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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Current practice of investigating abnormal uterine bleeding via dilatation and curettage is sometimes open to question, and outpatient procedures are emphasised. The therapeutic effect of curettage in normalising menstrual patterns is being discussed. In a prospective study we answered the question of diagnostic and therapeutic effects of curettage. Over a period of 6 months, all patients with curettage treated in our department were investigated (history, risk factors, previous hormonal treatment, preoperative haemoglobin value, type of anaesthesia, complications, histology). Curettages performed for the purpose of abortion, as well as in combination with conisation of the uterine cervix, were not included in the study. 234 curettages were carried out. Clinical indications were as follows: in 29% of the cases recurrent preclimacteric metrorrhagia, in 27% climacteric metrorrhagia, in 24% PMB (postmenopausal bleeding). In 19 cases we found an Hb value lower than 10.5 g%. Risk factors (obesity, hypertension, diabetes mellitus) for endometrial cancer were found in 38% of MB and in 20% of climacteric metrorrhagia. In 9 cases, the histological diagnosis was endometrial cancer (clinical indications: 5 PMB, 3 climacteric metrorrhagia, 1 recurrent preclimacteric metrorrhagia). Our study shows, that the indication for curettage should be applied generously, especially in cases of abnormal postmenopausal and perimenopausal bleeding.
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PMID:[The value of curettage in the assessment of abnormal uterine bleeding]. 221 Mar 9

The clinical use of estrogens and progestogens for menopausal women is reviewed, discussing the indications, results of studies on effectiveness of various agents o each target organ, contraindications, risk-benefit ratio, and types of drug preparations available and used in European countries. The indications for menopausal hormone replacement are primarily to prevent myocardial infarction and osteoporosis, and also to treat early menopause, urogenital atrophy, and severe skin, mucous membrane and psychic disorders. Mechanisms of action of estrogens and progestins, and anticipated results are detailed for each of the indications. Contraindications typical of oral contraceptives usually do not apply for hormone replacement. For example, only severe acute liver disease, current thromboembolism, endometrial cancer other than I, and breast cancer within 3-5 years of primary treatment are contraindications. Neither cervical, ovarian or vulvar cancer, diabetes, varicose veins, hypertension, nor history of liver disease or thromboembolism are contraindications: in some cases progestins or transdermal estrogens are recommended. Estrogen side effects suggest overdosage. Progesterone or its derivatives rather than oral contraceptive progestins are prescribed. There is a clear benefit, comparing cost of medication to that of treating consequences of estrogen deficiency. The preparations currently used in Europe include oral micronized estradiol, conjugated estrogens, transdermal patches, local vaginal estrogens, and injectable estradiol esters for those who cannot tolerate oral or transdermal agents. Preparations should contain progesterone unless the woman has had a hysterectomy. Combinations designed to avoid withdrawal bleeding are available.
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PMID:Clinical use of oestrogens and progestogens. 221 69

There is general evidence that the incidence of adenocarcinoma of the cervix has been rising, particularly among younger women. The determinants of these trends, however, remain largely unknown. We have reviewed the epidemiology of adenocarcinoma of the cervix using descriptive data from cancer registration and clinical series and two main sources of analytical data: clinical studies comparing cervical adenocarcinoma (AC) and squamous carcinoma (SC) and formal case-control and cohort epidemiological studies. In both the United States and northern Europe there is evidence of the rising frequency of AC in absolute and relative terms as compared to SC. These trends are generally restricted to younger women: under-age-35 AC incidence approximately doubled from the early 1970s to the early 1980s. Available data, although scanty, consistently show that the frequency of cervical adenocarcinoma rises with the number of partners and with decreasing age at first intercourse, suggesting a potential role for sexually transmitted (viral) factors. In clinical series, nulliparity was reported more frequently in AC than in SC cases but an inconsistent association was found in three formal epidemiological studies. Similarities with the epidemiology of endometrial cancer are also suggested from the association with overweight, while a possible relation with hypertension and diabetes is based on clinical series only and hence more difficult to interpret. Thus, adenocarcinoma of the cervix appears to share epidemiological characteristics with both adenosquamous cancer of the cervix and adenocarcinoma of the endometrium, although uncertainties in classification and registration leave several questions unanswered.
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PMID:Epidemiology of adenocarcinoma of the cervix. 222 71

Soskin, in his 1946 textbook, stated that insulin may be regarded as the dominant instrument in the symphony of endocrine action that results in normal carbohydrate metabolism. After almost half a century, great progress in the medical field has revealed that insulin plays more than even he described. Some aspects of important actions of insulin in our field as investigated in our laboratory are summarized below. 1. Role of insulin in reproductive endocrinology. (1) Correlation of insulin and testosterone in normal young women and patients with polycystic ovary syndrome (PCO). The sum of serum insulin values during 75g OGTT and serum testosterone values were positively correlated in normal women and patients with PCO. Glucose transport activities in isolated adipocytes from a typical PCO patient were decreased, but insulin binding activities were not, which indicates that insulin resistance in this patients is due to some post-receptor defects. (2) Insulin may be a risk factor of endometrial carcinoma. It is well-recognized that several diseases associate with hyperinsulinemia, such as obesity, PCO, diabetes mellitus, and hypertension are risk factors for endometrial carcinoma. The sum of the insulin values during OGTT was significantly higher in patients with endometrial carcinoma than in those without. 2. Role of insulin in perinatal medicine. (1) Increase in insulin secretion during pregnancy. High serum insulin concentration during OGTT, increased secretion of urinary C-peptide, and enhanced staining of insulin in B cells by the PAP method suggest that insulin secretion is enhanced during pregnancy. (2) Insulin resistance during pregnancy. Glucose utilization rate in both pregnant and progesterone-treated rats, as assessed by a glucose clamp technique, is significantly decreased as compared to nonpregnant rats. The technique of 2-deoxyglucose injection revealed that whole body insulin resistance is due to insulin resistance in individual insulin-sensitive tissues. The activities of 3-0-methyl-D-glucose transport in isolated rat skeletal muscle and human adipocytes were found to decrease during late pregnancy, but insulin binding activities were not. These results suggest that insulin resistance during pregnancy is due to some post-receptor mechanisms. (3) Physiological meaning of insulin in fetal growth.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The role of insulin in reproductive endocrinology and perinatal medicine]. 223 Apr 12

In order to study the risk factors associated with endometrial carcinoma, a case-control study conducted in the First Affiliated Hospital of Xian Medical University, from July 1984 to June 1988. Interviews with 102 cases and 102 matched controls were made. The authors analyzed the data, by using odds ratio, chi 2 test, chi 2 test for trend and logistic regression. The results indicated that risk factors related to endometrial carcinoma might be early menarche, low frequency of pregnancy, nulliparity or low parity and obesity. The factors of hypertension, diabetes, uterine curettage, fluoroscopy of pelvic cavity and mental trauma might also play a very important role in the pathogenesis of endometrial carcinoma. There was no association between endometrial carcinoma and oral contraceptives, age of first birth, sterilization, leiomyoma of uterus.
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PMID:[A case-control study on endometrial carcinoma]. 227 87

This review of endometrial cancer summarizes the demographic characteristics of patients with the disease, their hormonal risk factors related to endogenous and exogenous estrogens and medical history, and other risk factors. Endometrial cancer increased in incidence in the US in the early 1970s, but then declined again in the last 2 decades. Possible reasons are classification including estrogen- induced hyperplasia, but also increased use of exogenous estrogens primarily in post-menopausal women, who are the predominant victims. Postmenopausal estrogen usage decreased at the same time. The highest incidence occurs in Polynesian women, although US Caucasians have more endometrial cancer then Blacks or European women. Endometrial cancer is common in women with estrogen-secreting ovarian cancer. Women with polycystic ovaries, where the steroid androstenedione is secreted and converted to estrone in peripheral tissues, but progesterone is lacking, are higher risk for endometrial hyperplasia and cancer. Obese women are also at risk (estimated 20-fold), as they have low sex binding globulin and higher estrogen levels. Any exogenous estrogen, by any route, even if stopped for a week per month confers higher risk for endometrial cancer, as shown by virtually all case control studies. Very little data exists on the actual effect of taking progestins with postmenopausal estrogens. These tumors are less invasive, more differentiated, and often detected earlier than non-estrogen dependent endometrial cancers. Other putative risk factors, e.g., diabetes, hypertension, gall bladder disease, radiation exposure, and family history of breast cancer have no solid evidence for association. Smoking, however, is associated with a lower risk of endometrial cancer.
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PMID:Epidemiology of endometrial cancer. 257 97

The population attributable risk for endometrial cancer has been estimated in relation to its four major risk factors (overweight, estrogen replacement therapy, diabetes and hypertension) using data on 528 cases and 1626 controls collected within the framework of a hospital-based case-control study conducted since 1981 in the greater Milan area, northern Italy. Over 30% of the endometrial cancer cases diagnosed in the study population could be attributed to overweight, 10% to postmenopausal estrogen replacement therapy, and similar proportions (around 10%) to hypertension and diabetes. The overall estimate including the joint effect of the two conceptually preventable factors (overweight and estrogen use) was 40%, while further inclusion of diabetes and hypertension, which are not easily preventable per se but are still closely linked to 'westernization', indicated that over 50% of cases were attributable to the combined effect of these four factors. The validity of these findings, in strict terms, is limited to this area from northern Italy. However, they can be taken as a general indication of the scope for prevention of endometrial cancer in other southern European populations, sharing similarities in lifestyle and pattern of hormonal replacement therapy use.
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PMID:Population attributable risk for endometrial cancer in northern Italy. 259 36

Endometrial carcinoma found in patients younger than 50 years of age were analyzed clinicopathologically in comparison with those of other age groups. The results were 1) Out of 150 patients with endometrial carcinoma, 44 (29.3%) were diagnosed in those younger than 50 years of age and 17(11.3%) were under the age of 40. The average age of endometrial cancer was 53.6 years and that of atypical endometrial hyperplasia was 49.2. 2) The majority of these patients (93.4%) had ever complained of vaginal bleeding, whereas those younger than 40 years of age had in 82.4%. 3) History of irregular menstrual cycle was only observed in 25.6% of the patients with the age 50 or older, whereas it was complained of in 61.5% of those among forties and in 56.3% of those younger than 40. 4) Nulliparity was found in 19.8% among 50 and older, whereas 70.4% and 64.7% were seen respectively in those among forties and younger than 40. 5) Hypertension was found more frequently in older patients, but diabetes mellitus and obesity did not correlate with age. 6) Seventy cases (46.7%) has history of receiving screening for cervical cancer without detecting endometrial cancer. 7) Well differentiated adenocarcinoma (G1) and adenoacanthoma was observed frequently in younger age group. Endometrial hyperplasia was often combined with cancer in young women. Having the data above mentioned, importance of screening for endometrial cancer in younger women is discussed.
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PMID:[Clinicopathological analysis of endometrial carcinoma in young women]. 261 74

The authors present and discuss the results obtained with 202 Gynaegnost experiments in 161 women, between 45 and 65 years, nulliparous, or having experienced a late pregnancy, with menopause occurring after the age of 52 and undergoing or not estrogen-therapy after menopause, and presenting high blood pressure, obesity or diabetes. The purpose of this multicenter study, to be continued, was to demonstrate the efficacy of this tumor marker, in the early diagnosis of endometrial carcinoma, in high-risk women.
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PMID:[Experience and results with a lactate dehydrogenase marker in vaginal secretions of women at high risk for endometrial cancer]. 264 43

Current research on lipid alterations and the risk of ischemic cardiopathy is reviewed, and the relationship of such cardiopathy to exogenous hormonal treatment is examined. Most large epidemiological and intervention studies have focused on men. Men and women share some risk factors, including high serum cholesterol levels, adverse lipoprotein profile, smoking, hypertension, diabetes, obesity, advanced age, and according to some studies sedentary life style. Additional factors that may affect women more than men are elevated serum triglyceride levels, natural or surgical menopause, use of oral contraceptives (OCs), and possibly hormonal substitution therapy. Studies have revealed a characteristic female profile of lipids and lipoproteins that follows a predictable course with age and menopause. Average total cholesterol and LDL cholesterol are higher in men than in premenopausal women, but women's levels rise after menopause until they eventually exceed those of men. According to epidemiological study and clinical trials over the past 2 decades, the principal determinants of serum lipid levels and hyperlipidemia are similar for both sexes and include diet, smoking, physical exercise and other habits, and genetic factors. Lipid levels in women are also affected by endogenous estrogens, high-dose OCs, estrogen replacement therapy, and menopause. Several studies have shown that high serum concentrations of total and LDL cholesterol and relatively low levels of HDL cholesterol are correlated with development of atherosclerotic lesions and increased cardiovascular risk in men, and that lowering cholesterol reduces the risk. Thus far there are no conclusive studies demonstrating the benefits of reduced cholesterol levels for women, but studies that included women along with men suggested that they share the benefits. Low levels of HDL cholesterol and elevated serum triglyceride levels appear to be important predictors of ischemic cardiopathy in women. The coronary risk in former OC users does not appear to be higher than that of women who never used OCs. It is likely that the lower-dosed formulations now in use will mitigate the risk. The adverse effect of OCs on lipid levels appears to be related to the androgenicity of the progestin. Most of the progestins used in combined pills are related to the 19-nortestosterone group which tends to decrease HDL level and increase LDL and triglyceride levels. Many studies have demonstrated that postmenopausal use of estrogens alone result in a decrease in LDL and an increase in HDL levels. Most but not all studies have shown that hormonal substitution reduces risks of coronary disease. But the longterm effects of estrogen/progestin use, now recommended to avoid increased risk of endometrial cancer, are not known.
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PMID:[Women and ischemic cardiopathy]. 269 94


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