Conservative hysteroscopic treatment of stage I well differentiated endometrial cancer in patients with high surgical risk: a pilot study / 부인종양

OBJECTIVE: To report hysteroscopic treatment combined with levonorgestrel-releasing intrauterine device (LNG-IUD) to treat women with early well differentiated endometrial cancer (EC) at high surgical risk. METHODS: Nine women diagnosed with stage IA, grade 1 endometrioid EC which was contraindicated or refused standard treatment with external beam radiation therapy with or without brachytherapy were enrolled in our prospective study. Endo-myometrial hysteroscopic resection of the whole uterine cavity and the placement of LNG-IUD for 5 years was performed. Response rate, perioperative complications, and recurrence of disease were evaluated. RESULTS: None had intra or post-operative complications and all were discharged no later than the third day of hospitalization. After 6 months from surgery, all the women showed a complete regression of the lesion. All the women completed the 5 years follow-up and in no case was detected sign of recurrence. Two women died for causes unrelated to the tumor or the ongoing therapy. CONCLUSION: The alternative treatment with endo-myometrial hysteroscopic resection and LNG-IUD in women with stage IA, grade 1 endometrioid EC showed initial encouraging outcomes in terms of effectiveness and safety.

Cigarette smoking and cardiovascular risk in young women with polycystic ovary syndrome

To verify if in lean polycystic ovary syndrome [PCOS] patients, the smoking habitude might increase the risk of cardiovascular [CV] disease. In this prospective observational study, eighty-one women were divided into the following three groups: group I with 27 non-smokers, group II with 26 light-smokers [1-10 cigarettes/day], and group III with 28 heavy smokers [>10 cigarettes/ day]. They were submitted to fasting blood sampling; blood measurement of nitrites/nitrates [NO[2]-/ NO[3]], biochemical and hormonal parameters; ovarian ultrasonographic [US] analysis; doppler evaluation of uterine and ophthalmic arteries; brachial artery flow-mediated vasodilatation; 24-hour ambulatory blood pressure monitoring; and oral glucose tolerance test [OGTT]. Doppler analysis revealed higher uterine and ophthalmic arteries pulsatility index [PI] and ophthalmic artery back pressure in group III compared with group I. The brachial artery diameter and PI, at baseline, was similar among all groups. After the reactive hyperemia, a more intense vasodilatation was observed in group I in comparison with group III. The 24-hour blood pressure demonstrated that, in group III patients, the 24-hour, day- and night-time diastolic blood pressure [DBP], was higher in comparison with non-smokers. The atherogenic index of plasma [AIP] was higher in heavy smokers than in non-smokers. The leukocytes and homocysteine [HCY] values were increased in group III. The NO[2]-/ NO[3]- plasma levels were reduced in heavy smokers in comparison with non-smokers. The insulin, glucose and C-peptide plasma values were higher in group III than in other groups. In heavy smokers, the estimates of insulin sensitivity [ISI] and pancreatic beta-cell function [HOMA-B] were higher compared to the other groups. Smoking habitude in lean PCOS patients may increase the soft markers of CV risk