A novel pancreatic tumour and stellate cell 3D co-culture spheroid model.

BACKGROUND: Pancreatic ductal adenocarcinoma is a devastating disease with poor outcome, generally characterized by an excessive stroma component. The purpose of this study was to develop a simple and reproducible in vitro 3D-assay employing the main constituents of pancreatic ductal adenocarcinoma, namely pancreatic stellate and cancer cells. METHOD: A spheroid assay, directly co-culturing human pancreatic stellate cells with human pancreatic tumour cells in 3D was established and characterized by electron microscopy, immunohistochemistry and real-time RT-PCR. In order to facilitate the cell type-specific crosstalk analysis by real-time RT-PCR, we developed a novel in vitro 3D co-culture model, where the participating cell types were from different species, human and mouse, respectively. Using species-specific PCR primers, we were able to investigate the crosstalk between stromal and cancer cells without previous cell separation and sorting. RESULTS: We found clear evidence for mutual influence, such as increased proliferation and a shift towards a more mesenchymal phenotype in cancer cells and an activation of pancreatic stellate cells towards the myofibroblast phenotype. Using a heterospecies approach, which we coined virtual sorting, confirmed the findings we made initially in the human-human spheroids. CONCLUSIONS: We developed and characterized different easy to set up 3D models to investigate the crosstalk between cancer and stroma cells for pancreatic cancer.

Development of an enantioselective amine-silver co-catalyzed Conia-ene reaction.

The development of a novel cooperative catalytic system for an amine-silver co-catalyzed Conia-ene reaction of alkyne-tethered C-H-acidic compounds is reported. By using a cost-effective silver salt and a small diamine for the 5-exo-dig-cyclization the cyclopentane products are obtained in very good yields. The enantioselectivity of the reaction could be controlled by exchanging the diamine co-catalyst with a cinchona-derived primary amine.

Uso de pesarios en mujeres menores de 65 años con diagnóstico de prolapso de órganos pelvianos: estudio de factibilidad / Pessaries for pelvic organ prolapse: feasibility study

Antecedentes: El prolapso de los órganos pelvianos (POP) es una enfermedad prevalente. Los pesarios vaginales son una opción de tratamiento. Algunos especialistas prefieren la cirugía como el tratamiento de elección. Objetivo: Describir la respuesta subjetiva y complicaciones asociadas al uso de pesarios en pacientes <65 años con POP en el Hospital Dr. Sotero del Río. Métodos: Estudio retrospectivo de pacientes con POP sintomático <65 años con indicación de pesario, entre julio de 2009 y noviembre de 2012. Para la evaluación de los resultados subjetivos del uso de pesarios, se utilizó la escala PGI-I. Resultados: Cuarenta y nueve pacientes cumplieron los criterios de inclusión. En 39 pacientes el fitting fue exitoso. Veinticinco de las 39 pacientes, fueron capaces de acceder y usar el pesario, de las cuales 6 abandonaron el tratamiento. La mediana de la edad fue 62,5 años. Un 48 por ciento eran sexualmente activas. La mediana de seguimiento fue 9 semanas. Según POP-Q un 60 por ciento se encontraba en etapa III. El tipo de pesario más utilizado fue el Gellhorn. Trece pacientes presentaron efectos adversos, siendo lo más frecuente el flujo vaginal (40 por ciento). La respuesta subjetiva de mejoría estuvo disponible en 15 (64 por ciento) de 25 pacientes. Un 88 por ciento notaron mejoría subjetiva importante. Conclusión: El uso de pesarios vaginales en pacientes menores de 65 años con POP es factible, asociado a mejoría subjetiva de los síntomas, con baja tasa de complicaciones. Son necesarios estudios prospectivos de mayor tamaño muestral para evaluar este subgrupo.

Background: Pelvic organ prolapse (POP) is a common disease. Vaginal pessaries are a treatment option. Some specialists prefer surgery as the treatment of choice. Objective: To describe the subjective response and complications associated with the use of pessaries in patients <65 years old with POP in Dr. Sotero del Rio Hospital. Methods: Retrospective study of patients with symptomatic POP <65 and use pessary between July 2009 and November 2012. And assessment of the subjective results of using the PGI-I pessaries scale was used. Results: 49 patients met the inclusion criteria. In 39 patients the fitting was successful. 25 of 39 patients were able to access and use the pessary. 6 patients discontinued treatment. The median age was 62.5 years. 48 percent were sexually active. Median follow-up was 9 weeks. According POP-Q 60 percent were in stage III. The type of pessary was the most used Gellhorn. 13 patients had adverse effects. The subjective response improvement was available in 15 (64 percent) of 25 patients. 88 percent noted significant subjective improvement. Conclusion: The use of vaginal pessaries in patients under 65 with POP is feasible, associated with subjective improvement in symptoms, with low complication rate. Prospective studies are needed with larger sample sizes to evaluate this subgroup.

Colpoperineocleisis de Labhardt: una alternativa segura y eficaz para el tratamiento del prolapso genital en pacientes sin actividad sexual / Labhardt colpocleisis in the treatment of pelvic organ prolapse

Introducción: El prolapso genital impacta negativamente la calidad de vida y autoimagen de la mujer. Rutinariamente indicamos la colpoperineocleisis de Labhardt a pacientes de edad avanzada y sin actividad sexual. Objetivo: Evaluar los resultados con esta técnica e identificar posibles factores de riesgo que predigan la falla. Métodos: Análisis retrospectivo de pacientes tratadas con la técnica entre los años 2008-2010. Se realizó análisis univariado y multivariado para identificar factores de riesgo asociados a la falla y se construyeron curvas libre de falla anatómica a fin de evaluar la durabilidad. Resultados: 68 pacientes cumplieron los criterios de inclusión. La edad promedio fue 71,9 +/- 5,7 años; 95,6 por ciento fueron clasificadas en etapa III o IV según POP-Q. El tiempo operatorio fue de 54 +/- 20 minutos. Seguimiento promedio de 21 meses; la tasa de recidiva anatómica fue de 14,7 por ciento. La tasa de incontinencia de orina de esfuerzo (IOE) de novo fue de 5,9 por ciento. El análisis univariado identificó como factor predictor de recidiva el flujo vaginal posoperatorio; en análisis multivariado de Cox, esa condición mantuvo significancia estadística (OR 6,3). Se identificó como factor de riesgo el no acatamiento de la técnica quirúrgica (OR 7,2). Conclusión: La colpoperineocleisis de Labhardt es una técnica segura, con baja tasa de complicaciones, una tasa de recurrencia aceptable y baja tasa de IOE de novo. Pilar del éxito es evitar la infección y respetar la técnica quirúrgica. Es necesario estudios comparativos con otras técnicas oclusivas, como también evaluar el rol de la infección como causa de falla de la técnica.

Introduction: Genital prolapse affects up to 50 percent of multiparous women, impacting their quality of life and self-image. At our Institution Labhardt's colpoperineocleisis is usually proposed to older patients, without sexual activity, regardless the type or grade of prolapse. Objective: To evaluate the results with this technique and identify potential risk factors predicting the failure. Methods: Analysis of a retrospective cohort of patients treated with this technique between 2008 and 2010. Univariate and multivariate analysis were carried out to identify risk factors and failure-free curves were built to estimate durability. Results: 68 patients met the inclusion criteria. Average age was 71.9 +/- 5.7 years; 95.6 percent of patients were classified as stage III or IV based on POP-Q system. Operative time was 54 +/- 20 min. At 21 months of follow-up, recurrence rate was 14.7 percent. De novo stress urine incontinence (SUI) was diagnosed in 5.9 percent of patients. In univariate analysis, post operative vaginal discharge was identified as predicting factor for defect recurrence. In Cox analysis, this condition remained significant (OR 6.3), In addition, failure to observe the surgical technique was also identified as risk factor for defect recurrence (OR 7.2). Conclusion: Labhardt 's colpoperineocleisis is a safe technique, with low complication rate, acceptable recurrence rate, and low de novo SUI rate. Mainstay for success is to avoid infection and observe the surgical technique. Comparative studies with other occlusive techniques might be carried out, as well as exploring the role of infection as predisposing condition for failure.

Posición oficial de la Sociedad Chilena de Climaterio para el manejo clínico de la mujer climatérica / Official position of the Chilean Society of Climacteric on the management of climacteric women

The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

Trombohematoma subcorionico masivo: una patología placentaria emergente / Massive subchorionic thrombohematoma

El trombohematoma subcoriónico es una extravasación de sangre localizada en la placa coriónica, entre amnios y corion. Es muy infrecuente, el diagnóstico no es común, tiene alto riesgo perinatal y no hay casos comunicados en nuestro medio. Se presentan 12 casos de sospecha diagnóstica antenatal, confirmada en el examen histopatológico placentario. Se describe y discute el cuadro clínico, las complicaciones maternas y perinatales, el diagnóstico ultrasónico, el manejo y los resultados obtenidos. En nueve casos se identifcó una fase latente con hematoma de tamaño estable, entre el inicio de los síntomas y el parto, que duró en promedio 7,3 semanas. En ocho casos la fase latente fue seguida por una fase activa con aumento del hematoma asociado al parto prematuro. Tres embarazadas presentaron patología médica compleja con una muerte materna. Seis casos hicieron anemia severa y tres patología miscelánea. Hubo ocho amenazas de parto prematuro con tocolisis, tres rotura prematura de membranas, una colestasis y una preeclampsia. Los partos fueron prematuros, dos de 36 y 33 semanas y diez menores a 32 semanas. Siete prematuros tuvieron peso inferior a 1000 gramos y seis hicieron restricción fetal grave, en percentil <5 de la curva de crecimiento. Hubo complicaciones neonatales relacionadas con prematurez, restricción y bajo peso, manejados con hospitalización prolongada con promedio de 74 días (rango: 6-298 días). Diez neonatos sobrevivieron; hubo un mortinato y un mortineonato. La sobrevida fue 83,3 por ciento y la mortalidad de 16,6 por ciento que se comparan favorablemente con las cifras comunicadas.

Subchorial thrombohaematoma is caused by blood extravasations in the corionic plate, between amnion and chorion. It is a rare pathologic entity, that carries a high perinatal risk, which has not being published in our country up to now. We report 12 cases in which the diagnosis was suspected before birth, and confirmed in the placentary pathological examination. We describe the clinical presentation, fetal and maternal risks, ultrasonographic findings, treatment and clinical outcomes. In 9 patients a latent phase was identified with a stable size hematoma, which had a mean duration of 7.3 weeks. In 8 cases the latent phase was followed by an active phase, with increasing size of the hematoma associated with preterm labour. Three pregnant women had severe complications which caused one maternal death. Six had severe anemia and other three had minor complications. Eight had preterm labor symptoms which required tocolysis. Three had prelabour rupture of membranes, one cholestasis disease and preeclampsia. Preterm labours were at 36, 33 and other ten before 32 weeks of gestation. Seven preterm newborns weight less than 1000 grams and six had severe fetal restriction (p<5). Newborn complications were related with prematurity, requiring prolonged hospitalization (mean 74 days, range 6-298 days). Ten newborns survived. There were 1 still birth and 1 dead newborn. Survival rate was 83.3 percent and 16.6 percent mortality, better rates than previously published.

Posición oficial de la Sociedad Chilena de climaterio para el manejo de la mujer climatérica / Official position of the Chilean Society of menopause for the management of climacteric women

La mayoría de las mujeres ve afectada su salud en el período climatérico, ya sea por sintomatología que le deteriora su calidad de vida (CV) o por la aparición de enfermedades crónicas que le afectan sus expectativas de vida. Por lo tanto, es básico evaluar estos dos aspectos, teniendo como objetivos centrales de las eventuales intervenciones terapéuticas, mejorar la CV y reducir el riesgo de enfermedades cardiovasculares y/o fracturas...

Evaluación de la calidad de vida en mujeres de 40 a 59 años mediante la escala MRS (Menopause Rating Scale) / Assessment of quality of life using the Menopause Rating Scale in women aged 40 to 59 years

Background: Climacteric symptoms have a direct relationship with biological and sociocultural factors and significantly impair the quality of life of women. Aim: To assess quality of life and factors affecting it in women aged 40 to 59 years. Material and methods: The Menopause Rating Scale (MRS) was applied to 370 healthy women aged 49 ± 6 years, that accompanied patients to public hospitals in Santiago. Results: Forty four percent of women were postmenopausal and 6 percent used hormone replacement therapy. Half of the group had less than 12 years of formal education and 67 percent had a couple. The mean number of children was 2.8 ± 1.5. Total MRS score was 16.2 ± 8.5. The higher score was given by the psychological domain (7.7 + 4.4), followed by the somatic domain (5.8 ± 3.5). The urogenital domain had the lowest score (2.7 ± 2.9). Eighty percent of women had moderate to severe climacteric symptoms. A logistic regression analysis showed that the postmenopausal condition was the factor that caused the greatest derangement in quality of life, followed by her parity. Formal education had the lowest impact. Conclusions: In this sample of women, menopause significantly deteriorated quality of life and sociocultural factors such as the parity also had an impact.

Síntomas depresivos posinfarto al miocardio: detección precoz en una población hospitalizada / Depressive symptoms after an acute myocardial infarction

Background: Depression after myocardial infarction (MI) is a frequent disorder and it increases the long-term risk of cardiac mortality. Aim: To assess the frequency of depressive symptoms and the history of depression in hospitalized post-MI patients. Patients and Methods: During three months, depressive symptoms and history of depression were studied in 47 consecutive patients (mean age 59,8±9,5 years, 68 percent male), admitted for MI to the Barros Luco Trudeau Hospital. The Beck Depression Inventory (BDI) and the Composite International Diagnostic Interview (CIDI 2.1) were used with DSM-IV diagnosis criteria. Results: According to the results obtained using the CIDI, 27,7 percent of the patients had a history of depression. This occurred in 53,3 percent of women and 15,6 percent of men (p <0.01). During the hospitalization, 38,3 percent of patients had depressive symptoms (BDI ³ 17 points), affecting 60 percent of women and 28,1 percent of men (p <0.02). In women and patients with history of depression, depressive symptoms tended to be more common and more severe. Conclusions: Depressive symptoms in post-MI patients are frequent and attending physicians should actively detect them.

Prevalencia de deterioro cognitivo en una población geriátrica institucionalizada / Prevalence of cognitive impairment in an institutionalized geriatric population

El deterioro cognitivo (DC) y la demencia están estrechamente relacionadas con el incremento de la expectativa de vida, y se consideran entre los problemas de salud más importantes del presente siglo. Objetivo: Conocer la prevalencia de DC en una población de pacientes geriátricos institucionalizados. Sujetos y Métodos: Se entrevistaron 46 pacientes ingresados durante un mes en el Instituto Nacional de Geriatría, a los cuales se les aplicó una encuesta socio-demográfica y el Mini-mental Test de Folstein (MMSE) validado en Chile. Resultados: La edad promedio de la muestra fue de 77,3+7,7 años. La población estaba constituida en un 73,9 por ciento por mujeres. El 58,7 por ciento de los pacientes encuestados tenían menos de 6 años de escolaridad. Se detectó DC en el 58,7 por ciento (95 por ciento IC 43,2 por ciento - 73,0 por ciento) de los sujetos (<22 puntos en el MMSE) y sólo el 11,1 por ciento de ellos tenían un diagnóstico previo de demencia o de DC. Conclusión: El DC tiene alta prevalencia en la población geriátrica institucionalizada. Existe un bajo porcentaje de diagnóstico en aquellos pacientes con DC. La baja escolaridad se asocia con un puntaje menor en el MMSE.

¿Es el HOMA un instrumento adecuado para el diagnóstico de insulino resistencia en pacientes con síndrome de ovario poliquístico? / Value of Homeostasis Model Assessment (HOMA) as an approach for the diagnosis of insulin resistance in patients with Polycystic ovary syndrome (PCOS)

Un hallazgo fisiopatológico frecuente en pacientes con síndrome de ovario poliquístico (SOP) es la insulino resistencia, presente hasta en un 70 por ciento de estas mujeres. El patrón de oro para su diagnóstico lo constituye el clamp euglicémico-hiperinsulinémico, sin embargo lo engorroso de su realización ha hecho preferir clínicamente el uso del HOMA (Homeostasis Model Assessment) que tiene la ventaja de su simplicidad y bajo costo. Esta revisión tiene por objeto verificar la validez del HOMA como instrumento de diagnóstico de insulina resistencia en pacientes con SOP. Para esto se realizó una búsqueda detallada de la bibliografía médica al respecto en diferentes bases de datos. Aplicando distintos criterios se seleccionaron finalmente 4 artículos que constituyen la base de esta revisión. Fundamentados en la evidencia se concluye que el HOMA constituye una alternativa válida como método diagnóstico de insulina resistencia. Su correlación con el clamp euglicémico hiperinsulinémico varía de acuerdo a la patología estudiada y al estado nutricional, siendo la asociación más fuerte en el subgrupo de pacientes obesas o con sobrepeso.

Validez de la escala de Braden para predecir úlceras por presión en población femenina / Prediction of the pressure ulcer development in elderly women using the Braden Scale

Background: Pressure ulcers are a common complication among elderly patients confined to bed for long periods. The Braden scale is a commonly used risk assessment tool. Aim: To evaluate the use of Braden scale. Patients and methods: Seventy women aged 61 to 96 years, admitted to the Internal Medicine Service of Barros Luco-Trudeau Hospital, were studied. Their risk was evaluated using the Braden scale. The presence of pressure ulcer was diagnosed according to the National Pressure Ulcer Advisory Panel on admition, two weeks later and at discharge. Results: On admission, mean Braden scale score was 16.6±2.8 and 34 women had a score of 16 or less, that is considered of risk. Twenty five women (20 with a score of 16 or less) developed pressure ulcers, mostly superficial. The odds ratio of a score of 16 or less for the development of ulcers was 4.2 (95 percent CI 1.8-11.7, p <0.001). The sensitivity and specificity of such score were 80 and 69 percent respectively. Conclusions: The Braden scale predicts the risk of developing pressure ulcers with a good sensitivity and specificity in female elderly patients (Rev MÚd Chile 2004; 132: 595-600).

Indice de función sexual femenina: un test para evaluar la sexualidad de la mujer

Objetivo. Aplicar y validar en una población chilena el "Indice de Función Sexual Femenina" establecido en el International Consensus Development Conference on Female Sexual Dysfunctions. Material y método. 383 mujeres sanas de 20 a 59 a¤os con actividad sexual, beneficiarias del Centro de Salud "Carol Urzúa". Instrumento: cuestionario de 19 preguntas, agrupadas en seis dominios: deseo, excitación, lubricación, orgasmo, satisfacción y dolor. Análisis estadístico: Se utilizó ANOVA, Kruskall-Wallis, Chi cuadrado, regresión logística y alpha de Cronbach. Resultados. Edad media: 35,3ñ10,9 a¤os, casadas (50,4 por ciento) o conviviente (17,0 por ciento), con educación media (48,2 por ciento). La consistencia interna del test fue buena (>0,70). La sexualidad logra su máxima expresión a los 35-40 a¤os (puntaje: 29,1ñ4,9) para caer posteriormente (21,0ñ6,0), especialmente el deseo y excitación. Después de los 44 a¤os se incrementa el riesgo de disfunción sexual (OR:3,6; IC: 2,1-6,3; p< 0,0001). La mayor educación y la estabilidad de pareja disminuyen el riesgo (OR: 0,45; IC:0,28-0,80; p< 0,005 y OR:0,58; IC:0,35-0,98; p< 0,05 respectivamente). Conclusiones. El Indice de Función Sexual Femenino es un instrumento sencillo de aplicar, con propiedades psicométricas adecuadas que permite evaluar la sexualidad en diferentes etapas de la vida. Es adecuado para estudios epidemiológicos y clínicos.

Función sexual en mujeres usuarias de terapia de reemplazo hormonal / Sexual function in postmenopausal women using hormone replacement therapy

The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions. Aim: To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI. Material and methods: The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service. Results: The mean age of the sample studied was 51±5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3±5.8 in women between 45 and 49 years of age to 19.3±7.0 in women between 60 and 64 years (p <0.01). A significantly better sexuality was observed in HRT users, with FSFI scores of 28.1±5.5 and 24.6±6.8 in HRT users and non users, respectively (p <0.01). Women on HRT obtained a higher score in all of the test domains, especially in lubrication, orgasm and sexual satisfaction. Conclusions: Female sexuality decreases with aging. HRT users have a better sexual function than non users (Rev Méd Chile 2003; 131: 1251-55 ).

Factores de riesgo cardiovascular en una cohorte de mujeres de edad media / Cardiovascular risk factors in a cohort of middle-age women

Background: It is generally accepted that menopause significantly modifies cardiovascular risk. The effects of hormone replacement therapy (HRT) on this risk remain controversial. Aim: To study the prevalence of cardiovascular risk factors (RF) in middle-aged women and their changes with aging, menopause and hormone replacement therapy (HRT). Material and methods: cardiovascular risk factors were assessed in 576 women aged 40 to 59 years in 1991-92. Five years later, 467 of these women were reassessed. Results: Sedentarism (87.2 percent), dyslipidemias (71.5 percent), high blood pressure (13.5 percent), obesity (13.1 percent), smoking (12.4 percent) and diabetes (2.8 percent) were the most prevalent RF. Five years later, the prevalence of hypertension increased to 20.9 percent, the prevalence of obesity increased to 27.3 percent, smoking increased to 20.8 percent and diabetes to 5.9 percent. The prevalence of dyslipidemia did not change, although triglycerides levels rose from 125.9Ý56.4 to 136.8Ý63.5 mg/dl (p <0.001). Sedentarism dropped to 58.8 percent. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5 years follow-up from 3.8 percent to 35 percent. Women on HRT experienced 3 percent decrease in LDL-cholesterol and 9 percent increase in HDL-cholesterol levels. Conclusions: Middle aged women included in this cohort have a high prevalence of RF. There is a deterioration with age, but not with menopause. HRT improves the lipid profile

Utilidad de los anticonceptivos con gestagenos solos en pacientes con antecedentes personales de cancer de mama. Influencia de los gestagenos en el desarrollo del cáncer de mama / Utility of the contraceptives with single gestagens in patients with personal antecedents of breast cancer. Influence of the gestagens in the development of the breast cancer

Los gestágenos clásicamente han sido relacionado con el cáncer mamario. Por esto, cuando se requiere indicar un anticonceptivos hormonal en una paciente tratada por cáncer de mama, surge la opción del uso de anticonceptivos con gestágenos solos (POP). Algunos estudios sugieren un rol protector de los gestágenos en el cáncer de mama: 1) La progesterona inhibe la proliferación mamaria inducida por el estradiol. 2) Induce apoptosis celular, inhibiendo la síntesis de las proteínas antiapoptóticas, 3) Inhibe enzimas que aumentan la concentración de estrógenos en la mama. Contrariamente, otras investigaciones muestran una acción favorecedora del cáncer de mama: 1) La actividad mitótica en las mamas es máxima durante la fase lútea, período en que predomina la progesterona. 2) En cultivos celulares los gestágenos estimulan la proliferación de algunas líneas celulares de cáncer de mama. 3) El uso de anticonceptivos orales con progestágenos y la medroxiprogesterona de depósito aumentan en mujeres jóvenes el riesgo de cáncer mamario. 4) En el reemplazo hormonal postmenopáusico varios estudios sugieren que la medroxiprogesterona incrementa el riesgo oncogénico. Conclusión: No existen datos que permitan afirmar con certeza que el uso de POP no tiene riesgos en pacientes con cáncer de mama.

Prevalencia de los trastornos de la sexualidad en mujeres climatéricas: influencia de la menopausia y de la terapia de reemplazo hormonal / Prevalence of sexual dysfunction in climacteric women: influence of menopause and hormone replacement therapy

Background: Few trials have studied the prevalence of sexual dysfunction (SD) and related risk factors in postmenopausal women using the DSM-IV criteria. Aim: To evaluate the prevalence of SD in menopausal women and the impact of risk factors. Patients and methods: Five hundred thirty four healthy women, 40 to 64 years of age were interviewed using the Laumann test (DSM-IV). Results: Mean age was 52.4ñ5.7 years. Eighty three percent were peri or postmenopausal, 23 percent used hormonal substitution therapy and 79.2 percent were sexually active. Among sexually active women, the prevalence of SD increased along with age, from 22.2 percent at the 40-44 years old range to 66.0 percent in the 60-64 years old group. Hormone users and healthy women had a low risk for SD (Odds ratio (OR): 0.1 IC: 0.0-0.1 and OR: 0.6 IC: 0.3-0.9, respectively). The risk increased in menopausal women (OR: 3.3 IC: 1.6-6.9), those older than 49 years (OR: 3.4 IC: 1.8-6.4), those subjected to hysterectomy (OR: 3.7 IC: 1.3-10.6) or those with an impotent sexual partner (OR: 3.2 IC: 1.2-8.6). Conclusions: There is a high prevalence of SD among climacteric women. Estrogens, either endogenous or exogenous, have a positive influence on sexuality

Impacto de los factores de riesgo coronario en mujeres de edad media / Cardiovascular risk factors in mid age women with acute coronary syndromes

Background: In Chile, 40 percent of deaths due to acute myocardial infarction occur in women. Aim: To assess the presence of cardiovascular risk factors in women with acute coronary syndromes. Patients and methods: Thirty four women aged 46 to 55 years old, admitted to the hospital due to an acute coronary syndrome and 102 age matched healthy women were studied. A clinical history was obtained, blood pressure and fasting serum lipids were measured. Results: A history of high blood pressure was present in 65 and 16 percent of patients and healthy controls respectively. Seventy seven percent of patients and 36 percent of controls smoked, 76 percent of patients and 48 percent of controls were postmenopausal, 21 percent of patients an 5 percent of controls were diabetic. In patients and controls respectively serum total cholesterol was 230.1ñ36.2 and 211.2ñ34.8 mg/dl, serum triacylglycerol was 213.4ñ109.4 and 143.2ñ76.9 mg/dl and serum HDL cholesterol was 44.1ñ10.8 and 49.8ñ13.3 mg/dl (p<0.001 or less). In univariate analysis, the risk of acute coronary syndrome increased with high blood pressure (OR: 9.3, CI: 2.5-18.6), menopause (OR: 8.3, CI: 2,2-31:5), smoking (OR: 6.9, CI: 2.5-18.6), diabetes mellitus (OR: 5.0, CI: 1.4-17.5), a high total cholesterol/HDL cholesterol ratio (OR: 6.6, CI: 1.8-12.5) and hypertriglyceridemia (OR: 3.6, CI: 1.5-8.5). Logistic regression analysis showed that hypertension and menopause had the higher predictive values for acute coronary syndrome. Conclusions: In this group of women with acute coronary syndromes, the main coronary risk factors were high blood pressure and menopause

¿Son los estrógenos transdérmicos cardioprotectores? / Are transdermic estrogens cardioprotective?

Transdermic estrogens share many of the oral estrogens cardiovascular effects, but so far there are no studies proving that they have a cardioprotective effect neither in animals nor in human beings. The doubt is outlined moreover, when most of the investigations performed with oral estrogens in animals show an antiatherogenic effect, while the few experimental studies that hare been carried out with estrogen patches show contradictory results. We will have to wait for more extensive clinical trials to be able to know if the transdennic estrogens are really cardioprotective, however if we want to achieve some cardiovascular risk improvement with the current knowledge we will probably have to support the use of oral estrogens