A comparison of raloxifene and calcium plus vitamin D on vaginal atrophy after discontinuation of long-standing postmenopausal hormone therapy in osteoporotic women. A randomized, masked-evaluator, one-year, prospective study.

OBJECTIVES: We assessed the effects of the discontinuation of long-standing transdermal estrogen replacement therapy (>4 years) and substitution of this treatment by calcium or raloxifene on the vaginal epithelium and climateric symptoms in a study population of osteoporotic women. METHODS: A total of 136 women (mean age 55.5 years) were randomized to calcium (500 mg elemental calcium, 400 IU Vitamin D3) (n=40), raloxifene (60 mg/day) (n=48), or estrogen patches (3.9 mg estradiol) and progesterone (100 mg/day) (n=48). Treatment was given for 1 year. The vaginal maturation value (VMV), serum estradiol levels, and climateric symptoms using a 12-item modification of the SF-36 quality of life questionnaire were evaluated at baseline and at 6 and 12 months. RESULTS: At 6 months, mean VMV decreased significantly (P<0.001) in the calcium (-51.8%) and raloxifene (-18.6%) groups compared with baseline and the estrogen/progesterone group. At 12 months, significant decreases of mean VMV in the calcium (-38.7%) and raloxifene groups (-32%) (P<0.001) were also observed. Serum estradiol levels and changes of VMV correlated significantly at 6 months (rho=0.361, P<0.01) and at 12 months (rho=0.269, P<0.035). A significantly higher number of patients complained of hot flushes and palpitations in the calcium and raloxifene groups than in the estrogen/progesterone group. Raloxifene-treated women reported a significantly higher number of adverse events at 6 months compared to the other treatment groups. CONCLUSIONS: Withdrawal and change of long-standing transdermal hormone replacement therapy by treatment with calcium or raloxifene resulted in worsening of vaginal atrophy assessed by the VMV, although it was not clinically perceived by the patients. However, increases in dyspareunia and urinary leaks were reported. Menopausal complaints related to vasomotor symptoms worsened in the calcium- and raloxifene-treated groups and persisted throughout the study period.

ASCUS: comparative follow-up results related to previous SIL diagnosis.

The clinical significance of ASCUS (atypical squamous cells of undetermined significance) remains undetermined. In a variety of cases, it is possible to identify an underlying neoplastic squamous lesion. With the aim of establishing some rationale basis for management, we have evaluated the history and the follow-up of 137 woman diagnosed with ASCUS. These woman were distributed into two groups, with or without history of SIL (30 and 107 woman, respectively); 38 woman did not come to the control. In general, the rate was 30.3% for low grade SIL (squamous intraepithelial lesions) and 6.1% for high grade SIL. In both groups the rate of low and high grade SIL was similar. In our opinion, women that are diagnosed with ASCUS must be submitted to colposcopic exams independently of their history.

[Neutrophilia in the bronchoalveolar lavage of patients with AIDS and Pneumocystis carinii pneumonia. Reflections on its prognostic value in the Spanish setting]. / Neutrofilia en el lavado broncoalveolar de pacientes con SIDA y neumonía por Pneumocystis carinii. Consideraciones sobre su valor pronóstico en nuestro medio.

The prognostic value of neutrophilia (> 5%) in bronchoalveolar lavage (BAL) in our context is studied in 21 patients with AIDS and Pneumocystis carinii pneumonia. Neutrophilia does not seem to be a good prognostic indicator in our context. We have found this condition, with a mean of 6 +/- 4%, in only 33% of our sample. The sensitivity of this parameter with respect to risk of death was very low (25%), while specificity was moderate (65%). In contrast with what has been reported in studies done with Anglo-Saxon populations, neutrophilia in BAL is probably of little prognostic use in our context. This may be due to various factors, among them the type of population (most being intravenous drug users) and the therapeutic protocol (early empirical treatment).

Atipia citológica de significado incierto en células escamosas. Importancia del seguimiento de las pacientes. Relación con la edad y las células metaplásicas / Atypical squamous cells of undetermined significance. Importance of patient follow-up and relation with age and metaplastic cells

Objetivos: Evaluar la importancia de la edad y de las células sobre las que asientan las lesiones de atipia citológica de significado incierto en células escamosas (ASCUS) en relación con la evolución de la lesión. Material y método: Revisión de las citologías correspondientes a 296 pacientes diagnosticadas de ASCUS (ASC-US y ASC-H), desde 1995 a 1999 en el Servicio de Patología del Hospital del Mar de Barcelona. Evaluación de la aparición de displasia de cualquier grado en uno de los controles posteriores, en relación con los antecedentes, con el tipo de células sobre las que asientan los cambios, y con la edad de las pacientes. Resultados: Antecedentes: La tasa de aparición de lesión escamosa intraepitelial de bajo grado (LSIL) es variable y no tiene relación con los antecedentes de la paciente. La tasa de aparición de lesión escamosa intraepitelial de alto grado (HSIL) muestra un aumento lineal en relación con la gravedad de los antecedentes. Edad: Se observa mayor tasa de aparición de LSIL en mujeres menores de 45 años y mayor tasa de aparición de HSIL en mujeres mayores de 45 años, pero las diferencias no son estadísticamente significativas. Células escamosas inmaduras: Se observa mayor tasa de aparición de lesión escamosa intraepitelial (SIL) de cualquier grado cuando los cambios asientan sobre células escamosas inmaduras, pero las diferencias no son estadísticamente significativas. Conclusiones: Sí parecen tener importancia los antecedentes en relación con la recidiva de la lesión. Pese a que la tasa de aparición de HSIL es baja, aumenta en relación con la gravedad de los antecedentes. La identificación de una citología ASCUS en una paciente con antecedentes de displasia puede marcar la progresión-evolución del proceso displásico. Parece, además, que HSIL es más frecuente cuando ASCUS asienta sobre células escamosas inmaduras. Nuestros datos favorecen esta hipótesis, a pesar de que las diferencias no son estadísticamente significativas. Respecto a la edad, nuestro estudio confirma los datos establecidos previamente en la bibliografía. Por fin, parece importante el hecho de realizar controles citológicos al menos durante los primeros 2 años, dado que la tasa de aparición de HSIL es mayor en este período (AU)