CREATSAS MODIFICATION OF WILLIAMS VAGINOPLASTY

There are various operative techniques for neovagina creation. The Williams vaginoplasty is a simple and safe technique. We have modified this procedure as follows. The hymen is cut and stitched in three sites, and a strength absorbable material, Dexon or Vicryl 2-0, is used instead of catgut and nylon sutures. The advantages of our modification were recorded after 41 vaginoplasties. No complications were seen. Opening of the hymen, on the other hand, gives a better depth to the neovagina, and, therefore, postoperative hemorrhage during the first sexual intercourse is avoided

UNTREATED CERVICAL INFECTIONS, CHORIOAMNIONITIS AND PREMATURITY

Objective: To examine the relationship of endocervical pathogens and cervicitis with the development of chorioamnionitis, premature rupture of membranes (FROM) and prematurity. Methods: Three groups of pregnant women were included in the study: group A, controls with no evidence of cervicitis; group B, women with cervicitis due to pathogenic bacteria, who had been treated; and group C, women with untreated cervicitis who had not followed the prescribed therapy. Endocervical samples were cultured and aerobic and anaerobic bacteria isolated to examine the correlation of cervicitis with chorioamnionitis, FROM and prematurity. Results: There was a significantly higher incidence of prematurity in women with untreated cervicitis (group C). Mixed endocervical pathogens were most often involved (36.3%). A significantly higher number of endocervical pathogens were isolated in cases of chorioamnionitis (P < 0.001). Prematurity was seen in 39.6% of cases of chorioamnionitis. Prematurity was also more common in women with FROM (42.1%) than in those with intact membranes (11.8%). Conclusion: It is concluded that untreated endocervical infections are an etiological factor of chorioamnionitis, FROM and prematurity

Breast pain and mammographic density increase as a consequence of raloxifene therapy

A 55-yr-old post-menopausal woman with osteopenia and no history of breast disease is presented. She was placed on raloxifene HCl 60 mg and soon after developed severe breast pain. The follow-up mammogram, performed prematurely at 6 months, showed a marked increase in breast density. Therapy was accordingly stopped and mastodynia subsided. The patient’s mammogram regressed to pre-treatment status after 6 months off-therapy. (C) 2002, Editrice Kurtis

Endothelin plasma levels in primary amenorrheic adolescents before and after estrogen treatment

OBJECTIVE: We evaluated the effect of estrogen administration on endothelin (ET) secretion in primary amenorrheic (PA) adolescent girls. METHODS: Fifteen PA adolescents (ten hypergonadotropic, group A; five hypogonadotropic, group B) were treated with estrogen and progestogen tablets. A control group of ten healthy adolescents (group C) was included in the study. The ET 1-21, FSH, and LH plasma levels were tested before treatment (PrT) and immediately after the last estrogen tablet but before the progestogen administration (PoT). RESULTS: A statistically significant difference (P < .01) in ET 1-21 plasma values was found between PrT (9.66 +/- 0.80 pmol/L) and PoT (7.56 +/- 0.89 pmol/L) levels in group A cases. A similar reduction (P < .05) was recorded between PrT (8.06 +/- 0.46 pmol/L) and PoT (5.59 +/- 0.53 pmol/L) ET 1-21 plasma levels in group B cases. Endothelin 1-21 plasma PrT values were higher in both group A and B cases in comparison with controls (6.66 +/- 0.44 pmol/L; P < .01, P < .1, respectively). CONCLUSIONS: Estrogens administered to PA adolescents reduce ET 1-21 plasma levels in both hyper- and hypogonadotropism. Copyright (C) 1996 by the Society for Gynecologic Investigation

Mammographic changes associated with raloxifene and tibolone therapy in postmenopausal women: a prospective study

Objective: The prolonged use of estrogen therapy is associated with a slightly increased risk of breast cancer. Alternative therapies that are effective in the prevention of menopause, having associated morbidities but no unwanted effects, are of primary interest in the pharmacologic research. The aim of this study was to evaluate the effect of two alternative to estrogens drugs, the selective estrogen receptor modulator raloxifene and the tissue-specific tibolone, on the mammographic appearance of the breast. Design: The study group comprised 131 postmenopausal women aged 41 to 67 years. The women were at least 2 years postmenopausal, free of climacteric symptoms, and at the time of entry to the study had not had therapy for at least 9 months. Women with risk factors for osteoporosis or cardiovascular disease were allocated either to tibolone (n = 56) or raloxifene (12 = 48) therapy. Women with no risk factors and women who either did not qualify for or denied treatment (17 = 27) served as controls. The study duration was 12 months. Women received a baseline mammogram before commencing therapy and a repeat mammogram at the end of the study period. Mammogram findings were classified according to the modified Wolfe criteria by two expert radiologists. Results: No difference was identified between groups with respect to baseline characteristics associated with breast cancer risk. Similarly, no difference was detected between groups concerning the modified Wolfe classification of baseline mammographic findings. In the tibolone group, 10.7% of the women showed an increase in breast density in the 12-month reevaluation. The respective figure in the raloxifene group was 6.3%, whereas no woman in the control group showed an increase in breast density. Differences in the increase in breast density between groups did not, however, reach statistical significance. Accordingly, 10.7% of women in the tibolone group and 18.8% of women in the raloxifene group exhibited involutionary changes in the repeat mammogram, whereas 25.9% of women in the control group revealed a decrease in breast density in the 12-month examination. The percentages were not significantly different between groups. Conclusions: Breast density as shown by mammography was stable in a majority of patients and changed in a minority of cases for both tibolone and raloxifene. In most patients, these drugs are not likely to interfere with mammogram interpretation. Larger long-term studies are needed to confirm the impact of prolonged tibolone or raloxifene administration on mammography

Effect of hormone replacement therapy, tibolone and raloxifene on serum lipids, apolipoprotein A(1), apolipoprotein B and lipoprotein(a) in Greek postmenopausal women

The aim of this study was to assess the effect of estrogen, two regimens of continuous combined hormone replacement therapy (HRT), tibolone and raloxifene on serum lipid, apolipoprotein A(1) and B and lipoprotein(a) levels in Greek postmenopausal women. A total of 350 postmenopausal women were studied in a prospective open design. Women were assigned to one of the following regimens depending on the presence of risk factors for osteoporosis, climacteric symptoms and an intact uterus: conjugated equine estrogen 0.625 mg (CEE, n = 34), continuous combined CEE 0.625 mg plus medroxyprogesterone acetate (MPA) 5 mg, (n = 80), continuous combined 17beta-estradiol 2 mg plus norethisterone acetate (NETA) 1 mg (n = 58), tibolone 2.5 mg (n = 83) and raloxifene HCl 60 mg (n = 50). Forty-five postmenopausal women with no indications for HRT served as controls. Total cholesterol (TC), low-density lipoprotein (LDL) cholestrol and high-density lipoprotein (HDL) cholesterol, triglyceride (TG), apolipoprotein A, (ApoA(1)), apolipoprotein B (ApoB) and lipoprotein(a) (Lp(a)) levels were assessed in each subject at baseline, and at 6 and 12 months of therapy. All therapy regimens lowered TC levels compared to baseline (4.2-8.0% decrease). This effect was more prominent in the subgoup of women with high baseline TC levels (9.1-20.4% decrease). LDL cholesterol decreased significantly in CEE, CEE/MPA and raloxifene groups (-11.2%, -11.9% and -11.0%, respectively). Hypercholesterolemic women exhibited a steeper decrease in LDL cholesterol (10.6-27.8% in all therapy groups). TG levels increased significantly in the CEE and CEE/MPA groups (23.7% and 21.8%, respectively), while estradio/NETA had no effect on TG levels. Tibolone decreased TG levels markedly, by 20.6%, while raloxifene had no TG-lowering effect. HDL cholesterol and ApoA(1) were increased by CEE and CEE/MPA (HDL cholesterol, 7.4% and 11.8%, respectively; ApoA(1), 17.8% and 7.9%, respectively) and decreased by tibolone (HDL cholesterol, -13.6%; and ApoA(1), -9.9%). All therapy regimens except raloxifene lowered Lp(a) levels, with tibolone having the more pronounced effect (-13.2 to -29.0%). In conclusion, each therapy regimen had a different effect on lipid-lipoprotein levels, exerting favorable and unfavorable modifications. Hypercholesterolemic women seemed to benefit more from the cholesterol-lowering effect of estrogen replacement therapy/HRT. The choice for a particular regimen should be based on individual needs, indications and lipid-lipoprotein profile

Effect of hormone replacement therapy and tibolone on serum total homocysteine levels in postmenopausal women

Objective: To assess the effect of continuous combined hormone replacement therapy (HRT) or tibolone on serum total homocysteine (tHcy) levels in postmenopausal women. Study design: Ninety-five postmenopausal women aged 41-68 years were included in the study. Seventy-three women with climacteric complaints, osteopenia or osteoporosis received either conjugated equine estrogens 0.625 mg combined with medroxyprogesterone acetate 5 mg (CEE/MPA, n = 31) or tibolone 2.5 mg (n = 42). Twenty-two healthy women, matched for chronological and menopausal age, served as controls. Serum tHcy levels were assessed at baseline, 6, 12 and 18 months. Results: No difference was recorded between groups regarding demographic characteristics or mean baseline serum tHcy. Serum tHcy levels decreased significantly in the CEE/MPA compared to baseline (change at 18 months: -3.9%, P < 0.05). The magnitude of the decrease was higher in the subgroup of women with baseline tHcy levels above the median (change at 18 months: -15.0%, P < 0.01). No change in tHcy levels was detected in the tibolone group throughout the study period, either in the whole group (change at 18 months: 1.9%, NS) or in the subgroup with baseline tHcy levels above the median (change at 18 months: -3.23%, NS). Conclusion: Continuous CEE/MPA reduces tHcy especially in women with high pretreatment tHcy levels. Tibolone has no effect on serum tHcy levels at least during the first 18 months of therapy. Larger studies with longer follow-up are required to confirm these results. (C) 2003 Elsevier Ireland Ltd. All rights reserved

The effect of various regimens of hormone replacement therapy on mammographic breast density

Objectives: To evaluate the effect of three distinct hormone replacement therapy regimens on mammography. Methods: 121 postmenopausal women who had never received or were past users of hormone replacement therapy were studied prospectively. Women with an intact uterus were randomly allocated either to conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA, n = 34) or to 17beta-estradiol 2 mg plus norethisterone acetate 1 mg (E-2/NETA, n = 35). Hysterectomized women received CEE 0.625 mg (CEE, n = 25). Women who either declined or did not qualify for treatment served as controls (n = 27). Treatment was continuous and the study period lasted 12 months. Main outcome measures were the changes according to Wolfe classification between baseline and 12-month-mammograms. Results: No increase in breast density was identified in any of the women in the control group. Two women (8%) in the CEE group showed an increase in breast density. Four women (11.8%) in the CEE/MPA and 11 women (31.4%) in the Ez/NETA group revealed an increase in breast density. No woman in the therapy groups showed an involution of fibroglandular tissue while seven women (25.9%) in the control group exhibited involution of breast parenchyma. Conclusions: Our study suggests that hormone replacement therapy may suspend breast involution but does not increase breast density in the majority of patients. In the minority of patients who show a density increase, the magnitude of this increase varies according to the regimen employed. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved

The effect of hormone therapy and raloxifene on serum matrix metalloproteinase-2 and-9 in postmenopausal women

Objective: The aim of the study was to investigate the effect of continuous-combined hormone therapy and raloxifene on the total and active forms of serum matrix metalloproteinase (MMP)-2 and -9. Design: The study was double-blinded, with a placebo run-in period of 28 to 50 days. Twenty-eight women received either 17beta-estradiol 2 mg + norethisterone acetate 1 mg (E-2/NETA) or raloxifene HCL 60 mg for a period of 6 months. Total and active forms of MMP-2 and -9 were estimated at baseline and at month 6. Results: Total MMP-2 increased significantly in both E2/NETA and raloxifene groups (raloxifene baseline: 278.1+/-18.1 ng/mL; 6 months: 303.1+/-29.9 ng/mL, P=0.008) (E-2/NETA baseline: 281.9+/-27.5 ng/mL; 6 months: 298.8+/-12.7 ng/mL, P=0.025). Similarly, both treatments increased the active MMP-2 fraction, although only the raloxifene-associated increase acquired significance (raloxifene baseline: 24.9+/-8.6 ng/mL; 6 months: 31.6+/-15.3 ng/mL, P=0.045) (E-2/NETA baseline: 21.7+/-5.7 ng/mL; 6 months: 27.4+/-5.8 ng/mL, P=0.128). Total as well as active fractions of MMP-9 were not significantly affected by either treatment. Conclusions: Both E-2/NETA and raloxifene increased the total and active MMP-2 serum levels. MMP-9 was not significantly affected by either regimen. Larger, long-term clinical trials are needed to elucidate the effect of HT and raloxifene on MMPs and the possible clinical implications for cardiovascular health

Effect of hormone replacement therapy and tibolone on serum leptin levels in postmenopausal women

Objective: To evaluate the effect of estrogen replacement therapy (ERT), continuous combined hormone replacement therapy (HRT) and tibolone on serum leptin levels in healthy postmenopausal women. Methods: Eighty-four healthy postmenopausal women aged 43-63 years were studied prospectively. Hysterectomized women (n = 16) received conjugated equine estrogens (CEE) 0.625 mg. Women with an intact uterus were randomly allocated either to CEE+medroxyprogesterone acetate (CEE/MPA) 5 mg or tibolone 2.5 mg. Serum leptin levels were assessed at baseline and after 6 months of treatment. Results: The three groups did not differ with respect to age, body mass index (BMI) or baseline serum leptin levels. Overweight women (BMI > 25 kg/m(2)) had higher baseline leptin levels (27.0 +/- 11.4 ng/ml) compared to their lean counterparts (BMI less than or equal to 25 kg/m(2); leptin: 16.5 +/- 8.1 ng/ml, P = 0.0001). Neither CEE nor CEEMPA had any effect on serum leptin levels at the end of 6 months either in overweight or in lean women (overweight: CEE baseline 34.4 +/- 13.3 ng/ml, 6 months 36.9 +/- 15.8, P = 0.89, CEE/MPA baseline 22.4 +/- 9.8 ng/ml, 6 months 26.8 +/- 8.7 ng/ml, P = 0.1; lean: CEE baseline 12.6 +/- 4.4 ng/ml, 6 months 13.2 +/- 5.9 ng/ml, P = 0.36, CEE/MPA baseline 17.2 +/- 10.6 ng/ml, 6 months 18.8 +/- 8.8 ng/ml, P = 0.31). Similarly serum leptin remained unchanged at the end of the study in both lean and overweight women on tibolone (overweight: baseline 22.9 +/- 8.1 ng/ml, 6 months 18.5 +/- 12 ng/ml, P = 0.37; lean: baseline 13.2 +/- 5.6 ng/ml, 6 months 17.3 +/- 8.4 ng/ml). Conclusion: BMI is a strong determinant of serum leptin levels in healthy postmenopausal women. Neither ERT/HRT nor tibolone exert any effect on serum leptin after 6 months in lean or overweight postmenopausal women. Further studies are required to verify the exact role of estrogen and tibolone on leptin production and function in postmenopausal women. (C) 2003 Elsevier Ireland Ltd. All rights reserved