When to perform palliative surgery in the treatment of ovarian cancer: a brief review.

UNLABELLED: The objective of this review was to address the main indications for palliative surgery in the treatment of ovarian cancer. DESIGN: Articles from MEDLINE/PUBMED, EMBASE, and LILACS databases up to May 05, 2012 were included with no bars on foreign languages. The key words used were taken from the Medical Subject Headings and were as follows: ovarian cancer AND palliative surgery, ovarian cancer AND complications, and ovarian cancer AND intestinal obstruction. Subsequently, the references from the original articles were also analyzed. RESULTS: Among the complications developing in the course of malignant neoplasia, intestinal obstruction stands out as the main indication for palliative surgery, which may also be indicated for rectovaginal and enterovaginal fistulas, as well as for genital and lower gastrointestinal hemorrhage. CONCLUSION: Although incurable, the patients with complications due to ovarian cancer may have an extended survival and an improved quality of life with palliative surgery for the following reasons: a) improvement in the nutritional state after treatment for intestinal obstruction due to the possibility of oral nutrition; and b) improvement in clinical conditions, allowing for palliative chemotherapy.

Effects of the addition of methyltestosterone to combined hormone therapy with estrogens and progestogens on sexual energy and on orgasm in postmenopausal women.

OBJECTIVE: To evaluate the effect of the addition of methyltestosterone to estrogen and progestogen therapy on postmenopausal sexual energy and orgasm. METHODS: Sixty postmenopausal women in a stable relationship with a partner capable of intercourse, and presenting sexual complaints that appeared after menopause, were randomly divided into two groups: EP (n = 29) received one tablet of equine estrogens (CEE) 0.625 mg plus medroxyprogesterone acetate (MPA) 2.5 mg and one capsule of placebo; EP + A (n = 31) received one tablet of CEE 0.625 mg plus MPA 2.5 mg and one capsule of methyltestosterone 2.0 mg; The treatment period was 12 months. The effects of treatment on sexual energy were assessed using the Sexual Energy Change Scale. The ability to reach orgasm in sexual relations with the partner was verified through monthly calendars and by calculating the ratio between monthly frequency of orgasms in sexual relations and monthly sexual frequency. RESULTS: There was a significant relationship between improvement in level of sexual energy and the addition of methyltestosterone to CEE/MPA treatment (p = 0.021). No significant effect on orgasmic capacity was noted after the treatment period. CONCLUSION: Addition of methyltestosterone to CEE/MPA therapy may increase sexual energy, but might not affect the ability to obtain orgasm in sexual relations.

Hormone therapy following the Women's Health Initiative (WHI) study: perception of gynecologists in Brazil.

AIM: The objective of the present study was to evaluate the effects of the Women's Health Initiative (WHI) study on gynecologists in Brazil, with particular emphasis on knowledge, interpretation of the study and attitude regarding hormone therapy (HT). METHODS: A total of 806 gynecologists were evaluated through questionnaires. For the evaluation, questions regarding his/her degree of knowledge and interpretation of the WHI study, number of prescriptions written for HT and opinion regarding the ideal form of HT following the WHI study were analyzed. RESULTS: Physicians were found to have a good knowledge of the study (97.6%). The most common interpretation of the results of the WHI study referred to the single HT regimen used in the trial in patients with specific characteristics, this being the response of 66.3% of physicians. There was a reduction of 21.7% in the intention to prescribe HT, with 32.5% of gynecologists reporting changing to a different therapeutic regimen. After the WHI study, the gynecologists showed a preference for low doses of estrogens and progestogens. CONCLUSIONS: The WHI study had a relevant impact on the attitude of doctors in Brazil.