Controlled ovarian stimulation Health Dictionary

See TENS.... transcutaneous electrical nerve stimulation

One of a number of drugs subject to restricted use because of their potential for abuse. They include

opiates such as cocaine and morphine, amfetamine drugs, and barbiturate drugs. controlled trial A method of testing the effectiveness of new treatments or comparing different treatments. In a typical controlled drug trial, 2 comparable groups of patients suffering from the same illness are given courses of apparently identical treatment. However, only one group receives the new treatment; the second control group is given a placebo. Alternatively, the control group may be given an established drug that is already known to be effective. After a predetermined period, the 2 groups are assessed medically. Controlled trials must be conducted “blind’’ (the patients do not know which treatment they are receiving). In a “double-blind’’ trial, neither the patients nor the doctors who assess them know who is receiving which treatment. contusion Bruising to the skin and underlying tissues from an injury. convalescence The recovery period following an illness or surgery during which the patient regains strength before returning to normal activities.... controlled drug

An abnormal, fluid-filled swelling in an ovary. Ovarian cysts are common and, in most cases, noncancerous. The most common type, a follicular cyst, is one in which the egg-producing follicle enlarges and fills with fluid. Cysts may also occur in the corpus luteum, a mass of tissue that forms from the follicle after ovulation. Other types include dermoid cysts and cancerous cysts (see ovary, cancer of).

Ovarian cysts are often symptomless, but some cause abdominal discomfort, pain during intercourse, or irregularities of menstruation such as amenorrhoea, menorrhagia, or dysmenorrhoea. Severe abdominal pain, nausea, and fever may develop if twisting or rupture of a cyst occurs. This condition requires surgery.An ovarian cyst may be discovered during a routine pelvic examination and its position and size confirmed by ultrasound or laparoscopy. In many cases, simple ovarian cysts – thin-walled or fluid-filled cysts – resolve themselves. However, complex cysts (such as dermoid cysts) usually require surgical removal. If an ovarian cyst is particularly large, the ovary may need to be removed (see oophorectomy).... ovarian cyst

In the United Kingdom, controlled drugs are those preparations referred to under the Misuse of Drugs Act 1971. The Act prohibits activities related to the manufacture, supply and possession of these drugs, and they are classi?ed into three groups which determine the penalties for o?ences involving their misuse. For example, class A includes COCAINE, DIAMORPHINE, MORPHINE, LSD (see LYSERGIC ACID DIETHYLAMIDE and PETHIDINE HYDROCHLORIDE. Class B includes AMPHETAMINES, BARBITURATES and CODEINE. Class C includes drugs related to amphetamines such as diethylpropion and chlorphentermine, meprobamate and most BENZODIAZEPINES and CANNABIS.

The Misuse of Drugs Regulations 1985 de?ne the classes of person authorised to supply and possess controlled drugs, and lay down the conditions under which these activities may be carried out. In the Regulations, drugs are divided into ?ve schedules specifying the requirements for supply, possession, prescribing and record-keeping. Schedule I contains drugs which are not used as medicines. Schedules II and III contain drugs which are subject to the prescription requirements of the Act (see below). They are distinguished in the British National Formulary (BNF) by the symbol CD and they include morphine, diamorphine (heroin), other opioid analgesics, barbiturates, amphetamines, cocaine and diethylpropion. Schedules IV and V contain drugs such as the benzodiazepines which are subject to minimal control. A full list of the drugs in each schedule can be found in the BNF.

Prescriptions for drugs in schedules II and III must be signed and dated by the prescriber, who must give his or her address. The prescription must be in the prescriber’s own handwriting and provide the name and address of the patient and the total quantity of the preparation in both words and ?gures. The pharmacist is not allowed to dispense a controlled drug unless all the information required by law is given on the prescription.

Until 1997 the Misuse of Drugs (Noti?cation and Supply of Addicts) Regulations 1973 governed the noti?cation of addicts. This was required in respect of the following commonly used drugs: cocaine, dextromoramide, diamorphine, dipipanone, hydrocodeine, hydromorphone, levorphanol, methadone, morphine, opium, oxycodone, pethidine, phenazocine and piritranide.

In 1997 the Misuse of Drugs (Supply to Addicts) Regulations 1997 revoked the 1973 requirement for noti?cation. Doctors are now expected to report (on a standard form) cases of drug misuse to their local Drug Misuse Database (DMD). Noti?cation by the doctor should be made when a patient ?rst presents with a drug problem or when he or she visits again after a gap of six months or more. All types of misuse should be reported: this includes opioids, benzodiazepines and central nervous system stimulants. The data in the DMD are anonymised, which means that doctors cannot check on possible multiple prescribing for drug addicts.

The 1997 Regulations restrict the prescribing of diamorphine (heroin), Diconal® (a morphine-based drug) or cocaine to medical practitioners holding a special licence issued by the Home Secretary.

Fuller details about the prescription of controlled drugs are in the British National Formulary, updated twice a year, and available on the Internet (see www.bnf.org).... controlled drugs

A technique whereby a patient can deliver an analgesic substance (see ANALGESICS) in amounts related to the extent of the PAIN that he or she is suffering. For example, to combat post-operative pain, some hospitals use devices which allow patients to give themselves small intravenous amounts of opiates when they are needed. Pain is more e?ectively controlled if it is not allowed to reach a high level, a situation which tends to happen when patients receive analgesics only on ward drug rounds or when they ask the nursing sta? for them.... patient-controlled analgesia

A method of comparing the results between two or more groups of patients intentionally subjected to di?erent methods of treatment – or sometimes of prevention. Those subjects entering the trial have to give their informed permission. They are allocated to their respective groups using random numbers, with one group (controls) receiving no active treatment, instead receiving either PLACEBO or a traditional treatment. Preferably, neither the subject nor the assessor should know which ‘regimen’ is allocated to which subject: this is known as a double-blind trial.... randomised controlled trial

A method of electrical stimulation that is being used for the relief of PAIN, including that of MIGRAINE, NEURALGIA and phantom limbs (see AMPUTATION). Known as TENS, its mode of action appears to have some resemblance to that of ACUPUNCTURE. Several controlled trials suggest that it provides at least a modicum of relief of pain after operations, thereby reducing the amount of ANALGESICS that may be called for.... transcutaneous electrical nerve stimulation (tens)

A form of controlled trial that evaluates the effectiveness of a drug, or other treatment, in which subjects are randomly allocated to one of the study groups.

This random allocation means individuals are equally likely to be selected for the particular treatment being investigated or for the control group of the trial.... randomized controlled trials

see intervention study.... controlled trial

(DBS) a surgical treatment involving the implantation of a medical device that sends electrical impulses to specific parts of the brain. DBS in selected brain regions can provide benefits for treatment-resistant movement disorders, such as Parkinson’s disease, tremor, and *dystonia.... deep brain stimulation

a test for *phaeochromocytomas not displaying typically high levels of plasma *catecholamines. An intravenous bolus of *glucagon is administered and the test is positive when there is a threefold increase in plasma catecholamine levels with a consequent rise in blood pressure. The test is now very rarely used due to safer and more sensitive screening tests, combined with modern tumour imaging techniques.... glucagon stimulation test

a malignant tumour of the ovary, usually a carcinoma. Because of its wide-ranging pathology and an imperfect understanding of its causes, ovarian cancer is not readily detected in the early stages of development, when the tumour is small and produces few suspicious symptoms. Increased susceptibility to the disease is associated with raised serum levels of *CA125 (see also risk of malignancy index; BRCA1 and BRCA2). Diagnosis is based on the finding of a solid or cystic mass arising from the pelvis; there may be associated *ascites. The incidence of ovarian cancer reaches a peak in postmenopausal women; treatment involves surgery and most cases also require combined chemotherapy and/or radiotherapy.... ovarian cancer

a potentially life-threatening condition classically associated with ovarian stimulation using gonadotrophins in assisted conception procedures, such as in vitro fertilization (see superovulation). It is characterized by gross enlargement of the ovaries resulting in pain, bloating, nausea, vomiting, *haemoconcentration, and *ascites. The most severe cases require intensive care due to the high risk of thromboembolism and acute respiratory distress.... ovarian hyperstimulation syndrome

menopause occurring before the age of 40. It may be caused by autoimmunity, chemotherapy, radiotherapy, or genetic factors, for example a mutation in the FSH receptor gene causing excess secretion of gonadotrophins and small underdeveloped ovaries. Treatment is by hormone replacement, either with the contraceptive pill or HRT. *Oocyte donation should be discussed if the patient wishes for assisted conception.... premature ovarian failure

see intervention study.... randomized controlled trial

(rTMS) see transcranial magnetic stimulation.... repetitive transcranial magnetic stimulation

(TMS) stimulation of the brain by strong magnetic fields that induce electric currents in the underlying brain tissue. Repetitive transcranial magnetic stimulation (rTMS), consisting of a series of TMS pulses, is used to treat depression. Its clinical utility is controversial, with inconsistent research results regarding its efficacy. Although there have been some small studies regarding its use with other conditions, such as OCD, rTMS is not currently used routinely in the treatment for any illness other than depression.... transcranial magnetic stimulation

adj. relating to or occurring in a Fallopian tube and an ovary.... tubo-ovarian