Population-based survey on menopausal symptoms and treatment use.

OBJECTIVE: This article aimed to study the use of menopausal hormone therapy (MHT) among Spanish perimenopausal and postmenopausal women, the presence of menopausal symptoms and the sources of information. METHODS: The epidemiological study using a survey included Spanish perimenopausal or postmenopausal women aged between 40 and 70 years in August 2021. RESULTS: A total of 1254 women were included. In the postmenopausal group, 86% reported one or more menopausal symptoms; the most frequent was vulvovaginal dryness (57%). Among the symptomatic women, 15.2% used some treatment. Vasomotor symptoms (p = 0.001), vulvovaginal atrophy (p < 0.001) and symptoms related to sexuality (p < 0.001) were associated with greater use of treatments; 2.5% of postmenopausal women used MHT. In the perimenopausal group, 75.1% were symptomatic, hot flashes being the most frequent. Only insomnia was related to greater use of some treatment (p = 0.021); 1.6% of perimenopausal women used MHT. The most common reason for women's rejection of MHT was the fear of side effects, especially cancer. The gynecologist was the most frequently used source of information. CONCLUSIONS: Although there is a high prevalence of symptoms, the use of MHT in Spanish perimenopausal and postmenopausal women is very low.

Efficacy and safety of a phyto-SERM as an alternative to hormone therapy.

In this review, we analyze the efficacy and safety of DT56a in the treatment of postmenopausal symptoms. Similar to all selective estrogen receptor modulators (SERMs), DT56a demonstrates dual agonistic and antagonistic effects due to the synergy between its components. DT56a is referred to as a plant-origin SERM (phyto-SERM) and, for this reason, its therapeutic capacity in postmenopausal women differs from other phytoestrogens used independently. Although interesting data on relief of vasomotor symptoms have been reported for DT56a, further clinical studies with a greater number of cases and a longer period of study are required to correctly identify its indications for use as an alternative to hormone therapy, especially in preventing osteoporosis.

Soy isoflavones improve insulin sensitivity without changing serum leptin among postmenopausal women.

OBJECTIVE: To investigate the effect of a soy isoflavone extract over insulin sensitivity and plasma leptin levels. METHODS: Eighty postmenopausal women were randomly assigned to participate for 24 months either to a physical exercise and Mediterranean diet program (Control group: CG) or this intervention plus a daily oral intake of a soy isoflavone extract (Soy isoflavone group: SIG). Anthropometry, body composition analysis, blood biochemistry, menopausal symptoms and health-related quality of life were assessed at baseline and every 6 months. RESULTS: Sixty-five women completed the protocol with no differences found among groups at baseline in age and time since the menopause. At month 24, body mass index (BMI) was lower in the SIG as compared to the CG. Fat mass, glucose, insulin, HOMA-IR, tumor necrosis factor-α (TNF-α), Kupperman Index and Cervantes Scale values significantly decreased in the SIG as compared to baseline and to CG values. Kupperman scores and serum TNF-α levels significantly decreased in both studied groups. No changes in plasma leptin levels were observed after 24 months within and between groups. When analysis was stratified according to BMI values, changes in the aforementioned parameters displayed a similar trend; however, the impact over glucose, insulin and HOMA-IR values was more evident among obese women assigned to the SIG. CONCLUSION: Diet, physical exercise and a daily oral intake of soy isoflavones exerted a beneficial effect on the homeostatic model in postmenopausal women which was not related to significant changes in plasma leptin levels, despite a decrease in TNF-α, fat mass and Kupperman values.

17beta-Estradiol and/or progesterone protect from insulin resistance in STZ-induced diabetic rats.

Recent clinical and experimental evidences suggest that sex steroids protect from insulin resistance associated with diabetes. Therefore, we have assessed the influence of E2 and/or P4 on insulin sensitivity by euglicaemic-hyperinsulinaemic clamp in ovariectomized streptozotocin-induced diabetic rats, focusing on key proteins of insulin signaling in skeletal muscle. Although low plasma levels of E2 (days 6 and 11) increased Glut-4 plasma membrane content and subsequent improved insulin sensitivity, they could not fully reverse hyperglycaemia negative effects on p85alpha-IRS-1 association and IRS-1 content during 11 days. However, high plasma levels of E2 (day 16) could reverse hyperglycaemia effects not only on Glut-4 plasma membrane content but also on p85alpha-IRS-1 association and IRS-1 protein content level. In contrast, P4 treatment only improved insulin sensitivity when its plasma concentration was low (days 6 and 11) and its effects were not associated with any proteins study in this paper. The combined therapy had a synergic effect on insulin sensitivity when their plasma levels were low (day 6) or high (day 16), that could be associated with Glut-4 plasma membrane content modulation, p85alpha-IRS-1 association and IRS-1 amount. These new findings improve our understanding of biochemical basis of insulin resistance due to hyperglycaemia and could open up new possibilities of treatment in uncontrolled type 1 DM.

Thyroid carcinoma originating in a teratoma of the ovary.

The malignant degeneration of a cystic teratoma of the ovary is a rare complication which different authors place at between 0.8 to 4%. Adenocarcinomas represent a relatively rare complication, 8% of secondary cancers, those of thyroid origin being reported in only 5 cases. The aim of this paper is to present the sixth such case of thyroid carcinoma developed in a mature teratoma in the ovary.

Preoperative colonoscopic diagnosis of villous adenoma of the appendix. Report of a case and review of the literature.

This case of villous adenoma of the appendix reported is unique by virtue of its having been diagnosed preoperatively using colonoscopy. Only 45 such lesions have been described previously, and a review of those cases reveals that 93 percent were discovered at appendectomy performed either incidentally or for acute appendicitis. The malignant potential of this entity is unknown and its treatment is controversial. Because of a report association between adenomas of the appendix and other gastrointestinal neoplasms, long-term surveillance is recommended.

Percutaneous endoscopic gastrostomy: clinical experience and follow-up.

To assess our clinical experience with this method of enteral feeding, we conducted a retrospective study and follow-up of 73 patients having percutaneous endoscopic gastrostomy (PEG). In addition, we conducted a telephone survey of 42 persons who cared for the PEG tube. The most common indication was neurologic impairment of deglutition. Early and late complications occurred in 12% and 33% of cases, respectively, and were usually minor. Our 30-day survival was 74%. Most patients (77%) maintained their weight with standard tube feedings. Satisfaction with and acceptance of the PEG was almost universal. Patients should be carefully selected, with attention to long-range benefit.

Esophageal-atrial fistula.

We report an unusual case of an esophageal-atrial fistula in a patient with CREST (calcinosis, Raynaud's phenomenon, esophagitis, sclerodactyly, telangiectasia) variant of scleroderma. An ulcer in Barrett's esophagus perforated into the left atrium and led to systemic embolization and cerebral abscess. A review of similar reports of esophageal-atrial fistula reveals a symptom complex that includes chronic esophageal pathology, gastrointestinal bleeding, and neurological signs. An antemortem diagnosis has never been made.