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Metastatic endometrial cancer in lung and liver:: Complete and prolonged response to hormonal therapy with progestins

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GYNECOLOGIC ONCOLOGY 1999年第2期72卷 250-255页

作者： Crespo, C González-Martín, A Lastra, E García-López, J Moyano, A Hosp Ramon y Cajal Med Oncol Serv E-28034 Madrid Spain

A double complete and prolonged response of metastatic endometrial carcinoma to medroxyprogesterone is reported. A 61-year-old woman with metastatic endometrial carcinoma in lung and liver achieved a complete clinical response with medroxyprogesterone lasting for 2 years. She discontinued the therapy by herself and developed a pulmonary relapse, which disappeared after retreatment with the same hormonal therapy. At present, she is alive without evidence of disease 6 years after starting progestins for metastatic disease and 14 years after treatment of the primary tumor. Progestin therapy in metastatic endometrial carcinoma is discussed, emphasizing the factors predicting response. (C) 1999 Academic Press.

关键词：癌/药物疗法癌/继发性子宫内膜肿瘤/药物疗法子宫内膜肿瘤/病理学肝肿瘤/药物疗法肝肿瘤/继发性肺肿瘤/药物疗法肺肿瘤/继发性甲羟孕酮/治疗应用孕酮同源物/治疗应用体层摄影术 X线计算机女(雌)性人类中年人

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A treatment algorithm for the management of epistaxis in hereditary hemorrhagic telangiectasia

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AMERICAN JOURNAL OF RHINOLOGY 1999年第4期13卷 319-322页

作者： Lund, VJ Howard, DJ Inst Laryngol & Otol London WC1X 8DA England

We examined the management options used for epistaxis of varying severity in patients with hereditary, hemorrhagic telangiectasia (HHT) to develop a treatment algorithm. Fifty patients with HHT were studied from 1991 to 1997 to consider various treatment options and their relative efficacy. There were 28 females and 22 men;their ages ranged from 15 to 85. Follow-up ranged from 6 months to 6 years. A wide variety of treatments had been used (including various forms of cautery, septal surgery, topical and systemic hormones, antifibrinolytic therapy, arterial ligation, laser therapy, and closure of the nostrils). Treatments used during the follow-up period were argon laser therapy (40), systemic estrogen or progesterone (17), septodermoplasty (12), or closure of the nostrils (14). Patients were divided into those with mild to moderate disease (requiring one or no blood transfusions during the course of their illness) and those with severe disease (requiring more than one blood transfusion). Using this broad categorization, those with mild to moderate disease did well with sequential argon laser therapy with or without the adjunct of septodermoplasty or hormone therapy. Those with severe disease did not find argon laser therapy beneficial but found their epistaxis completely slopped with closure of the nasal cavities. Based on these findings, a simple treatment algorithm defines the optimum treatment options for epistaxis in this difficult-to-treat group of patients.

关键词：算法抗纤维蛋白溶解药/治疗应用动脉/外科学输血烧灼术队列研究鼻出血/药物疗法鼻出血/外科学鼻出血/治疗雌二醇同源物/治疗应用炔雌醇/治疗应用随访研究激光凝固术结扎术甲羟孕酮/治疗应用鼻腔/外科学鼻中隔/外科学鼻窦/血液供给孕酮同源物/治疗应用毛细血管扩张遗传性出血性/并发症青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Prolonged endocrine responses to medroxyprogesterone in postmenopausal women with respiratory insufficiency

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OBSTETRICS AND GYNECOLOGY 2000年第2期96卷 243-249页

作者： Saaresranta, T Irjala, K Polo-Kantola, P Helenius, H Polo, O Turku Univ Hosp Dept Pulm Dis FIN-20520 Turku Finland Turku Univ Hosp Dept Obstet & Gynecol FIN-20520 Turku Finland Turku Univ Hosp Dept Clin Chem FIN-20520 Turku Finland Turku Univ Dept Biostat Turku Finland Turku Univ Dept Physiol Turku Finland

Objective: To evaluate the endocrinologic changes associated with, and possibly responsible for, prolonged ventilatory improvement after short-term medroxyprogesterone acetate (MPA) in chronic respiratory failure. Methods: Fourteen postmenopausal women with permanent or previous episodic hypercapnic or hypoxemic respiratory failure were enrolled in a placebo-controlled, 12-week, single-mask trial including 14-day treatment periods with placebo and MPA (60 mg daily) and a 6-week followup. We evaluated the duration of MPA-induced alterations on serum concentrations of progesterone, estradiol, testosterone, FSH, LH, sex hormone-binding globulin (SHBG), and prolactin. Hormones were measured four times: at baseline, after 14 days with MPA, and during the washout on days 21 and 42. Results: With MPA, FSH decreased 42.7% (P < .001, 95% confidence interval [CI] -54.5 -31.6), LH 62.1% (P < .01;95% CI -81.0, -32.6), and SHBG 58.1% (P < .001;95% CI -63.0, -43.9). Luteinizing hormone remained decreased (-28.7%;P < .01;95% CI -42.0, -14.2) at the 3-week washout, whereas FSH and SHBG were back to pretreatment levels. Prolactin had a borderline initial increase of 23.5% (P = .097;95% CI -3.5, 50.5) with MPA and a significant increase at the 3-week (31.9%;P < .05;95% CI 1.0, 62.9) and 6-week (26.4%;P < .05;95% CI 4.4, 48.3) washouts. Conclusion: Medroxyprogesterone acetate 60 mg daily for 2 weeks has both immediate (FSH, LH, and SHBG), prolonged (LH), and rebound endocrinologic (prolactin) effects up to 6 weeks after treatment. The MPA-induced widespread endocrine aftereffects could explain the earlier reported prolonged ventilatory improvement. ((C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：慢性病性腺甾类激素/血液醋酸甲羟孕酮/药理学醋酸甲羟孕酮/治疗应用绝经后期孕酮同源物/药理学孕酮同源物/治疗应用呼吸功能不全/药物疗法单盲法治疗结果女(雌)性人类中年人

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Effects of Simvastatin or hormone replacement therapy, or both, on fibrinogen, factor VII, and plasminogen activator inhibitor levels in postmenopausal women with proven coronary artery disease

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期86卷 80-+页

作者： Sbarouni, E Melissari, E Kyriakides, ZS Kremastinos, DT Onassis Cardiac Surg Ctr Dept Cardiol 2 Athens 17674 Greece Onassis Cardiac Surg Ctr Dept Hematol Athens 17674 Greece

We treated postmenopausal women with coronary artery disease and hypercholestrolemia with simvastatin, hormone replacement therapy, and their combination, in a randomized, crossover, placebo-controlled study. We found no significant change in fibrinogen and factor vn levels with any treatment, whereas plasminogen activator inhibitor levels were significantly reduced with hormone replacement therapy alone and in combination with simvastatin, and simvastatin alone had no significant effect.

关键词：抗胆固醇血症药/免疫学抗胆固醇血症药/治疗应用抗原/血液生物学标记/血液冠心病/血液冠心病/诊断冠心病/药物疗法交叉研究药物疗法联合雌激素类共扼(USP)/治疗应用因子Ⅶ/代谢纤维蛋白原/代谢激素替代疗法高胆固醇血症/血液高胆固醇血症/药物疗法甲羟孕酮/治疗应用纤溶酶原灭活剂/血液绝经后期/血液孕酮同源物/治疗应用斯伐他汀/治疗应用女(雌)性人类中年人

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Individual and combined effects of estrogen progestin therapy and lovastatin on lipids and flow-mediated vasodilation in postmenopausal women with coronary artery disease

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期33卷 2030-2037页

作者： Herrington, DM Werbel, BL Riley, WA Pusser, BE Morgan, TM Wake Forest Univ Sch Med Dept Internal Med Cardiol Winston Salem NC 27157 USA Wake Forest Univ Sch Med Dept Neurol Winston Salem NC 27157 USA Wake Forest Univ Sch Med Dept Publ Hlth Sci Winston Salem NC 27157 USA

OBJECTIVES We sought to examine the individual and combined effects of estrogen/progestin therapy versus lovastatin on lipids and flow-mediated vasodilation in postmenopausal women with heart disease. BACKGROUND Little information is available regarding the relative benefits of estrogen replacement therapy versus reductase inhibitors and the potential utility of their combination as lipid-lowering therapy for postmenopausal women. METHODS We conducted a randomized, double-blind, crossover trial in 24 postmenopausal women, each of whom received the following drug regimens during three consecutive six-week treatment periods: 1) hormone replacement (oral dose of 0.625 mg/day conjugated equine estrogens and 2.5 mg/day medroxyprogesterone acetate);2) 20 mg lovastatin/day and 3) hormone replacement plus lovastatin. RESULTS Total and low density lipoprotein (LDL) cholesterol were significantly lowered and high density Lipoprotein (HDL) cholesterol was significantly increased by all three regimens compared with baseline (p < 0.05). Lovastatin was more effective than estrogen/progestin in reducing LDL (p < 0.001), but estrogen/progestin was slightly more effective in increasing HDL. The hormone replacement and lovastatin regimen blocked the estrogen-associated increase in triglycerides. Hormone replacement (alone and with lovastatin) resulted in increases in brachial artery flow-mediated vasodilator capacity (p = 0.01 for both regimens) and the area under the curve (p = 0.016 and p = 0.005, respectively) compared with baseline. Percent dilation was greatest after the hormone replacement regimen, whereas the area under the curve was greatest after hormone replacement plus lovastatin (69% improvement vs, baseline). CONCLUSIONS In postmenopausal women with coronary disease and hyperlipidemia, conjugated equine estrogen produced significant improvements in lipids and vasodilator responses despite the concurrent administration of low dose medroxyprogesterone acetate. Low dose lov

关键词：抗胆固醇血症药/治疗应用血流速度肱动脉/药物作用肱动脉/生理学胆固醇 LDL/血液胆固醇 LDL/药物作用冠心病/血液冠心病/药物疗法冠心病/病理生理学交叉研究双盲法药物疗法联合雌激素类共扼(USP)/治疗应用洛伐他汀/治疗应用醋酸甲羟孕酮/治疗应用绝经后期孕酮同源物/治疗应用回顾性研究治疗结果血管舒张/药物作用老年人老年人 80以上女(雌)性人类中年人

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Sex offenders, sentencing laws and pharmaceutical treatment: A prescription for failure

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BEHAVIORAL SCIENCES & THE LAW 2000年第1期18卷 83-110页

作者： Stone, TH Winslade, WJ Klugman, CM Univ Texas Inst Med Humanities Med Branch Galveston TX 77555 USA

The phenomenon of adults who have sexual interests involving children as partners, or pedophiles, is considered among the most sociopathological of human conditions. Considerable literature is devoted to issues and problems associated with or related to pedophilia, including prevalence, etiology, treatment, and outcome studies. The sexual victimization of children, based upon data gathered from a number of sources, suggests an intractable problem that is national in scope. Recent manifestations of society's efforts to deal with the sexual victimization of children include the enactment of criminal sentencing laws that mandate the treatment of offenders with certain pharmaceutical agents, such as medroxy-progesterone acetate ("MPA"). Because sentencing laws as a rule vary widely from state to state, there is considerable variation as to who is subject to MPA treatment laws, and how such laws-including specific provisions, such as clinical criteria, if any, required for treatment;type and period of treatment plans;informed consent;etc-are implemented. Most important, these sentencing laws may have remarkably little relation to what is widely considered effective treatment for pedophilia disorders. We examine in detail the most recent sentencing laws pertaining to treatment of persons who have been convicted of sex offenses involving children as victims. Our critique may offer insight and suggestions as to how such sentencing laws can be more suitably tailored to the treatment needs of persons with pedophilia disorders. Copyright (C) 2000 John Wiley & Sons, Ltd.

关键词：阉割猥亵儿童/预防和控制精神病人强制住院/立法和法学罪行/心理学刑法/立法和法学甲羟孕酮/治疗应用恋童癖/治疗孕酮同源物/治疗应用性犯罪/预防和控制性犯罪/心理学治疗结果美国成年人儿童儿童学龄前人类

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Diagnosis of lymphangioleiomyomatosis by CT-guided retroperitoneal biopsy

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CLINICAL RADIOLOGY 2000年第6期55卷 477-478页

作者： Pickhardt, PJ Kazerooni, EA Flint, A Univ Michigan Med Ctr Dept Radiol Ann Arbor MI 48109 USA Univ Michigan Med Ctr Dept Pathol Ann Arbor MI 48109 USA

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Low-dose contraceptive estrogen-progestin and coronary artery atherosclerosis of monkeys

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OBSTETRICS AND GYNECOLOGY 2000年第2期96卷 250-255页

作者： Adams, MR Anthony, MS Manning, JM Golden, DL Parks, JS Wake Forest Univ Sch Med Dept Pathol Comparat Med Winston Salem NC 27157 USA William Paterson Univ Dept Exercise & Movement Sci Wayne NJ USA

Objective: To determine the separate and combined effects of the estrogen and progestin components of a modern triphasic oral contraceptive (OC) formulation on extent of coronary artery atherosclerosis. Methods: Female cynomolgus monkeys (n = 81) were fed atherogenic diets for 32 months. After the first 7 months, they were randomized to four groups and treated triphasically for 21 of each 28 days with ethinyl estradiol (E2) (monkey equivalent of 30-40 pg), levonorgestrel (monkey equivalent of 50-125 mu g), a combination of the two steroids, or placebo. Results: Treatment with estrogen alone reduced coronary artery atherosclerosis extent 67% compared with untreated controls (P < .05). Treatment with progestin alone had no effect (P > .20). While atherosclerosis extent in monkeys treated with the combined OC was reduced 28%, this did not differ statistically from the other groups (P > .20). Conclusion: In doses used for oral contraception, E2, like all other estrogens studied to date, has a marked inhibitory effect on atherosclerosis progression. Levonorgestrel, at doses used in modern OC formulations, antagonizes this effect. When considered with other experimental evidence, these findings support the concept that progestins used in OCs and hormone replacement therapy can antagonize estrogen's atheroinhibitory effects. Whether this occurs seems to depend on a relative balance between estrogen and progestin with respect to dose, potency, route, and pattern of administration. However, when considered with evidence from previous studies, the findings also indicate a modest atheroinhibitory influence of combination (estrogen-progestin) OCs. ((C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：避孕药口服复合/投药和剂量避孕药口服复合/治疗应用冠状动脉疾病/预防和控制疾病模型动物用药计划表雌二醇同源物/投药和剂量雌二醇同源物/治疗应用炔雌醇/投药和剂量炔雌醇/治疗应用左炔诺孕酮/投药和剂量左炔诺孕酮/治疗应用脂蛋白类/血液成束猴孕酮同源物/投药和剂量孕酮同源物/治疗应用随机分配动物女(雌)性

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