Removing the uterus and both ovaries: pros and cons of hysterectomy and bilateral oophorectomy

Removing the uterus and both ovaries, due to many reasons, are still performed at perimenopausal age and due to many reasons, uterus and ovaries removal are still performed at reproductive age. Hysterectomy with or without salphingooophorectomy is still the most common procedure performed not only in developing countries but also in developed countries. Among of all reasons the most frequent one is to improve the quality of life and prevent future malignancies if the uterus and both ovaries are not removed. Malignancies might probably occur although the incidence rate is very low. When both of the ovaries are removed, estrogen will decrease significantly, this will cause short and long term medical problems and decrease the quality of life. The incidence of coronary heart disease and fractures increases as estrogen decreases. A study performed by Parker et al with some of 10.000 women who underwent total hysterectomy and bilateral salphingooophorectomy at the age of 50 - 54 years old and did not receive HRT, shows that 838 died due to heart disease.1 Other studies reported cognitive disturbances among women who underwent bilateral salphingooophorectomy.2 Further more, the incidence of depression, anxiety and sexual disturbances is higher in women whose ovaries were removed compared to those who underwent natural menopausal state. If both ovaries were removed and then medical problems occured, the next question would be whether the clinician is willing to give HRT or whether the patient is willing to have HRT? In Indonesia, clinicians are afraid of giving HRT and patients are not willing to have HRT. Then what will happen to the patient? Symptomatic medication is then given. One of the reasons of removing both ovaries is to prevent the occurence malignancies of ovary and breast. HRT will increase the incidence of breast cancer. If it is so, then the patient is at the point of no return. If the uterus is removed, will medical problems happen? Yes, there are papillary thyroid cancer found in women whose uterus were removed.3 It shows that uterus also plays important role in controlling thyroid glands. Levi et al. reported an increased risk of epithelial thyroid cancer in women with artificial menopause (OR 6.3%, 95% CI: 1.7 - 23.2).4 Several studies in Europe and USA concluded that hysterectomy will increase the risk of thyroid cancer.5,6 Estrogen indirectly takes part in controlling the release of HRT, if there is no estrogen then HRT release will increase and trigger the growth of thyroid tumor.3 Myometrium and endometrium also have the ability to produce thyroid hormone. The level of iodothyronine deodinase enzyme is high in myometrium and endometrium, especially during pregnancy.7,8 There are 2 types of deodinase enzyme, type 2 and type 3. D2 enzyme transforms T4 to active T3, while D3 transforms T4 to inactive T3.7,8 If uterus is removed, the T3 will decrease and HRT release will be uncontrolled. Estrogen only (+ progesterone) will increase D2 enzyme activity while estrogen + progesterone will increase D3 activity.9 It shows that estrogen plays more important role in increasing D2 enzyme activity. If there is no uterus, then there is no D2 enzyme available. Uterus also has the ability to syntezise prostacycline. Prostacycline has vasodilatation effect, increasing the blood flow to the heart. Women without uterus will have an increased risk of heart disease. Removing the uterus has to be considered carefully. The incidence of malignancies as a consequence of conserving the uterus is lower compared to the adverse effect due to hysterectomy and bilateral salphingooophorectomy. Further study is needed in Indonesia to evaluate the consequences of hysterectomy and bilateral salphingooophorectomy towards thyroid cancer and quality of life in the future

Evidence Based Patient-Centered Care: Are We Ready?

N/

ETIK, HUKUM DAN SOSIAL PADA PENANGANAN INFERTILITAS

Pasangan suami isteri akan menempuh segala cara untuk mendapatkan keturunan, karena keturunan adalah anugerah yang dititipkan tuhan kepadanya. Bila pasangan suami isteri sudah berusaha tetapi keturunan belum mereka peroleh atau disebut infertilitas, maka usaha untuk memperoleh keturunan akan dilakukan mulai dari  teknik sederhana sampai yang menggunakan teknologi yang canggih serta modern, namun tetap saja angka keberhasilan nya masih rendah. Dewasa ini telah diciptakan suatu metode untuk membantu para pasutri mendapatkan keturunan, yaitu dengan cara   Assisted Reproductive Technology (ART), atau artinya dalam bahasa Indonesia Teknologi Reproduksi Berbantu. Salah satu metode ART adalah in vitro fertilization (IVF), atau yang dikenal dikalangan dokter maupun orang awam adalah Bayi Tabung . Dari semua cara penanganan infertilitas, maka ART banyak menimbulkan masalah etik, hukum dan sosial. 

KETIDAK-NYAMANAN DI RONGGA MULUT PADA WANITA MENOPAUSE DAN FAKTOR-FAKTOR INTRAORAL YANG BERPERAN (Studi Pustaka)

In menopausal women, there are physiological changes as a consequence of the decrease in secretion of oestrogen and ovary function that produce oestrogen. Numerous metabolic, psychological and physical changes have been associated with this event. In this paper we described oral discomfort in menopausal women. Dentist should know about oral discomfort in menopause including oral dryness, burning sensation, altered taste perception and ulceration, because this symptoms could become a reason for menopausal women to see a dentist. In the management of oral discomfort in menopausal women dentist should collaborate with gynecologist

Tailoring Immunotoxin AS Anticancer Drug

The conventional treatments for cancer have been considered unsatisfatory, with limited efficiency in terms of discriminative cancer cell adverse reaction against the normal compartments, a number of immunological approaches had been implemented. Since cancer cells could exhibit tumor specific antigen (s), a highly specific antibody could be used to direct any anticancer drug, biological agent or radioisotope selectively against the cancer cells and does not harm the normal cells. The specific antibody could be raised by immunization with purified tumor specific antigen (s). The biological agent could be obtained as toxin, either derived from bacteria e.g. diphtheria toxin or derived from plants e.g. castor ricin, which could destroy and kill cancer cells after contacts. A hybrid molecule constructed between antibody and toxin has been known as "immunotoxin". The selectivity of the antibody against a given tumor specific antigen could be increased by using a monoclonal antibody, made by hybridoma technique and immunological engineering. Accordingly, the efficiency of the destructive or killing effect of the toxin could be eventually increased by purification technique, biochemical and genetic engineering. In a preliminary study ricin from castor (Ricinus communis) have been purified and separated into two protein fractions (RCAI = 12.000 dalton and RCA II = 60.000 - 65.000 dalton). The latter showed toxin property, and was tested in vitro both against normal cells and against cancer cells. In the microcy totoxicity assay the ricin showed both the short term and the long term killing effect as measured after 1, 4, 16 and 24 hours. The killing effect against cancer cells was stronger as compared to that against normal cells. The acute or short term effect was observed at lower concentration of ricin (10-6 and 10-12 g/ml) after 1 and 4 hours contacts. The long term effect resulted in 90% and nearly 100% cytotoxicity in higher concentration of ricin. Further development of the immunotoxin are in progress. Various aspects dealing with technical problems and clinical aplications will be discussed

Endokrinologi ginekologi

195 p. : 25 cm

Menopause and hormone replacement therapy

<p>The global population in the 21st century has reached 6.2 billion people, by the year 2025 it is to be around 8.3-8.5 billion, and will increase further. Elderly people are expected to grow rapidly than other groups. The fastest increase in the elderly population will take place in Asia. Life expectancy is increasing steadily throughout developed and developing countries. For many  menopausal women, increased life expectancy will accompanied by many health problems. The consequences of estrogen deficiency are the menopausal symptoms. The treatment of menopause related complaints and diseases became an  important socioeconomic and medical issue. Long term symptoms, such as the increase in osteoporosis fractures, cardio and cerebrovascular disesses and dementia, created a large financial burden on individuals and society. All these health problems can be lreated or prevented by hormone replacement therapy (HRT). Natural HRT is usually prefened. Synthetic  estrogen in oral contraceptives (oc) are not recommended for HRT. Many contra-indications for oc, but now it is widely usedfor HRT. The main reasons for discontinuing HRT are unwanted bleeding, fear of cancer, and negative side effects. Until now there are sill debates about the rebrtonship between HRT and the incidence of breast cancer. Many data showed that there were no clear relationship between the use of HRT and breast cancer. ThereÎore, nwny experts advocate the use of HRTfrom the first sign of climacteric complaints until death.<em> <strong>(Med J Indones 2001;10: 242-51)</strong></em></p><p><strong>Keywords:</strong><em> estrogen deficiency, climacteric phases, tibolone.</em></p

Menopause dan Andropause

Jakartaix, 233 p : Illus, Tab; 24 c