Association between high levels of gynoid fat and the increase of bone mineral density in women.

Introduction: In women, bone mineral density (BMD) is related to age, estrogenic action, and appendicular skeletal muscle mass (ASMM). The gynoid fat distribution is linked to estrogenic action.Objective: This study aimed to assess whether an increase of gynoid fat is associated with high BMD independent of age and ASMM.Methods: An observational study was performed in women aged between 20 and 79 years. Fat mass, ASMM, and BMD were measured with dual-energy X-ray absorptiometry. The binned scatterplots and multivariate linear regression models were used to study the relationship between hip BMD and age, height, android fat, gynoid fat, and ASMM.Results: Of 673 women invited, 596 accepted to participate. Their mean age was 55.4 ± 12.8 years, weight 63.4 ± 9.4 kg, height 1.61 ± 0.06 m, body mass index 24.54 ± 3.59 kg/m2, average hip BMD 0.914 ± 0.122 g/cm2, android fat 2.12 ± 0.83 kg, gynoid fat 4.54 ± 1.07 kg, and ASMM 15.15 ± 1.97 kg. The final regression model included age (linear coefficient -0.004; 95% confidence interval [CI]: -0.005 to -0.003; p < 0.001), ASMM (linear coefficient 0.013; 95% CI: 0.009 to 0.018; p < 0.001), and gynoid fat (linear coefficient 0.013; 95% CI: 0.005 to 0.022; p < 0.002).Conclusion: Gynoid fat is associated with BMD in the hip independently of age and ASMM.

Sertraline improves the somatic and psychological symptoms of the climacteric syndrome.

OBJECTIVE: To evaluate the efficacy of sertraline versus placebo in the management of somatic and psychological complaints of the climacteric syndrome. METHODS: We conducted a randomized, double-blind, placebo-controlled trial. A total of 44 women with moderate to severe complaints, defined as 16 or more points according to the Menopause Rating Scale (MRS) considering only the psychological and somatic domains, were incorporated into the trial and randomized to receive either sertraline (50 mg/day) or placebo. Both groups were evaluated at baseline and after 45 and 90 days of treatment. A reduction of 50% or more in the score was considered as a successful response. RESULTS: Thirty-three patients finished the trial (16 in the sertraline group and 17 in the placebo group), showing an odds ratio of 7.94 (95% confidence interval 1.3-57.3), p = 0.0038 for the sertraline group, in spite of the prominent effect of placebo. CONCLUSIONS: Sertraline was more effective than placebo in the management of the somatic and psychological complaints of the climacteric syndrome.

[Are transdermic estrogens cardioprotective?]. / Son los estrógenos transdérmicos cardioprotectores?

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 transdermic 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.

Prolonged effectiveness of Norplant(R) capsule implants: a 7-year study.

Soft tubing Norplant(R) contraceptive implants were studied in 1210 women for 7 years to measure the duration of effectiveness and the magnitude of the pregnancy rates over that time. Mean age at enrollment was 27.4 years. Of the enrollees, 42% were US residents. One-sixth (16.1%) weighed >/=70 kg at the time of implant placement. At the end of 5 years, the cumulative pregnancy rate was 1.1/100; at the end of 7 years, it was 1.9/100. No pregnancies occurred to any of the 400 women who enrolled in the study at age >/=30 years and who weighed <100 kg. Among women aged 18-33 years, the 7-year Norplant pregnancy rates are comparable to the median pregnancy rates of tubal sterilization methods for women of the same age and duration of use. For women aged >/=34 years, without regard to weight at admission, the 7-year effectiveness of soft tubing Norplant equals or surpasses that of tubal sterilization. For continuing implant users, annual pregnancy rates <1.0/100 in years 6 and 7, together with low cumulative pregnancy rates, testify that Norplant capsule implants remain highly effective for 7 years.

The performance of levonorgestrel rod and Norplant contraceptive implants: a 5 year randomized study.

A new contraceptive (LNG rod implants, Jadelle, Leiras Oy's registered trademark for rod implants) was prospectively evaluated in randomized 5 year comparison with Norplant (Population Council's registered trademark for contraceptive implants releasing levonorgestrel) capsule implants. The study involved 1198 women at seven centres. No pregnancies occurred in the first 4 years. At 5 years, the cumulative pregnancy rate was 1 per 100 users or less for each regimen. Annual discontinuation rates averaged 11-12 per 100 users (P > 0.05), corresponding to 5 year continuation rates of 55.1 for rods and 53.0 per 100 for capsules. Mean annual discontinuation rates for menstrual disturbances were 3.5 and 4.2 per 100 for rod and capsule implants respectively (P > 0.05), and mean annual removal rates for medical problems were 3.5 and 3.0 per 100 (P > 0.05) respectively. Apart from menstrual problems, headache, weight gain and acne were the principal medical reasons for removal. In proportional hazard analyses, family formation variables, age, parity and desire/non desire for another child, recorded at admission, significantly affected discontinuation rates for major decrement categories and for all reasons combined. Mean rod removal time was half that of Norplant (P < 0.01); complications of rod removal were at a lower rate. With these contraceptives indistinguishable in performance except for ease and speed of removal, LNG rod implants appear to be preferable to Norplant for use through 5 years by virtue of relative ease of removal.

PIP: This paper presents the 5-year randomized study on the performance of levonorgestrel rod (LNG) and Norplant contraceptive implants in 1198 women in 7 centers. In the first 4 years, no pregnancies occurred. At 5 years, the cumulative pregnancy rate was 1/100 users or less for each regimen. Annual discontinuation rates averaged 11-12/100 users, corresponding to a 5-year continuation rate of 55.1/100 for rods and 53.0/100 for capsules. Mean annual discontinuation rates for menstrual disturbances were 3.5/100 for rod and 4.2/100 for capsule implants. Reasons for discontinuation of use were vaginal spotting or bleeding, irregular bleeding, headache, weight gain and acne. Proportional hazard regression models established that family formation variables, age, parity, and desire for another child, recorded at admission, significantly affected discontinuation rates for major decrement categories and for all reasons combined. Mean rod removal time was half that of Norplant. Complications of rod removal were at a lower rate. This study concludes that there is an extremely high contraceptive effectiveness for LNG rod and Norplant implants; however, LNG rod implants were more preferable than Norplant for its relative ease in removal.

Clinical performance of a new two-rod levonorgestrel contraceptive implant: a three-year randomized study with Norplant implants as controls.

In a randomized three-year clinical trial at seven clinics, the performance of levonorgestrel rod (LNG ROD) implants used by 600 women was compared with that of soft tubing NORPLANT implants used by 598 women. No pregnancies occurred in either group of women and, accordingly, body weight did not affect the efficacy of either type of implant. There were neither statistically significant nor important differences in termination rates for any reason over the three years. Complaint and illness rates during use of either of the two implant types were statistically indistinguishable and were attributable to the same set of conditions. Seventy-one per 100 of the women using each implant regimen continued to the three-year point, for an average annual continuation rate of 89 per 100. Removals of LNG ROD implants were accomplished in about half the time required for removal of Norplant capsule implants (p < 0.001).

[Prognostic factors in epithelial neoplasm of the ovary. A multivariate analysis]. / Factores pronósticos en cáncer epitelial del ovario. Un estudio de multivarianza.

The results in the treatment of ovarian cancer in our center are analyzed from 1976 until 1989. Seventy nine patients have been treated. Patients were staged as by FIGO guidelines. Thirty three patients were staged as stage I, 9 as stage II, 26 as stage III and as stage IV. Median follow-up is 72 months with a minimum of 12. The actuarial survival was 93.8% for stage I, 36.3% stage II, 6.9% stage III 6.9% stage III and 9% in stage IV. The analysis of the prognostic factors was made by the Cox model. The clinical stage was the principal prognostic factor. No prognostic factors were found in stage I, II and IV but in stage III, complete surgery, well differentiated tumors and the possibility of rescue were of good prognosis.

[Cyclic ethinyl estradiol and medroxyprogesterone in climacteric women. Their clinicAL efficacy and patterns of uterine bleeding]. / Etinil estradiol y medroxiprogesterona cíclicos en mujeres climatéricas. Eficacia clínica y patrones de sangrado uterino.

The study evaluated the clinical efficacy substitutive hormonotherapy regime in a group of 40 postmenopausal, women with moderate to severe symptomatology and negative progesterone challenge test. Each cycle consisted in the administration of 15 micrograms of ethinyl estradiol during 21 days, plus 10 mg medroxyprogesterone acetate (MPA) the last 10 days. Each patient received four cycles of therapy with 10 days of interval between them. The global clinical response was evaluated as favorable (excellent and good responses) in 97.5% of the patients. All the patients showed an improvement of the vaginal trophism (colpocytology). The great majority of the women experimented cyclical bleeding as consequence of the treatment. The post-therapeutic bleeding (Withdrawal) was the predominant bleeding pattern. This fact suggests that the 10 mg of MPA added daily during 10 days could allow a suitable opposition to the estrogenic proliferative effect inducing an adequate secretory response and the subsequent endometrial desquamation.

[Actinomycosis of the female genital tract]. / Actinomicosis del tracto genital femenino.

PIP: Actinomycosis is a rare infection caused by 2 different types of bacteria. Actinomycosis develops in the mouth, on the face, in the lungs, or in the digestive tract. Abdominal, pelvic, or genital actinomycosis is very rate; up to now there are only 300 cases reported in the published literature. This article presents the 3rd case that ever occurred in Chile. A 27 year-old patient, wearer of a Lippes Loop, was hospitalized for recurrent abdominal pains and for purulent discharges from the vagina. A diagnosis of endometritis and bilateral tubo-ovarian abcess was followed by laparotomy, which revealed an abdominal cavity filled with pus and with necrotic tissues. After extensive laboratory examination actinomycosis was diagnosed and the patient successfully treated with antibiotics. Since 1973 the association between actinomycosis and IUD use has been made several times, although the mechanism of association is not well known. Several types of IUDs have been involved in actinomycosis cases. The disease, which was once fatal in 80% of cases, is today treated with penicillin and tetracycline, and by surgery.^ieng