effect of a non-steroidal aromatase inhibitor anastrazole on symptomatic uterine leiomyomata in premenopausal women

To evaluate the effect of a non-steroidal aromatase inhibitor anastrazoIe on symptomatic uterine leiomyomata in premenopausal women. This was a prospective intervention study carried out at Kasr El-Aini hospital. 48 premenopausal women with symptomatic uterine leiomyomata were enrolled and treated with anastruzole 1mg daily for three cycles of 28 day each. The effect of treatment was evaluated on leiomyoma and uterine volumes, endometrial thickness, gonadotrophins, estradiol and hematocrite levels, menstrual pattern, severity of leiomyoma-related symptoms and adverse effects. The effects of leiomyoma location, size and age of participants on tumor volume changes were evaluated. 40 women with 52 Ieiomyomata finished the study. Anastrazole resulted in a mean 52% reduction of leiomyoma volume [173.7 to 83.3ml, p<0.00.], a 29% reduction in total uterine volumes [290.2 to 205. 1ml, p<0.001] and an increase of the hematocrite levels [34.3% to 38.1%, p<0.001] at the end of treatment. Leiomyoma location had no significant effect on volume decrease. Leiomyoma volume decreased in women aged older than 40 years [p<0.001], whereas no significant difference was found in women younger than 40. The size of large Ieiomyomata [greater than 50mm] decreased significantly [p<0.001], Less difference was observed in small leiomyomata [50mm or less] [p=0.01]. No difference were detected in hormonal status. Aromatase inhibitor, Anastrazol was useful in the management of symptomatic Leiomyoma without causing serious hypoestrogenic adverse effects. Further clinical trials are warranted regarding long-term administration

comparative study of single dose, double-dose methotrexate and surgical management of ectopic pregnancy regarding safety, efficacy and tubal patency

To evaluate the safety, efficacy of two Meth-otrexate [MTX] regimens for treatment of ectopic pregnancy [EP] and determine the future fertility after medical and surgical management of ectopic pregnancy. 75 cases with EP, 52 were stable and eligible for medical treatment. 24 cases received MTX 50mg/m2, additional dose was given one week later if B-HCG did not decline by 15% between day 4 and 7, while 28 cases received MTX 50mg/m[2] on days 0 and 4, additional doses were given on day 7 and/or on day 11 if HCG levels did not decrease by 15% during the follow-up period. 23 cases underwent surgery. Hysterosalpingogram [HSG] was performed to assess future fertility of patients after receiving treatment for EP. Overall success rate for single-dose and double-dose protocol was 79% and 85.7% respectively. The difference in success rate between the two regimens was most evident at B-HCG concentrations between 2000-5000mIU/mL; 75% for the single dose regimen and 85.7% for the two-dose regimen which favor using the two-dose regimen in this category of patients. Treatment was well tolerated in both groups, most side effects were mild and transient. Regarding future fertility; tubal patency was 94.2% after medical treatment and 82.6% after salpingectomy. The 2-dose protocol is a hybrid between the two previously established protocols; the single dose and the multi-dose MTX. It may optimize the balance between convenience and efficacy. Single-dose regimen is most suitable for low B-HCG <2000mIU/mL mIU/mL, the 2-dose regimen is more suitable for higher B-HCG 2000-5000, while B-HCG >5000mIU/mL has a high failure rate with medical treatment. In a limted number of patients, no safety concerns were noted with either the single-dose or the 2-dose protocols. Medical treatment should be offered to stable patients whenever feasible because it preserves their future fertility meanwhile cost effective