State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS)

PCOS, a heterogeneous disorder characterized by cystic ovarian morphology, androgen excess, and/or irregular periods, emerges during or shortly after puberty. Peri- and post-pubertal obesity, insulin resistance and consequent hyperinsulinemia are highly prevalent co-morbidities of PCOS and promote an ongoing state of excess androgen. Given the relationship of insulin to androgen excess, reduction of insulin secretion and/or improvement of its action at target tissues offer the possibility of improving the physical stigmata of androgen excess by correction of the reproductive dysfunction and preventing metabolic derangements from becoming entrenched. While lifestyle changes that concentrate on behavioral, dietary and exercise regimens should be considered as first line therapy for weight reduction and normalization of insulin levels in adolescents with PCOS, several therapeutic options are available and in wide use, including oral contraceptives, metformin, thiazolidenediones and spironolactone. Overwhelmingly, the data on the safety and efficacy of these medications derive from the adult PCOS literature. Despite the paucity of randomized control trials to adequately evaluate these modalities in adolescents, their use, particularly that of metformin, has gained popularity in the pediatric endocrine community. In this article, we present an overview of the use of insulin sensitizing medications in PCOS and review both the adult and (where available) adolescent literature, focusing specifically on the use of metformin in both mono- and combination therapy

Flexible and mobile doctors as a strategy for capacity problems.

Background: Medical specialists in the Netherlands are coping with a high workload and long waiting lists of patients. Most doctors are selfemployed and working in a partnership with colleagues. This system of small companies of doctors is restrictive to mobility and flexibility in careers, because every change within the partnership will cause income consequences for all members. Restrictions towards flexibility and mobility can have a negative effect on satisfaction and career challenge. In earlier research a loss of capacity is detected, caused by early retirement, turnover to other occupations and under-capacity (part-time) caused by inflexible work conditions. Aim: This study is focussed on the preferences and types of flexibility and mobility among doctors. Furthermore, insight in the relationship between preferred flexibility and satisfaction will be given and finally, the gain of capacity under flexible conditions can be traced. Methods: A questionnaire (online and a written version) was sent to all doctors in different (28) medical specialisms in almost all Dutch hospitals. Most doctors answered the online questionnaire. The response was 31% (N=2.746) which is moderate but acceptable for this population- wide survey. The response analysis showed comparable figures with earlier research. Results: Flexibility in time is preferred by 80% of all respondents. Most doctors wish part time participation. Others want flexible schedules or a sabbatical. Especially part-time, young female doctors, who are not self-employed and who experience dissatisfaction with their workload and have work family conflicts, prefer flexibility in time. Flexibility in tasks is preferred by 60% of all respondents. Partly they wish to specialise on a part of their domain and prefer to drop all management tasks. Night, and weekend shifts and several additional duties are also not favourable tasks. Doctors, who are dissatisfied with their work and the time they can spend on the main task, prefer flexibility in tasks. Mobility is preferred by almost 50% of all respondents. Partly a permanent change to another location/hospital is preferred. Others would prefer a temporary change: stationed to another location. A combination of both options was often mentioned. Especially young self-employed doctors, who are dissatisfied with their work, would prefer more mobility. If flexible conditions as preferred would be facilitated respondents mentioned how much years extra they would work and also how much time (Fte) per year. 54% of all respondents intend to work more years as planned if the work conditions will be more flexible. Most of them would work 2 to 5 years longer. Only 18% of the respondents would work less. Conclusions: Conclusion is that most doctors are positive towards flexible work conditions. Self-employed doctors especially prefer mobility, and doctors who are contracted prefer flexibility in time. Flexibility in tasks is not influenced by the type of work relation. Finally, if flexible conditions are facilitated a lot of extra capacity would be activated. (aut. ref.

Flexibel werken: medisch specialisten willen geen fulltime baan.

Ruim 2700 medisch specialisten reageerden op een enquête over flexibilisering van de werkomstandigehden. De meesten van hen staan daar positief tegenover. Relatief veel medisch specialisten hebben behoefte aan een andere taakinvulling dan het traditionele fulltime werken en het complete takenpakket. Het maatschaps- en samenwerkingsverband en de vakgroepstructuur bieden mogelijkheden tot flexibiliteit. 'Interim-specialisten' kunnen worden ingezet op plaatsen waar sprake is van een acuut capaciteitsgebrek. Flexibiliteit draagt bij aan het terugdringen van voortijdige praktijkbeëindiging, uitval door arbeidsongeschiktheid en uitstroom naar andere beroepen. Flinke capaciteitswinst is hiervan het gevolg. (aut.ref.

Fluorescein angiography for the detection of metastases of ovarian tumor in the abdominal cavity, a feasibility pilot

Background and Objectives: The growth and progression of ovarian tumor metastases at the peritoneal surfaces of the abdominal cavity are coupled with neovascularization. Newly formed tumor vessels show a more diffuse pattern and are more permeable for macromolecules than normal vessels. We investigated the possibility to detect (small) ovarian metastases in the abdominal cavity by means of fluorescein angiography. Study Design/Patients and Methods: Eighteen patients known with ovarian cancer or with suspicion for this disease received sodium fluorescein intravenously in different doses (0.4-1.6 ml of a 25% solution), whereafter fluorescence detection by laparoscope was carried out. The distribution pattern of fluorescein was gained from 0 to 120 min by pooling the data collected in different patients at various time intervals. Results: Three phases could be discriminated, that is, rapid filling of blood vessels after administration of fluorescein, diffuse extravasation of fluorescein into surrounding tissues, and clearance of fluorescein from vessels and surrounding tissue. Differences in accumulation of fluorescein could be visualized only after 1 hour or more. Fluorescence imaging more then 60 minutes after administration of fluorescein did not give additional information compared to the inspection using white light, which was confirmed by histology. These observations were dose-independent. Conclusions: The concentration gradient differences of fluorescein between healthy and pathological tissue in the abdominal cavity are too small to indicate tumor neovascularizatio

Epidemiologic and mucosal immunologic aspects of HPV infection and HPV-related cervical neoplasia in the lower female genital tract: A review

Human papillomavirus (HPV) infections are known to play an important role in the pathogenesis of cervical neoplasia. Considering the morbidity and mortality of cervical cancer, infection with HPV can be regarded as a worldwide problem, especially in developing countries. Currently, many studies focus on the development of both prophylactic and therapeutic HPV vaccines. Crucial for these vaccination protocols to be successful is that they will result in a long-lasting ability to generate an immune response that will eliminate the virus. HPV transmission and subsequent infection is a local event in the lower female genital tract and therefore the efficacy of vaccines against this locally transmitted infection can be best assessed by parameters of local immunity. In this review we describe both the epidemiology of HPV-related cervical neoplasia and the general aspects of mucosal immunity in the female genital tract while focusing on the local humoral immunity in HPV-related cervical neoplasia