Does the menopausal status of female gynecologists affect their prescription of menopausal hormone therapy?

OBJECTIVE: To evaluate whether menopausal status and symptoms among female gynecologists would influence their clinical behavior related to menopausal hormone therapy (MHT). METHODS: Female gynecologists of 11 Latin American countries were requested to fill out the Menopause Rating Scale and a questionnaire containing personal information and that related to MHT use. RESULTS: A total of 818 gynecologists accepted to participate (86.4%). Overall, the mean age was 45.0 ± 10.7 years, 32.2% were postmenopausal, and 17.6% worked in an academic position; 81.8% reported that they would use MHT if they have symptoms, regardless of menopausal status. Academic gynecologists favor personal MHT use at a higher rate (p = 0.04) and have a higher MHT prescription rate as compared to non-academic ones (p = 0.0001). The same trend was observed among post- as compared to premenopausal ones (p = 0.01) and among those who had hysterectomy alone as compared to those experiencing natural menopause (p = 0.002). The presence of menopausal symptoms did not influence their MHT prescription. Current use of MHT and alternative therapy was higher among post- than premenopausal gynecologists (both, p = 0.0001) and among those who had undergone hysterectomy than those experiencing natural menopause. A 38.5% perceived breast cancer as the main risk related to MHT, and a high proportion prescribed non-hormonal drugs (86.4%) or alternative therapies (84.5%). CONCLUSION: Most female gynecologists in this survey would use MHT if menopausal symptoms were present. Postmenopausal physicians use MHT and prescribe it to their symptomatic patients at a higher rate than premenopausal physicians.

Type II diabetes mellitus and menopause: a multinational study.

BACKGROUND: Type II diabetes mellitus causes metabolic changes that may lead to early menopause and worsen climacteric symptoms. OBJECTIVES: To determine the risk factors for type II diabetes mellitus and assess the impact of this disease on the age of menopause and on climacteric symptoms. METHODS: A total of 6079 women aged between 40 and 59 years from 11 Latin American countries were requested to answer the Menopause Rating Scale and Goldberg Anxiety-Depression Scale. RESULTS: The prevalence of diabetes was 6.7%. Diabetes mellitus was associated with arterial hypertension (odds ratio (OR) 4.49; 95% confidence interval (CI) 3.47-5.31), the use of psychotropic drugs (OR 1.54; 95% CI 1.22-1.94), hormonal therapy (OR 1.46; 95% CI 1.11-1.92), ≥ 50 years of age (OR 1.48; 95% CI 1.17-1.86), overweight or obese (OR 1.47; 95% CI 1.15-1.89), and waist circumference ≥ 88 cm (OR 1.32; 95% CI 1.06-1.65). Factors associated with lower risk of diabetes were the use of hormonal contraceptives (OR 0.55; 95% CI 0.35-0.87), alcohol (OR 0.73; 95% CI 0.54-0.98) and living in cities > 2500 meters above sea level (OR 0.70; 95% CI 0.53-0.91) or with high temperatures (OR 0.67; 95% CI 0.51-0.88). In turn, diabetes tripled the risk of menopause in women under 45 years of age. Diabetes did not increase the risk of deterioration of quality of life due to climacteric symptoms. CONCLUSION: Menopause does not increase the risk of type II diabetes mellitus. Diabetes is associated with early menopause in women under 45 years of age.

Sutura mecanica automatica de bronquio. Estudio experimental y su aplicacion en cirugia humana. / Automatic mechanical sutures of the bronchi.Experimental study and its use in human surgery

En una serie de 14 perros y en otra de 15 pacientes fueron practicadas resecciones pulmonares empleando sutura mecanica automatica bronquial con el instrumento TA 30, que instala una doble hilera de agrafes metalicos antes de la seccion del bronquio. En los animales se estudio el proceso de cicatrizacion del munon y se reconocio su menor componente inflamatorio con respecto a otras series en que se emplearon puntos con hilos de distintos materiales. A los pacientes operados por variada patologia se les realizaron tanto lobectomias como neumonectomias. Excepto el alto costo relativo del instrumento y de sus repuestos, y la imposibilidad de usarlo en casos de tumores hiliares muy proximos a la carina, no encontramos objeciones a la sutura mecanica automatica. En cambio, reconocemos como ventajas que reduce el tiempo operatorio y que, al no abrirse el bronquio previamente a la sutura, no se comunica su luz con la cavidad pleural. Debido a ello, se evitam los inconvenientes que puede ocasionar este ultimo hecho, habitual en el curso de la sutura manual: hipoventilacion, entrada de sangre al lobulo restante o pulmon contralateral y contaminacion de la pleura por secreciones potencialmente patogenas

Volvulos del colon. / Volvulus of the colon

Se analizan los factores predisponentes y desencadenantes de los volvulos del colon.Se hace una breve referencia sobre las caracteristicas clinicas, radiologicas y tipos de tratamiento de cada uno de los segmentos. Se trataron: 1 volvulo del colon derecho, 3 del transverso y 16 del sigmoides, analizando sus resultados. Se comenta la conducta seguida en el volvulo de cada segmento

Cirugia de las metastasis pulmonares. / Surgery of pulmonary metastasis

En una serie de 24 pacientes se realizaron 27 intervenciones quirurgicas para tratar metastasis pulmonares presumiblemente unicas o multiples, luego de haber excluido por los medios de diagnostico habituales, la presencia de otras localizaciones metastasicas. La sobrevivencia a los 5 anos se aproximo al 9%

Neoplasias primitivas multiples.Localizacion pulmonar. / Multiple primitive neoplasms.Pulmonary localization

Se presentan 37 casos de neoplasias multiples. En cada paciente, por lo menos una de ellas estaba radicada en el pulmon. Un grupo de enfermos padecieron 2 canceres pulmonares metacronicos. Estas ultimas observaciones son de interes, porque en todas se practicaron resecciones sucesivas con intervalos de entre 1 e 1/2 y 6 anos.En un caso que fuera sometido a neumonectomia para tratar el primer tumor, se extirpo un segmento del pulmon restante 3 anos despues. La posibilidad de tener que operar nuevamente a pacientes portadores de cancer pulmonar, es un argumento mas para defender las tecnicas conservadoras, siempre que esta conducta no afecte la radicalidad del procedimiento. A 11 casos les fueron efectuados estudios inmunologicos, sin hallarse estado imunitario diferente respecto al grupo testigo, con cancer unico controlado, o en etapa de diseminacion