Letrozole as an appropriate therapeutic modality for infertile women with endometrial hyperplasia

To evaluate the impact of oral letrozole therapy for 3-months on infertile patients with pathologically confirmed endometrial hyperplasia [EH]. The study comprised 17 infertile patients with EH. All patients underwent full clinical examination, transvaginal ultrasonography [TVU] to determine endometrial thickness [ET] and estimation of serum E2 levels. All patients were prescribed letrozole 2.5 mg tablets once daily for 3 months and underwent endometrial biopsy at end of treatment. The study outcome was defined as regression of EH to histologically normal endometrium at end of treatment. At the end of the 3-months treatment period, all patients showed significant reduction of preliminary endometrial thickness and decrease of serum E2 levels. All cases with simple EH without atypia [n=10] showed good response with a mean regression rate of ET of 70.2%, while was 59.3% in cases of complex EH without atypia [n=5] and 53% in cases of complex EH with atypia [n=2]. The overall pathological success rate was 88.2%; 100% in simple EH without atypia, 80% in complex EH without atypia and 50% in EH with atypia. For EH without Atypia in infertile patients oral letrozole therapy for 3-months resulted in high regression rate of endometrium and high pathological success rate. However, further large scale studies with dosage modification are needed to determine its true efficacy in EH with atypia in infertile patients

Impact of naloxone and droperidol on postoperative epidural morphine analgesia

This study was designed to evaluate the impact of epidural naloxone [N] or droperidol [D] on the outcome of epidural morphine analgesia. The study comprised 60 females assigned to undergo abdominal hysterectomy randomly allocated into three equal groups [n=20], each received medication mixture via infusors; Group M received 3 mg morphine in 100 ml bupivacaine 0.125% at rate of 2 ml/hr; group M+N and M+D received the same mixture, but with the addition of naloxone so as to provide an infusion rate of 0.167 micro g/kg/hr of naloxone in group M+N or droperidol in a dose of 1.25 mg/day continuous infusion in group M+D. Pain sensation was evaluated using 100-mm visual analogue scale, postoperative nausea and vomiting [PONV] was monitored on a four-point scale: 0: no, 1: mild not requiring an antiemetic, 2: moderate requiring an antiemetic and 3: severe nausea/vomiting, resistant to antiemetic. Pruritus was evaluated using a four-point scale: 0=no, 1= mild, 2 moderate and 3= severe itching. Somnolence was graded as follow: 1=clear mentality, 2= good response to verbal command but drowsy and 3= poor response to repeated verbal command. Respiratory depression was assessed as 1= no respiratory depression and 2= respiratory depression exists with a respiratory rate<8 breaths/min. All parameters were assessed at 2, 4, 8, 16, 32, and 48 hr PO. At 8-hrs PO, VAS scores were significantly lower in M+N [P1 =0.017] and M+D [P1 =0.034] groups compared to group M., with a non-significant [P2>0.05] reduction of VAS scores between combination groups but in favor of group M+N. Thereafter, VAS scores were significantly lower in groups M+N and M+D compared to group M with a significant reduction of VAS scores in group M+N compared to group M+D. Epidural naloxone [Group M+N] significantly reduced the frequency and severity of side effects in comparison to group M and significantly reduced the frequency and severity of somnolence and respiratory depression and non-significantly reduced the frequency and severity of PONV in comparison to group M+D. On the other hand, epidural droperidol [Group M+D] significantly reduced the frequency and severity of pruritus and respiratory depression but reduced the frequency of PONV and somnolence non-significantly in comparison to group M. Moreover, epidural droperidol significantly reduced the frequency and severity of pruritus compared to epidural naloxone. It could be concluded that epidural co-administration of morphine and naloxone or morphine and droperidol provided more effective postoperative analgesia with a significant reduction of morphine-induced side effects; however, droperidol appears to be a better alternative when pruritus is taken into consideration, while naloxone is a better alternative when somnolence is taken into consideration