Type of axial analgesia does not influence time to vaginal delivery in a Proportional Hazards Model.

OBJECTIVE: To create a Proportional Hazards Model of prospective factors associated with time-to-vaginal-delivery (TTVD). METHODS: We analyzed a group of 144 women undergoing childbirth who received one out of two possible axial analgesia techniques, to find-out factors associated with TTVD. The patients were randomly assigned to receive either a levobupivacaine labor epidural (bolus concentration 0.25 % or less; infusion concentration 0.125 % or less) or a combined spinal-epidural procedure (morphine 0.20 mg, fentanyl 25 µg and hyperbaric bupivacaine 2.5 mg as spinal components) for labor analgesia. The factors initially chosen were: mother age, height and weight, parity, gestational age, newborn weight, type of labor, analgesic procedure, levobupivacaine and fentanyl doses, Bromage scale, pain Numeric Rating Scale, and a satisfaction interview. Cesarean section was the censored variable in our model. A systematic multivariate Cox regression was performed. RESULTS: Our Final Model stated that nulliparous women had 2.5 times more chances of having longer TTVD than primiparous (p < 0.001, CI 1.76-3.8), and 3.4 times more (p = 0.015, CI 1.27-9.25) than multiparous. Women with oxytocin-augmented labor had 2.05 times more chances (p = 0.001, CI 1.31-3.22) of having longer TTVD than patients without oxytocin. An induced partum had 3.8 times more chances (p < 0.001, CI 2.09-6.8) of having longer TTVD compared to a spontaneous partum. CONCLUSION: Parity, labor augmentation, induction of labor and fetal weight determine TTVD; axial analgesia-related factors do not contribute to the model.

Insoluble carob fiber rich in polyphenols lowers total and LDL cholesterol in hypercholesterolemic sujects.

Recently, polyphenols have been found to affect blood lipids in animals in a similar manner as soluble dietary fibre. The aim was to assess whether an insoluble dietary fiber very rich in polyphenols has a beneficial effect on serum lipids in humans. In a double-blind randomized placebo-controlled clinical study with parallel arms, 88 volunteers with hypercholesterolemia were randomly assigned to consume daily either, fiber with insoluble 84% polyphenols 4 g twice a day (n = 43) or placebo (n = 45). Serum total, LDL and HDL cholesterol and triglycerides were assessed at baseline and after 4 weeks. The insoluble polyphenols consumption reduced the total cholesterol by 17.8 +/- 6.1% (p < 0.05), LDL cholesterol by 22.5 +/- 8.9% (p < 0.001), LDL: HDL cholesterol ratio by 26.2 +/- 14.3% (p < 0.001) and triglycerides by 16.3 +/- 23.4% (p < 0.05) at the end of the study compared with baseline. No significant differences were found during the study time in the placebo group for the lipid profile. The consumption of fiber very rich in insoluble polyphenols shows beneficial effects on human blood lipid profile and may be effective in prevention and treatment of hyperlipemia.

Vascular reactivity and atheromatous plaques in post-menopausal women on tibolone treatment. Open prospective study with Doppler ultrasonography in internal carotid artery.

BACKGROUND: Arteriosclerosis is the main cause of ischaemic ictus. The middle cerebral and anterior cerebral arteries, which irrigate over 70% of the entire cerebral tissue, spring from the internal carotid. Additionally, it is in the extracraneal vessels that embolism, thrombosis and stenosis originate more frequently. AIM: To evaluate the variations in blood flow (pulsatility index: PI) and to assess the evolution of atherogenic lesions (thickening of the vascular intima and the presence of atheromatous plaques) in the internal carotid artery after tibolone therapy. SUBJECTS AND METHODS: A total of 116 healthy menopausal women were included in this open, prospective and comparative study. Of them, 101 subjects completed the 48 weeks follow-up. Subjects were allocated in two groups: group T (n = 55) received 2.5mg/day of tibolone daily and group C (n = 61) was a free-treatment control group. To evaluate both resistance to blood flow and the existence and evolution of atheromatous plaques in the internal carotid, an ultrasonograph with a pulsed Doppler was used. The PI was used as the parameter of vascular tone. To study atherosclerotic lesions in the internal carotid artery, we used morphological criteria. Measurements were done before entering in the study, and at 12, 24, 36 and 48 weeks of treatment. RESULTS: After tibolone treatment the PI in the internal carotid artery was observed markedly diminished. Moreover, tibolone reduces both the thickness and length of atheromatous plaque and the degree of vascular stenosis. CONCLUSION: tibolone administration reduced the carotid atheromatous plaque in thickness and length and improved cerebral perfusion.

Tibolone and risk of endometrial polyps: a prospective, comparative study with hormone therapy.

OBJECTIVE: To assess the incidence of endometrial polyps during postmenopausal replacement therapy with tibolone, using an appropriate control group. DESIGN: A total of 485 postmenopausal women were included in this open, prospective, comparative study for a duration of 36 months. Of this group, 249 women received 2.5 mg/day of tibolone and 244 women served as controls, receiving continuous-combined estrogen-progestogen therapy (HT). Transvaginal ultrasound, hysteroscopy, and directed biopsies were performed before treatment was initiated and at the end of the study. RESULTS: Two hundred twenty-one of the women receiving tibolone and 203 receiving continuous-combined HT completed the study. Endometrial polyps were detected in 74 women (33.4%) from the tibolone group and in 22 women (10.8%) from the HT group (P < 0.01). The vaginal bleeding rate did not differ between the groups. The frequency of atrophic polyps was significantly higher in the tibolone group (P < 0.01). No difference was found in the size of the polyps. CONCLUSIONS: Tibolone increases by threefold the risk for endometrial polyps.

Influences of hormone replacement therapy on postmenopausal women's health perceptions.

OBJECTIVE: To assess the beliefs of climacteric women regarding their health, menopause, and hormone replacement therapy (HRT). DESIGN: Medical students asked to interview 526 healthy women, ranging from 40 to 64 years of age, between January and February of 2002. Of that number, 26 (4.9%) declined to participate in the interview. Thus, 500 women were interviewed about their beliefs and perceptions regarding their quality of life and health risks, as well as their opinions on menopause and HRT. RESULTS: The mean age of the sample was 53.3 +/- 6.2 years; 83.4% were postmenopausal, and 18.8% were HRT users. Of the women interviewed, 38.6% believed that their health was good. Although 78.8% thought that cancer is the main cause of death, 64% of them considered themselves to be at high risk for cardiovascular disease and osteoporosis. Most (64%) believed that menopause deteriorates the quality of life and that it increases cardiovascular risk (52.4%) and osteoporosis (72.0%). The HRT users perceived that they had better health status (48.9% v 36.2%, P < 0.02) and smaller cardiovascular risk (54.3% v 66.3%, P < 0.04) than did the nonusers; however, they ignored the preventive effect of estrogens in osteoporosis. CONCLUSIONS: Women believe that menopause deteriorates their health. The HRT users perceived themselves to be healthier and to have a smaller risk for cardiovascular disease.

Efficacy and safety of Ibuprofen arginine in the treatment of primary dysmenorrhoea.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of ibuprofen arginate in the treatment of patients with primary dysmenorrhoea in normal clinical practice. STUDY DESIGN: In this open trial, patients received an initial oral dose of ibuprofen arginine 600mg at the onset of pain, followed by the same dose every 6 hours, if necessary, with a maximum daily dose of 2400mg. The study assessed the evolution of pain intensity, rapidity of action, need for supplementary analgesics, decrease in working or school hours lost, and safety and tolerability of ibuprofen arginine treatment. Each patient was evaluated prior to inclusion in the study and after one and three cycles. RESULTS: From the 1093 recruited patients, 854 women were evaluable for safety and tolerability, and 838 for efficacy. Significant improvement in pain relief was observed 15 minutes after treatment compared with baseline values (p < 0.001). At 15 and 30 minutes the percentage of patients reporting a marked decrease in pain intensity was 82.2% and 97.6%, respectively. Additionally, a significant reduction in absenteeism from work or school (from a mean of 4.6-0.8 hours per cycle) was observed (p < 0.001). Thirty-eight patients presented with adverse events in the trial period, but only 26 subjects (3% of 854) in the adverse events cohort reported having a possible adverse event, with gastrointestinal complaints being the most frequent. CONCLUSION: Ibuprofen arginine appears to be effective, fast, safe and well tolerated in the treatment of patients with primary dysmenorrhoea.

Position of the Spanish Menopause Society regarding the management of menopausal symptoms in breast cancer patients.

Breast cancer is the most common female cancer in Spain. Its high prevalence, its high survival rate, and its incidence are the reasons treatment is increasingly sought for common problems by young women who have survived it. Besides the contraception and fertility issues, many breast cancer survivors develop sexual disorders and menopausal symptoms, whether as a consequence of treatment-induced menopause or side effects of treatment. For such reasons, a panel of experts from the Spanish Menopause Society has met to develop usage recommendations for the relief of vasomotor symptoms and for sexual and reproductive health in patients with breast cancer based on the best evidence available.

Effect of combined spinal-epidural analgesia versus epidural analgesia on labor and delivery duration.

OBJECTIVE: To determine whether combined spinal-epidural analgesia (CSEA) can decrease the known epidural effect of lengthening delivery. METHODS: Between April and May 2010, 144 women undergoing childbirth in hospital with epidural pain relief were randomized to receive either low-dose epidural analgesia (LEA) or CSEA. The spinal component included 2.5mg of bupivacaine, 25 µg of fentanyl, and 200 µg of morphine. The epidural component of the CSEA procedure was started once pain returned. The primary outcome was total labor duration measured from the time of initiation of labor analgesia to delivery. RESULTS: The difference in duration between LEA (n=72) and CSEA (n=72) was 5 minutes for labor (P=0.82), 2 minutes for delivery (P=0.60), and 7 minutes for total labor duration (P=0.75). The combined group used less levobupivacaine (P<0.001) and had lower sensory blockade at the dermatomal level (P=0.037). Women in the CSEA group had a higher incidence of pruritus (P=0.002) and lightheadedness (P=0.02) during labor; and a higher incidence of pruritus (P=0.002), nausea-vomiting (P=0.026), and drowsiness (P=0.003) in the postpartum period. CONCLUSION: As compared with LEA, CSEA did not shorten the duration of labor length; however, it did reduce levobupivacaine consumption and motor weakness.

Review article: vitamin D acquisition and breast cancer risk.

OBJECTIVE: The aim of the study was to focus on the association of vitamin D and breast cancer. METHODS: The study of evidence concerning vitamin D's influence on the origin and development of breast cancer from a PubMed and individual searches. RESULTS: Body sunlight exposure may reduce the prevalence of breast cancer. However, these studies correspond to global populations of different countries and regions without considering other geographic factors and individual, ethnic, and cultural factors that may affect sunlight exposure. Epidemiological analyses show that low vitamin D ingestion is associated with increased risk of breast cancer. Studies measuring serum vitamin D metabolites in women who were followed many years suggest that low circulating 25-hydroxyvitamin D3 levels are associated with increased breast cancer risk. CONCLUSIONS: Although there are controversial results, it seems plausible that sufficient endogenous vitamin D levels may have a protective function on mammary cells, reducing breast cancer risk.

Vaccinium macrocarpon: an interesting option for women with recurrent urinary tract infections and other health benefits.

AIM: To review the scientific publications concerning the clinical use and mechanism of action of the North American cranberry (Vaccinium macrocarpon) for women with recurrent urinary tract infections (UTI) and other health conditions. METHODS: This is a retrospective study of published information concerning Vaccinium macrocarpon retrieved from a PubMed and individual searches. RESULTS: Urinary tract infections are very common in women, cause discomfort, and may aggravate other genitourinary conditions. The available scientific information supports a clinical benefit of Vaccinium macrocarpon in the prevention of recurrent UTI in women. There is a non-significant reduction of UTI associated with Vaccinium macrocarpon treatment during pregnancy. A group of proanthocyanidins (PAC) with A-type linkages have been isolated from Vaccinium macrocarpon which inhibit P-fimbriae synthesis and induce a bacterial deformation, on both antibiotic-susceptible and antibiotic-resistant uropathogenic Escherichia coli. It is plausible that cranberry PAC prevent bacteria from adhering to the uroepithelium of the bladder, thereby blocking the ability of E. coli to infect the urinary mucosa. CONCLUSION: Cranberry treatment is a safe, well-tolerated supplement that does not have significant drug interactions. Although investigations are in the early stages, experimental and preclinical studies suggest that cranberry components may have other potential benefits, including anti-infective, anticancer and antioxidant effects, which may be considered as positive for different age-related conditions. In addition, cranberry components may induce positive cardiovascular and metabolic changes, and may improve neuropsychological activity. These effects warrant further clinical research to better place the role of cranberry products for women.

Effects of the Mediterranean diet on longevity and age-related morbid conditions.

OBJECTIVES: To delineate the influences of the Mediterranean diet (MD) on human mortality and age-related morbid conditions, principally the metabolic syndrome, hypertension, cardiovascular disease, excess body weight, cancer, poor bone mineralization and rheumatoid arthritis, and neurodegenerative disorders. METHOD: Citations were selected from a PubMed search according to their clinical and experimental relevance. RESULTS AND CONCLUSIONS: Individuals who adhere to the principles of the traditional MD tend to have a longer life-span. Both men and women who report eating foods closest to the MD are about 10-20% less likely to die over the course of a study of heart disease, cancer or any other cause. The longevity of Mediterranean people has been related to olive oil, and its several microcomponents of antioxidant potential, present in all MD variants. The prevalence of the metabolic syndrome may be reduced by a MD. The MD is significantly inversely associated with both systolic and diastolic blood pressure. It also has benefits in relation to the prevention of cardiovascular events, reduces the risk of mortality after myocardial infarction, and reduces peripheral arterial disease. The risk of obesity decreases with increasing adherence to the traditional MD. The MD also has a preventive effect on cancer, through its antiproliferative and pro-apoptotic effects, mostly due to the components of virgin olive oil and vegetables. There is some evidence of the benefits of the MD in relation to bone metabolism, rheumatoid arthritis, and neurodegenerative age-related diseases (cognitive deficit, Alzheimer's disease, Parkinson's disease).

Raloxifene plus ossein-hydroxyapatite compound versus raloxifene plus calcium carbonate to control bone loss in postmenopausal women: a randomized trial.

OBJECTIVE: To compare the efficacy and safety of adding ossein-hydroxyapatite compound (OHC) or calcium carbonate (CC) to raloxifene (RLX) therapy for controlling bone loss in postmenopausal women. DESIGN: : Ninety postmenopausal women were assigned to treatment with RLX plus OHC (group 1, 48 women) or RLX plus CC (group 2, 42 women) for up to 3 years in an open-label, comparative study. Ultrasound measurement of amplitude-dependent speed of sound (ADSoS) was used to evaluate mean changes in bone mineral density. The primary endpoint was mean change of ADSoS from baseline. An intention to treat and per protocol analysis were carried out. Adverse effects were also recorded. RESULTS: Over the study period, the mean ADSoS diminished in both groups even though the rate of reduction was higher in the RLX plus CC group, with a mean change in ADSoS score of -18.72 m/s from baseline to year 3 in the RLX plus OHC group and -63.64 m/s in the RLX+CC group (P = 0.006). Similar results were seen on T and Z scores. Adverse effects were infrequent and the number and type were similar between groups. CONCLUSIONS: RLX plus OHC appears to be more effective in controlling bone loss than RLX plus CC for the control of bone loss in postmenopausal women.

Factors influencing long-term outcome of loop endometrial resection.

STUDY OBJECTIVE: To analyze factors that contribute to long-term success of loop endometrial resection (ER). DESIGN: Observational cohort study (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. PATIENTS: Two hundred eighty-six premenopausal women with menometrorrhagia resistant to medical treatment. INTERVENTION: Loop endometrial resection. MEASUREMENTS AND MAIN RESULTS: Mean follow-up was 47 months. Life table analysis with log rank test was determined to calculate the risk of hysterectomy after ER. Patient age, length of follow-up, adenomyosis, and uterine size were analyzed independently. More than 75% of patients benefited from the procedure, avoiding hysterectomy after 5 years. CONCLUSION: Length of follow-up, patient age, and the presence of adenomyosis strongly influence the long-term success of ER. The procedure should be considered an intermediate step between medical treatment and hysterectomy.

Endometrial intraepithelial neoplasia diagnosed at endometrial resection.

The literature has no reported cases of isolated endometrial intraepithelial neoplasia found at endometrial resection. If endometrial cancer is occult it might not be detected at diagnostic hysteroscopy or during resection, especially if destructive techniques are used. A 51-year-old woman had history of menorrhagia, with diagnostic hysteroscopy showing benign functional endometrium and diagnosed as dysfunctional uterine bleeding. Endometrial resection was performed and the pathologic examination in one stripe of resected tissue found focal, isolated endometrial intraepithelial neoplasia. This case reinforces the importance of pathologic tissue examination after endometrial ablation. Care must be taken when performing second-generation nonhysteroscopic ablation techniques, as even with direct visualization a premalignant lesion can be missed.

Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment--a prospective, randomized, and controlled clinical trial.

PURPOSE: To evaluate the effectiveness of uterine artery embolization (UAE) in the management of bleeding in patients with uterine fibroids and to compare UAE with hysterectomy, particularly with regard to length of hospital stay and associated complications (ie, safety). MATERIALS AND METHODS: A prospective clinical trial was performed with patients who were randomly assigned to one of two groups: patients who were offered the option of undergoing either UAE or hysterectomy (group 1) and patients who were not informed of the alternative treatment-that is, UAE (group 2). The primary variables that were considered for evaluation of the effectiveness, efficiency, and safety of the two procedures were, respectively, bleeding cessation, total length of hospital stay, and resulting complications. The lengths of hospital stay in the two study arms were compared on an intent-to-treat basis. Owing to crossover between the treatment arms, however, effectiveness and safety were evaluated on the basis of the actual treatment received. RESULTS: The clinical success rate for the patients who underwent UAE, which was based on the cessation of bleeding, was 86% (31 of 36 patients). The mean hospital stay for group 1 was 4.14 days shorter than that for group 2 (P <.001). Ten (25%) of the 40 patients who underwent UAE experienced minor complications, in contrast to four (20%) of the 20 who underwent hysterectomy and experienced major complications. CONCLUSION: Compared with hysterectomy, UAE is safe and effective for treatment of bleeding fibroids, necessitates a shorter hospital stay, and results in fewer major complications.

Analisis general y peculiaridades metabolicas del acetato de medroxiprogesterona: Papel de los gestagenos en el estudio WHI / General analysis of medroxiprogesterona acetate

Los gestágenos son sustancias químicas que inducen una transformación secretora del endometrio. De la testosterona derivaron fármacos con propiedades progestácionales, los 19- norderivados (levonorgestrel, noretisterona, dexogestrel, etc). De la progesterona se obtuvieron los pregnanos (medroxiprogesterona, megestrol, ciproterona, etc). En los últimos años se ha logrado producir progesterona natural oral. La medroxiprogesterona se ha usado ampliamente en anticoncepción y terapia de reemplazo hormonal (TRH). El estudio WHI ha sugerido que la medroxiprogesterona podría ser responsable de algunos efectos negativos de la TRH. Algunas investigaciones sugieren que la medroxiprogesterona de depósito aumenta ligeramente el riesgo de cáncer de mama; su uso en postmenopáusicas se asocia a mayor densidad mamográfica, un conocido factor de riesgo, y en cultivos celulares tiene un efecto proliferativo; además, se ha descrito un mayor riesgo en hormonoterapia que incluye gestágenos. Desde el punto de vista cardiovascular, aunque en dosis bajas la medroxiprogesterona no modifica sustancialmente el perfil lipídico, sí altera la función endotelial, no afecta la coagulación, pero puede aumentar los receptores de trombina. No hay estudios claros que permitan identificar con seguridad si la medroxiprogesterona tiene efectos deletéreos. Sin embargo, algunas observaciones sugieren cautela en pacientes con riesgo elevado de cáncer de mama o de enfermedad cardiovascular