[Show abstract][Hide abstract] ABSTRACT: Objectives To compare the effect of conjugated equine estrogens (CEE) and raloxifene on lipid profile and hemostasis. Materials and methods A double-blind, randomized and parallel study was performed with 90 healthy postmenopausal women, aged 54 &PLUSMN; 5 years, divided into three groups and submitted to daily therapy with either CEE 0.625 mg, raloxifene 60 mg or placebo for 4 months. The lipid profile, coagulation and fibrinolytic factors were analyzed. Results CEE increased the levels of high density lipoprotein cholesterol (HDL-C) from 49.0 to 56.8 mg/dl (p < 0.001), very low density lipoprotein cholesterol (VLDL-C) from 17.2 to 22.3 mg/dl (p < 0.001), and triglycerides from 86.0 to 111.7 mg/dl (P < 0.001.), and decreased the levels of low density lipoprotein cholesterol (LDL-C) from 121.0 to 106.5 mg/dl (p < 0.001). The only significant effect of raloxifene was an increase in the levels of HDL-C from 46.0 to 47.8 mg/dl (p = 0.019). There was no significant reduction in LDL-C, from 115.5 to 110.2 mg/dl (p=0.06), VLDL-C, from 21.7 to 20.0 mg/dl (p=0.201), and triglycerides, from 108 to 100 mg/dl (p=0.201). CEE decreased the levels of fibrinogen, from 370.5 to 326.8 g/l (p=0.039) and the levels of antithrombin III, from 99.5 to 93.2% (p < 0.001). Raloxifene decreased the levels of fibrinogen, from 354.7 to 302.0 g/l (p = 0.009) and the levels of antithrombin III, from 102.4 to 98.5% (p = 0.039). CEE increased levels of protein C from 103.7 to 115.3 mg/l (p < 0.001) and raloxifene did not change the levels of protein C (107.9 to 105.1 mg/l; p = 0.158). CEE decreased the antigen levels of tissue plasminogen activator (t-PA) from 8.8 to 6.8 U/ml (p < 0.001), and of plasminogen activator inhibitor (PAI-1) from 30.8 to 21.6 U/ml (p < 0.010), whereas raloxifene had no significant effect on either t-PA, from 9.6 to 9.2 U/ml (p = 0.235) or PAI-1 antigen levels, from 32.1 to 30.4 U/ml (p = 0.538).
[Show abstract][Hide abstract] ABSTRACT: To evaluate the results of the uterine artery embolization (UAE) for the treatment of uterine fibroids.
Twenty-six patients with ultrasonographic diagnosis of uterine leiomyomata were submitted to UAE with polyvinyl alcohol particles. Imaging and clinical follow-up was performed before the procedure, at 3 months, and 1 year after.
All procedures but one were technically successful. Control of menorrhagia and pelvic pain were reported after UAE by 87.5% and 84.2% of patients, respectively. The initial medium uterine volume was 385 cm(3), after 3 months 255 cm(3) and after 1 year 202 cm(3). The mean uterine volume decrease was 29% after 3 months and 41% after 1 year of follow-up (P<0.001). Clinical and biochemical findings consistent with ovarian failure were observed in three patients (12% of the patients).
UAE represents a new therapeutic approach in the treatment of uterine leiomyomata. The procedure appears effective in controlling symptoms and represents an alternative to hysterectomy.
No preview · Article · Oct 2002 · International Journal of Gynecology & Obstetrics
[Show abstract][Hide abstract] ABSTRACT: Objective: To establish the relations between androgenic profiles and ovarian histologic findings in patients with postmenopausal hyperandrogenism suggestive of tumoral origin. Design: Six patients with clinical signs of hyperandrogenism were evaluated through basal hormonal serum determinations, dexamethasone depression test associated with sequential human chorionic gonadotropin stimulation test, and adrenal and ovarian morphologic study by ultrasonography and computerized tomography. Once the diagnosis of probable ovarian hyperandrogenism of tumoral origin was established, the patients were submitted to hysterectomy and bilateral salpingo-oophorectomy. Basal hormonal serum determinations were repeated after surgery. Measurements: Basal serum determinations of FSH, LH, estradiol, testosterone, androstenedione, dehydroepiandrosterone and its sulphate, and 17α-hydroxyprogesterone. Androgenic profile after depression with dexamethasone 2 mg daily for 3 days, and dexamethasone plus human chorionic gonadotropin for 4 days, and basal serum androgenic profile after surgery. Results: Histologic studies of the ovaries revealed bilateral stromal hyperplasia (2 cases); unilateral stromal hyperplasia (3 cases), associated with clear cell adenocarcinoma (1 case), stromal luteoma (1 case), and Leydig cell tumor (1 case) of the other ovary; and steroidal cell tumor of the hilar region of the ovary (1 case). Conclusion: The probability of neoplastic origin of ovarian hyperandrogenism associated with androgenic profile and/or ovarian morphologic study suggestive of neoplasia in postmenopause is 50%.