was undertaken in Glasgow in 2004/05.

In total,
74 women (18%) experienced at least one episode of mastitis.
More than one half of initial episodes (53%) occurred within the first four weeks postpartum.
One in ten women (6/57) were inappropriately advised to either stop breastfeeding from the affected breast or to discontinue breastfeeding altogether.



2012년 7월 25일 수요일

Breast Milk Jaundice and Maternal Diet with Chinese Herbal Medicines


Evidence-Based Complementary and Alternative Medicine
Volume 2012, Article ID 150120, 6 pages

Yi-HaoWeng,1 Ya-Wen Chiu,2, 3 and Shao-Wen Cheng1


Our objective was to identify the association between maternal diet with Chinese herbal medicines and prolonged jaundice of breast-fed infants. Healthy infants at 25 to 45 days of age were eligible for enrollment into this prospective study. Jaundice was defined as a transcutaneous bilirubin (TcB) value ≥ 5mg/dL. A questionnaire survey asking feeding type, stool pattern, and maternal diet was conducted at the time of TcB measurement. A total of 1148 infants were enrolled, including 151 formula-fed, 436 combination-fed, and 561 breast-fed infants. The incidences of jaundice were 4.0% in formula-fed infants, 15.1% in combinationfed infants, and 39.8% in breast-fed infants (P < 0.001). In addition, jaundice was noted in 37.1% of preterm infants and 25.0% of term infants (P < 0.001). Furthermore, jaundice was more common in breast-fed infants whose mothers did not consume the traditional Chinese herbal medicines than in breast-fed infants whose mothers did consume such medicines (P < 0.001). 


In conclusion, this cohort study has identified late-preterm birth and breast feeding as the contributory factors for prolonged jaundice of apparently well infants. The data indicate that postpartum diet with Chinese herbal medicines is associated with breast milk jaundice.






late-preterm infant & breast-feeding 군일수록 황달 유병율 높음.




 
완전모유수유군의 상대위험도 19.881, 혼합수유군 4.539, 조산군 1.998 순으로 나타남. 





한약 복용군에서 황달 유병율의 유의성 있는 감소 및 대변 횟수의 적정성을 보이고 있음.






(후기)모유 황달과 관련하여 요인을 분석한 논문.
조산, 완전 모유수유아들에게 황달 비율이 높음.
한약 복용군(생화탕, 사물탕, 두충. 기타 한약은 조사되지 않음.)의 infant에서 황달 비율이 유의성있게 낮음.

1. 모체의 식이 상태에 따라 모유 성분의 변화가 있다.
   (changes in maternal diet can affect the composition of breast milk)
2. 성분이 확인되지 않았지만, 한약 복용은 모체와 신생아에게 모두 도움이 될 수 있다. 
   (our results indicate that a combination of chinese medicines with a traditional chinese maternal diet may decrease the development of prolonged jaundice.)
3. 산모가 감초를 복용함으로써 빌리루빈 청소율을 높인다는 보고.
(Traditional Chinese medicine and treatment of neonatal jaundice, 1996 -> 인진, 대황, 감초, 황금, 황련)
(Neonatal jaundice--traditional Chinese medicine approach, 2001 -> 비슷한 내용)
4. 모유는 빌리루빈의 재흡수를 촉진하며, 장간순환하는 빌리루빈 양이 증가하면서 황달이 연장됨.
(Enterohepatic circulation of nonconjugated bilirubin in rats fed with human milk, 1990)



Efficacy of Acupressure on Breast Engorgement during Breast--feeding in Postpartum Mothers

Chia-hui Chen


 Background and purpose: The World Health Organization (WHO) recommends that breastfeeding is the best ideal method to provide newborns with nutrients. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods for up to two years of age or beyond. There are many advantages of breastfeeding. However, the pain caused by breast engorgement is one of the reasons women discontinue breastfeeding. The general management of breast engorgement is to encourage early breastfeeding and increase breastfeeding frequency. However, non-rooming-in mothers are unable to relieve breast engorgement due to low suction frequency. The pain caused by breast engorgement discourages mothers to keep breastfeeding. Acupressure has the effect of removing obstructions from meridians to facilitate breast milk ejection, and reduce pain caused by breast engorgement. The purpose of this study is to determine the effect of acupressure to relieve breast engorgement.
 
  Methods: A randomized controlled trial was conducted on 60 postpartum non-rooming-in women in a postpartum care center at a Chiayi regional teaching hospital. Participants had been randomized equally to experimental and controlled group (each group had 30 persons). The member of each group signed the different kind of agreement to make sure they didin’t know another intervention ,to avoid placebo effect .In the experimental group, the women received acupressure and hand expression of breast milk daily for 3 days. The acupoints were 屋翳 (Wu-Yi, ST15) , 膺窗 (Ying-Chuang, ST16) , 乳根 (Ru-Gen, ST17) and 膻中 (Dan-Zhong, CV17). In the control group, the women proceeded with only hand expression of breast milk. The assessment of the subjects included recording their basic characteristics, completion of a subjective breast engorgement scale, and physiological measurements. Interventions was performed by the same researcher with the same approach and strength. Another nurse help the participants to fill the engorgement symptoms rating scale. All data collected were analyzed with Microsoft Excel 2007 and SPSS Version 18. Paired-samples t-test, independent t-test and Chi-Square test were used to evaluate differences in basic characteristics and outcome indicators. Generalized estimating equation (GEE) models were used to determine relationships between breast engorgement and basic characteristics. Data were again collected one month after intervention, and were subjected to Fisher’s exact test analysis.
 
  Results: The basic characteristics of subjects in the two groups were homogeneous. In both groups, there were significant statistical differences (P < 0.001) in the extent of breast engorgement, subjective breast pain, and subjective breast discomfort at 5 minutes and 30 minutes after intervention on the 1st, 2nd and 3rd day postpartum. Comparisons between the experimental group and the control group showed significant improvements (P < 0.001) in all outcome indicators. After including the basic characteristics of subjects into the analysis, no significant changes in the results were found. Furthermore, results obtained from the data collected one month after intervention showed that subjects in the experimental group experienced no breast pain. In contrast, 39.3% of subjects in the control group experienced intermittent breast pain. Moreover, 3.3% and 53.6% of subjects in the experimental group and control group, respectively, experienced localized breast engorgement.
 
  Conclusion: Acupressure had significant effects in reducing breast engorgement. It should be promoted to help lactating women to breastfeed successfully. The results of the present study can be used as a reference for postpartum breast engorgement care.


원본 못 구함.
지압 시간, 빈도에 대한 정보를 얻을 수 없음.

2012년 7월 23일 월요일

산후신통 중 요통, 골반통 검사법의 민감도 특이도


Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review



Daniela Aldabe • Stephan Milosavljevic • Melanie Dawn Bussey






1) 임신 중 SIJ의 불균형
2) 근피로도가 높아져서 동원율이 높음
3) 보행시 체간부 회전율이 높아짐
4) P4 test, ASLR test가 효용성이 높다.
 ASLR test - 체간에서 다리로의 부하 전이를 평가하는 골반 기능 평가 방법
                - pos : 골반대의 불균형 의미
 P4 test - 임신 중, 산후 골반통을 평가하는 민감도, 특이도가 높은 검사 방법
  이 두 검사는 LBP, 부인과적 증상과 산후 골반통을 감별하는데 도움이 된다.


The posterior pelvic pain provocation test in pregnant women (1994)


 P4 test(posterior pelvic pain provocating test)
 - 임산부의 요통과 골반통을 감별하는 간단한 검사법
 - 민감도 : 81%, 특이도 80% 보고.





Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain(2000)


15가지 검사법을 적용해서 민감도와 특이도를 검사해 보았을 때, P4 test가 골반대(SIJ 포함) 병변에서는 가장 효율적.




최소 84% 이상의 민감도, 98%의 특이도를 보임.



기타

The long dorsal sacroiliac ligament pain test도 제안이 되었으나, palpation test이므로 연습이 조금 필요할 듯 하다. 
임산부의 골반은 ant. tilt로 LDL 의 장력이 최대가 되므로 이 부위의 신장성 통증은 당연히 따라다니는 부분이다.

2012년 7월 20일 금요일

Effect of Zingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial


Abstract

Background

Zingiber officinale R. rhizome (ginger) is a popular spice that has traditionally been used to combat the effects of various inflammatory diseases. The aim of this study was to evaluate the effects of ginger on pain relief in primary dysmenorrhea.

Method

This was a randomized, controlled trial. The study was based on a sample of one hundred and twenty students with moderate or severe primary dysmenorrhea. The students were all residents of the dormitories of Shahed University. They were randomly assigned into two equal groups, one for ginger and the other for placebo in two different treatment protocols with monthly intervals. The ginger and placebo groups in both protocols received 500 mg capsules of ginger root powder or placebo three times a day. In the first protocol ginger and placebo were given two days before the onset of the menstrual period and continued through the first three days of the menstrual period. In the second protocol ginger and placebo were given only for the first three days of the menstrual period. Severity of pain was determined by a verbal multidimensional scoring system and a visual analogue scale.

Results

There was no difference in the baseline characteristics of the two groups (placebo n = 46, ginger n = 56). The results of this study showed that there were significant differences in the severity of pain between ginger and placebo groups for protocol one (P = 0.015) and protocol two (P = 0.029). There was also significant difference in duration of pain between the two groups for protocol one (P = 0.017) but not for protocol two (P = 0.210).

Conclusion

Treatment of primary dysmenorrhea in students with ginger for 5 days had a statistically
significant effect on relieving intensity and duration of pain.



생강 1500mg로 원발성 생리통을 갖고 있는 가임기 여성(이란, 대학생)에게 월경 예정일 2일전부터 5일동안 투여한 결과 유의성 있는 통증 강도 및 기간의 감소가 관찰되었음.

이전 보고에서 생강의 항염증 효과(COX, LOX의 억제를 통한 LT, PG의 합성 억제)가 알려져 원발성 생리통에서도 같은 기전으로 작용한 것으로 보임.


이번 연구에서 유효 성분인 gingerol, shogaol의 함량이 조사되지 않음.


최근 보고(조직배양생강과 한국재래종 생강의 유효성분 비교, 조만현 외, 한국자원식물학회, 2011년)에서 6-gingerol 의 함량이 종류에 따라 차이가 있지만 0.1~0.3%(최고 75~80% EtOH 추출 상 0.6%)로 보고되는 바, 추정을 하면 3mg/day의 gingerol 정도로 추정할 수 있으나 확실하지는 않다. 

2012년 7월 19일 목요일

Prevalence of hyperglycemia during pregnancyaccording to maternal age and pre-pregnancy body mass index in Japan, 2007–2009


Abstract

Objective

To assess the prevalence of hyperglycemiaaccording to maternal age and pre-pregnancy body mass index (BMI) among Japanese women before introduction of the current diagnostic criteria.

Methods

In a retrospective study, data were analyzed from women with singleton pregnancies who were registered with the JSOG Successive Pregnancy Birth Registry System and who gave birth at 22 weeks of gestation or more between January 2007 and December 2009.

Results

Among 138 530 women, 3667 (2.6%) were diagnosed with hyperglycemia including gestational diabetes and diabetes mellitus. The prevalence of hyperglycemia increased with advancing maternal age and increasing BMI. Among women aged ≤ 24, 25–34, 35–39, and ≥ 40 years, the prevalence was 0.4%, 0.8%, 1.5%, and 4.0%, respectively, in lean women (BMI < 18.5); 1.0%, 1.6%, 2.3%, and 3.1%, respectively, in normal weight women (BMI 18.5–24.9); and 5.7%, 9.2%, 12.9%, and 15.2%, respectively, in obese women (BMI ≥ 25.0). Of the 1181 newborns with a birth weight of 4000 g or more, 1046 (88.6%) were born to women not diagnosed with hyperglycemia.

Conclusion

The results may reflect the baseline prevalence of hyperglycemia and macrosomic neonates (birth weight ≥ 4000 g) during the era of the old diagnostic criteria in Japan.

GDM/DM 그룹에서 임신 전 BMI가 높은 군의 비율이 높음
고령과 GDM/DM 그룹은 상관관계가 있음.

35세 이상 BMI 25이상에서 높은 관측빈도가 나타남
특히, 나이 요인보다는 임신전 BMI가 더 많은 영향을 주는 것으로 보임.

고혈당에 대한 유병율
기준값보다 BMI 상대위험도는 5.65, 고령은 3.04, 고령 BMI는 최대 15.1까지 나타남.
 




Vitamin D for Menstrual and Pain-Related Disorders in Women


Primary dysmenorrhea is among the most common menstrual disorders, occurring in at least 50% of reproductive-age women.Dysmenorrhea is characterized by pelvic pain beginning shortly before the onset of menses or at the beginning of menstrual flow and then lasting several days. The disorder results in substantial impairment in normal functioning and is among the most common causes of school and work absenteeism in young women. The main source of pelvic pain is believed to be prostaglandins synthesized from omega-6 fatty acids prior to menses, which control vasoconstriction and uterine contraction. Though nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives are effective at managing pain in many patients, these medications are not without risks. Given the high prevalence of dysmenorrhea and the long duration over which affected women may suffer, treatment options with fewer adverse effects are needed.
In this issue, Lasco and colleaguesreport findings from a small randomized trial of the effect of high-dose vitamin D therapy on pain associated with primary dysmenorrhea. Forty women seeking treatment were randomized to receive either a single oral dose of 300 000 IU of vitamin D3(cholecalciferol) (n = 20) or a placebo (n = 20), given 5 days before the expected start of their next menstrual period. After 2 months, mean pain scores had decreased 41% from baseline levels among women assigned to vitamin D treatment, while no difference was observed among women assigned to placebo (P < .001). The largest benefits were observed among women reporting the highest pain scores at baseline. Furthermore, women assigned to vitamin D reported no use of NSAIDs to manage pain during the 2-month follow-up period, while 40% of the women assigned to placebo reported NSAID use at least once (P = .003).
While the effect of vitamin D on dysmenorrhea has not been evaluated previously, a small number of studies have suggested a role for vitamin D in other menstrual and pain-related conditions in women, including premenstrual syndrome (PMS), fibromyalgia, and endometriosis. Low dietary vitamin D intake was associated with the initial development of moderate to severe PMS in a substudy within the prospective Nurses' Health Study II cohort. Bertone-Johnson and colleagues3(2005) found that women consuming 700 IU/d or more of vitamin D had a significant 41% lower risk of developing PMS over the next 2 to 4 years compared with women consuming approximately 100 IU/d (P value for trend, .01). In a smaller cross-sectional study, women reporting to consume 100 IU/d or more of vitamin D from food sources had 70% lower prevalence of PMS compared with those reporting to consume less than 100 IU/d (95% CI, 0.10-0.98). However, late luteal phase serum 25-hydroxyvitamin D3 (25[OH]D) levels were not associated with prevalence.4
Chronic widespread pain and fibromyalgia syndromes are significantly more prevalent in women than in men, likely owing to the influence of sex steroid hormones.Several well-designed observational studies in women have reported inverse associations between fibromyalgia pain and 25(OH)D levels, though results overall have been inconsistent.Relatively few studies have evaluated the role of vitamin D in endometriosis, which is a prominent cause of secondary dysmenorrheal and associated pelvic pain. Interestingly, Somigliana and colleagues(2007) observed significantly higher 25(OH)D levels among patients with endometriosis compared with controls in a cross-sectional study and a positive correlation between 25(OH)D levels and disease severity, suggesting that the relation between vitamin D and endometriosis is likely complex and not yet well understood.
Vitamin D may have a positive impact on dysmenorrhea and related syndromes through a variety of mechanisms.In the endometrium, 1,25-dihydroxyvitamin D (1,25[OH]2D), the bioactive form of vitamin D, decreases prostaglandin synthesis by suppressing expression of cyclooxygenase-2, and increases prostaglandin inactivation by up-regulating 15-hydroxyprostaglandin dehydrogenase. In addition, 1,25(OH)2D down-regulates prostaglandin receptor expression. 1,25(OH)2D may also exert anti-inflammatory effects through other pathways, such as by inhibiting nuclear factor–κB signaling and increasing mitogen-activated protein kinase phosphatase 5 activity, thus blocking cytokine production via p38 activation.
The strong benefit of vitamin D on dysmenorrhea observed by Lasco and colleaguesprovides important support for larger, long-duration randomized trials of vitamin D in the treatment of menstrual pain and other pain-related conditions in women. These trials must address several key issues. First, it is important to know how long reductions in pain associated with a single high-dose vitamin D therapy would persist and how often treatment would need to be repeated. If 300 000 IU is required every 2 months, this would equate to approximately 5000 IU per day, considerably higher than the tolerable upper intake level set by the Institute of Medicine of 4000 IU/d.Each single dose would need to be effective for multiple months for average daily vitamin D intake to remain below this level. Furthermore, because treatment for menstrually related conditions may be necessary throughout the premenopausal years, follow-up of participants in clinical trials of vitamin D must be extended to better evaluate adverse effects and compare risks and benefits. This is especially pertinent given the findings reported by Sanders and colleagues10 (2010), who observed increased risks of fracture and falls among older women treated with a single 500 000 IU dose annually over 3 to 5 years, especially within the first 3 months after treatment. A third consideration is the baseline serum level of 25(OH)D at which supplementation may be beneficial. Women eligible for the present trial were those with 25(OH)D levels in the lower quartile of the laboratory's normal range. It thus remains unknown whether improvements in dysmenorrhea pain would be observable among women with higher baseline 25(OH)D levels.
If these findings are confirmed in future randomized trials, vitamin D supplementation may become an important new treatment option for women who experience menstrual pain disorders. In the meantime, encouraging all women to obtain the recommended dietary allowance for vitamin D (≥600 IU/d for women of reproductive age),10 as well as screening for low serum 25(OH)D levels among women with other risk factors for vitamin D deficiency, would be a rational interim approach.


2012년 7월 17일 화요일

Phytoestrogens for menopausal symptoms: A review


  • John A. Eden

Abstract

Objective

To review the evidence that isoflavones are effective treatments for menopausal symptoms and to present the safety data.

Methods

The databases Scopus, ScienceDirect and Primo Central Index were searched and preference was given to systematic reviews and meta-analyses.

Results

The available evidence suggests that isoflavones do not relieve menopausal vasomotor symptoms any better than placebo. Long-term safety studies suggest that women who consume a diet high in isoflavones may have a lower risk of endometrial and ovarian cancer.

Conclusions

Isoflavones cannot be recommended for the relief of hot flushes.

Keywords

  • Phytoestrogen; 
  • Isoflavone; 
  • Menopause; 
  • Endometrium; 
  • Breast cancer; 
  • Cardiovascular; 
  • Meta-analysis; 
  • Hot flush; 
  • Climacteric; 
  • Vasomotor; 
  • Thrombosis; 
  • Review

1. Introduction

Phytoestrogens are plant-derived chemicals [1] that are structurally or functionally similar to oestradiol (E2). There is a large number of different classes of phytoestrogens, but the main type that have been given therapeutically to menopausal women are isoflavones and so they will be the focus of this review.
Isoflavones are naturally occurring polyphenol flavonoids. In the human diet, they are mostly found in legumes such as soybean, chickpeas, alfalfa and red clover [1] and [2]. The major isoflavones are daidzein and genistein. Daidzein can be formed from formononetin and in the gut is further metabolised to equol and 0-desmethylangolensin (0-DMA). Genistein can be produced from biochanin A. Genistein, daidzein, equol and 0-DMA can all be found in human blood [2].
There have been numerous human clinical trials giving isoflavones as purified extracts and sometimes as food products such as soy-protein. Theoretically, if a phytoestrogen product is given to postmenopausal women, then it might relieve menopausal symptoms such as hot flushes and vaginal dryness. However, they may also be the risk of oestrogenic side effects such as endometrial hyperplasia, breast cancer and thrombosis.

2. Methods

The goal of this review was two-fold. The first aim was to examine the evidence that phytoestrogens are effective treatments for relieving menopausal symptoms (in particular hot flushes). The second goal was to present the available safety data on these compounds. To this end, I used the University of New South Wales Library search engine, Sirius, to seek articles in Scopus, ScienceDirect and Primo Central Index, using the keywords phytoestrogenisoflavonemenopauseendometriumbreast cancercardiovascular,meta-analysishot flushclimactericvasomotorthrombosis and review. Preference was given to the most recent meta-analyses and systematic reviews.

3. Results

Five meta-analyses [3][4][5][6][7] and [8] and one review [9] were found which examined the impact of phytoestrogens on menopausal symptoms. One meta-analysis reviewed side effects of isoflavones [10]; another soy intake and breast cancer risk [11]. The impact of isoflavones on breast density was the subject of a meta-analysis [12] as was one on vascular endothelial function [13].

3.1. Are phytoestrogens efficacious for relieving menopausal symptoms?

Jacobs et al. [3] reviewed 17 soy isoflavone randomised controlled trials (RCTs) of menopausal vasomotor symptoms. The studies were so heterogenous that they did not perform a meta-analysis. They concluded that the RCTs had numerous deficiencies and conflicting results. A systematic review by Howes et al. [4]combined all the available soy and red clover studies. Their meta-analysis favoured isoflavones over placebo but the magnitude of the difference was very small and not likely to be clinically relevant. They did find some evidence that higher doses of isoflavones were more likely to relieve symptoms.
The Nelson systematic review [5] examined a number of non-hormonal therapies including soy isoflavones, red clover extracts, selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenaline reuptake inhibitors (SNRIs), clonidine and gabapentin. These authors concluded that SSRIs, SNRIs and clonidine did have evidence of efficacy. However, their meta-analysis failed to show efficacy for red clover extracts and even though the statistical analysis did favour soy isoflavones over placebo, the heterogeneity of the studies led them to conclude that the efficacy of soy isoflavones for hot flushes could not be established with certainty. Bolanos et al. [6] and Tempfer et al. [7] came to a similar conclusion.
Williamson-Hughes et al. [8] reviewed soy isoflavone studies and agreed with the previously mentioned studies that the poor standard of the trials and the marked heterogeneity of the RCTs meant that a meaningful meta-analysis could not be performed. They also pointed there was marked variation in the dose and type of isoflavones used.

3.2. Safety profile of phytoestrogens used to treat menopausal women

Tempfer et al. [10] identified 174 RCTs comparing phytoestrogens (n = 5502) with placebo or no treatment (n = 4806). Side effects were reported in 92 studies. In broad terms, the safety studies on isoflavones are reassuring. There appears to be no evidence of increased rates of endometrial or breast cancer but the studies are too small to be definitive.

3.3. Endometrial and breast cancer risk

There is some evidence that life-long exposure to soy might lower breast cancer risk [9]. However, this is a completely different situation to a Western woman taking a soy or red clover supplement for a few months or years after menopause. The review by Cassidy concluded that the studies to date were too small to be convincing [9]. Palacios et al. [12] performed a 3 year RCT of 70 mg soy isoflavone extract versus placebo (n = 395). Endometrial biopsies and mammograms were performed at inclusion, year 1 and year 3. Transvaginal ultrasound measurement of endometrial thickness was performed at inclusion and annually. No endometrial or breast cancers were found. No change in breast density nor endometrial thickness was detected over the 3 years. One case of simple endometrial hyperplasia was found. Similar results were found by Steinberg et al. [13] and Reed et al. [14].
Ollberding et al. [15] performed a prospective cohort study of 46,027 women with an intact uterus who were followed up for an average of 13.6 years. Careful dietary histories were obtained and dietary isoflavone intake calculated. They found evidence of an inverse relationship between dietary isoflavones intake and risk of developing endometrial cancer.
Myung et al. [16] published a meta-analysis of soy intake and risk of gynaecological cancers. Like Ollberding, they found that high soy intake was associated with a lowered risk of endometrial cancer. They also showed decreased risk of ovarian cancer amongst those with the highest soy intake.
In the Tempfer et al. review [10], there were 153 (7.8%) gynaecological or urological adverse events (AEs) in the phytoestrogen group compared with 117 (6.6%, p = 0.61). Rates of vaginal bleeding or spotting were similar as was the incidence of endometrial hyperplasia.

3.4. Cardiovascular system

Soy protein, but not purified isoflavones lower cholesterol [17]. Isoflavones given to postmenopausal women improve flow-mediated dilatation but not endothelial function [18]. One RCT of postmenopausal women (n = 350) given 91 mg isoflavone (as soy protein) or placebo were followed for 2.7 years. The main end-point was carotid intimal thickness measured with ultrasound. No differences were found. No human RCTs examining risk of thrombosis could be found.

3.5. Thyroid

Theoretically, isoflavones may interfere with thyroid function. Several studies measured thyroid function as a parameter [12] and [13] and no impact of isoflavones was found.

4. Discussion

After 2 decades of research into isoflavones it is disappointing that their therapeutic effects are still not clear. If there is an impact of isoflavones on menopausal flushing then it is small and not much more than placebo. On the positive side, there are several large RCTs and a couple of very large cohort studies demonstrating that dietary soy and/or purified isoflavones do not increase the risk of uterine nor breast cancer. There is evidence supporting the concept that soy might lower the risk of endometrial and ovarian cancer. Isoflavones appear to have minor positive effects on blood vessels and soy protein (and not purified isoflavones) has been shown to have a cholesterol lowering effect. More studies are needed into the impact of soy and purified isoflavones on thrombosis.
All the authors who performed meta-analyses commented on the heterogeneity of the studies. Another issue was the great variety of products with differing composition of isoflavones. The lack of studies on thrombosis was surprising considering the well-known effects of oral oestrogen on the clotting system.
In conclusion, it is difficult to recommend isoflavones as a treatment for menopausal flushing. Studies to date suggest that they are safe to the endometrium and breast. Further studies into the clotting system are recommended.

Practice points

Meta-analyses of RCTs of isoflavones given to relieve menopausal flushing have consistently failed to show a therapeutic effect.
Isoflavones may lower the risk of endometrial and ovarian cancer.
Soy protein (and not purified isoflavones) lower cholesterol.

Research agenda

New phytoestrogenic substances need to be identified and tested.
The safety of isoflavones on the clotting system needs to be established.

Contributors

There were no contributors.

Competing interest

None.

Provenance and peer review

Commissioned and externally peer reviewed.

References

    • [2]
    • J. Vacek, B. Klejdus, L. Lojkova, V. Kuban
    • Current trends in isolation, separation, determination and identification of isoflavones: a review
    • J Sep Sci, 31 (2008), pp. 2054–2067
    • [5]
    • H.D. Nelson, K.K. Vesco, E. Haney et al.
    • Non hormonal therapies for menopausal hot flashes systematic review and meta-analysis
    • JAMA, 295 (2006), pp. 2057–2207
    • [6]
    • R. Bolanos, A. Del Castillo, J. Francia
    • Soy isoflavones versus placebo in the treatment of climacteric vasomotor symptoms: systematic review and meta-analysis
    • Menopause: J North Am Menopause Soc, 17 (3) (2010), pp. 660–666
    • [10]
    • C.B. Tempfer, G. Froese, G. Heinze, E.K. Bentz, L.A. Hefler, J.C. Huber
    • Side effects of phytoestrogens: a meta-analysis of randomized trials
    • Am J Med, 122 (2009), pp. 939–946
    • [14]
    • S.D. Reed, K.M. Newton, A.Z. LaCroix, L.C. Grothaus, V.S. Grieco, K. Ehrlich
    • Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal alternatives for menopause (HALT) study
    • Menopause: J North Am Menopause Soc, 15 (1) (2008), pp. 51–58
    •  | 
    • [17]
    • A. Dewell, P.L.W. Hollenbeck, C.B. Hollenbeck
    • Clinical review: a critical evaluation of the Role of soy protein and Isoflavone supplementation in the control of plasma cholesterol concentrations
    • J Clin Endocrinol Metab, 91 (2006), pp. 772–780


갱년기 증상(특히 안면홍조)에 대해서 PE는 명확한 효과를 보이지 않음. 
자궁내막암, 난소암, 유방암 발생위험도를 낮춰주는 효과는 보임.
자궁내막증식증이나 유방암 발생을 높이는 부작용은 없는 것으로 보임.
내피기능과는 관련없이 혈관이완을 돕고, 콜레스테롤을 낮추는 효과는 인정됨.
혈전형성과 관련된 보고는 없음.
-> 안면홍조를 치료하는데 이소플라본을 권장하기는 어렵다.