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Microsoft word - saw palmetto.doc
Robert Pastore, Ph.D.
Modern usage of saw palmetto is focused on BPH (benign prostatic hyperplasia).
Benign prostatic hyperplasia is one of the most common medical conditions in
middle-aged and elderly males, with an incidence of approximately 50-60
percent in men age 40 to 60, and greater than 90 percent in men over 80.
However, there are some cases that begin as early as the late 20s, and may
have an incidence rate of 10 percent at that age.
This non-malignant enlargement of the prostate which is caused by hormonal processes and/or imbalances within the prostate forces most of the growth of
the prostate gland inward, compressing the urethra and causing the typical
urinary symptoms characteristic of the disease, including: decreased force and
strength of the urine stream, urinary hesitancy, urgency, frequency, post-void
dribbling, incomplete emptying of the bladder, painful urination, and nighttime
Testosterone is converted in prostate cells to dihydrotestosterone (DHT), catalyzed by the enzyme 5-alpha-reductase (5-AR). DHT binds to androgen
receptors in the prostate cells, stimulating cellular growth and division.
In BPH tissue, 5-AR levels are higher than in tissue not affected by BPH. The
presence of DHT may also stimulate 5-AR activity, worsening the problem by
Standardized saw palmetto extract has been found to be a potent inhibitor of
5-AR, resulting in decreased DHT. Saw palmetto also inhibits the binding of
testosterone and DHT to androgen receptors. Another component of BPH is inflammation within the prostate gland. A
standardized saw palmetto has been shown to inhibit 5-lipoxygenase and thus
reduce pro-inflammatory chemicals such as arachidonic acid metabolites
leukotriene B4 (LTB4) and 5-hydroxyeicosatetraenoic acid (5-HETE).
Numerous human trials report that saw palmetto improves symptoms of benign
prostatic hypertrophy (BPH) such as nighttime urination, urinary flow, and
overall quality of life. The effectiveness may be similar to the medication finasteride (Proscar®) with fewer side effects. Although the quality of these
studies has been variable, overall they suggest effectiveness. Saw palmetto has
not been thoroughly compared to other types of drugs used for BPH, such as
doxazosin (Cardura®) or terazosin (Hytrin®).
The dose of standardized saw palmetto used in research is 85 - 95% fatty acids
and sterols, at a dose of 160 mg twice per day.
Is saw palmetto just for men? Not exactly, many medical doctors that are
aware of the clinical research on saw palmetto are employing it in PCOS cases
(polycystic ovarian syndrome). One of the most troubling symptoms of women
with PCOS is hirsutism (too much hair, in the wrong places). Hirsutism is
thought to be mostly due to excessive levels of androgenic hormones. Examples of androgens are testosterone, androstenedione, and DHEA. DHT is the
hormone in your skin that stimulates hirsutism, which is male pattern hair
growth. If you can reduce DHT, you may be able to reduce hirsutism or male
Traditional indications for the use of Saw palmetto include: cystitis, chronic
bronchitis, asthma, diabetes, dysentery and indigestion. The berries have also
been thought to be an aphrodisiac. It has been suggested that saw palmetto
may block some effects of testosterone and therefore reduce male pattern hair loss, similar to the medication finasteride (Propecia®). More studies are
necessary to evaluate saw palmetto for hair loss.
1. Bent, S., Kane, C., Shinohara, K., Neuhaus, J., Hudes, E. S., Goldberg,
H., and Avins, A. L. Saw palmetto for benign prostatic hyperplasia. N
2. Boyle, P., Robertson, C., Lowe, F., and Roehrborn, C. Meta-analysis of
clinical trials of permixon in the treatment of symptomatic benign
prostatic hyperplasia. Urology 2000;55(4):533-539.
3. Braeckman J, Denis L, de Leval J, and et al. A double-blind, placebo-
controlled study of the plant extract Serenoa repens in the treatment of benign hyperplasia of the prostate. Eur J Clin Res 1997;9:247-259.
4. Descotes J, Rambeaud J, Deschaseaux P, and et al. Placebo-controlled
evaluation of the efficacy and tolerability of Permixon in benign
prostatic hyperplasia after exclusion of placebo responders. Clin Drug
5. Feifer, A. H., Fleshner, N. E., and Klotz, L. Analytical accuracy and
reliability of commonly used nutritional supplements in prostate disease.
6. Gerber, G. S., Zagaja, G. P., Bales, G. T., Chodak, G. W., and Contreras,
B. A. Saw palmetto (Serenoa repens) in men with lower urinary tract
symptoms: effects on urodynamic parameters and voiding symptoms.
7. Gerber, G. S., Kuznetsov, D., Johnson, B. C., and Burstein, J. D.
Randomized, double-blind, placebo-controlled trial of saw palmetto in
men with lower urinary tract symptoms. Urology 2001;58(6):960-964.
8. Kaplan, S. A., Volpe, M. A., and Te, A. E. A prospective, 1-year trial
using saw palmetto versus finasteride in the treatment of category III
prostatitis/chronic pelvic pain syndrome. J Urol 2004;171(1):284-288.
9. Preuss, H. G., Marcusen, C., Regan, J., Klimberg, I. W., Welebir, T. A.,
and Jones, W. A. Randomized trial of a combination of natural products (cernitin, saw palmetto, B-sitosterol, vitamin E) on symptoms of benign
prostatic hyperplasia (BPH). Int Urol.Nephrol. 2001;33(2):217-225.
10. Veltri, R. W., Marks, L. S., Miller, M. C., Bales, W. D., Fan, J., Macairan,
M. L., Epstein, J. I., and Partin, A. W. Saw palmetto alters nuclear
measurements reflecting DNA content in men with symptomatic BPH:
evidence for a possible molecular mechanism. Urology 2002;60(4):617-
11. Willetts, K. E., Clements, M. S., Champion, S., Ehsman, S., and Eden, J.
A. Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. BJU.Int 2003;92(3):267-270.
12. Wilt, T. J., Ishani, A., Stark, G., MacDonald, R., Lau, J., and Mulrow, C.
Saw palmetto extracts for treatment of benign prostatic hyperplasia: a
systematic review. JAMA 11-11-1998;280(18):1604-1609.
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