Ischemic colitis in postmenopausal women taking hormone replacement therapy.

BACKGROUND AND AIM: Estrogen and progestins have established effects on the gastrointestinal tract and ischemic colitis was related in the past with certain regimens including both hormones. On this basis, we aimed to evaluate a group of postmenopausal women who presented with ischemic colitis after taking hormone replacement therapy (HRT) for the last several months. METHOD: Postmenopausal women taking conjugated estrogens, conjugated estrogens plus medroxyprogesterone acetate, 17beta-estradiol plus norethisterone and estradiol valerate plus norgestrel are included in the present study. All patients, without a medical history of bowel problems, reported an acute crisis of colitis a few months after the beginning of the treatment. RESULTS: Fasting, parenteral nutrition, intravenous antibiotic treatment with metronidazole and discontinuation of HRT proved successful. Antibiotics were continued after the patients' discharge from the hospital. A second-look colonoscopy, 3 to 4 months after the initial episode, was normal in all cases. CONCLUSION: Ischemic colitis is a rare complication of HRT that should not be ignored when HRT is prescribed.

Treating intraepithelial lesions of the uterine cervix by laser CO2. Evaluation of the past, appraisal for the future.

BACKGROUND AND OBJECTIVE: Carbon dioxide laser (CO2) has been widely used in the past for the treatment of squamous intraepithelial lesions (SIL) of the uterine cervix. We present our 10-year experience of using this modality while evaluating its current and future use. MATERIALS AND METHODS: From 1988 to 1998, 3,078 women were treated for an intraepithelial lesion of the uterine cervix (SIL) by laser CO2 either by vaporization or conization. The procedure was performed on an outpatient basis and was well tolerated by the great majority of patients. The mean age of the women treated by vaporization was 27.5 years whereas of those managed by conization, 34.8 years. RESULTS: From the 3,078 women, 750 (24.4%) underwent laser vaporization and the remaining 2,328 (75.6%), conization of the cervix. Complications were minimal and consisted of intraoperative and postoperative bleeding (0.56%), pelvic infections (0.04%) and cervical stenosis (1.1%). Mean follow-up time was 83 months (range 24-142). Relapsing disease (either persistent or recurrent) was detected in 5.6% of the vaporization and 3.9% of the conization group. CONCLUSIONS: The management of SIL of the uterine cervix by laser CO2 offers excellent success rates with minor complications. The preservation of the anatomical integrity of the cervical tissue offers a better follow-up of these patients and the potential for repeat treatment. Although other treatment modalities are available, we believe that laser CO2 represents an excellent surgical tool for the management of intraepithelial lesions of the uterine cervix.

Postmenopausal uterine bleeding.

The purpose of this study was to evaluate the incidence of the etiologic factors of postmenopausal uterine bleeding and the recurrence rate of uterine bleeding before total hysterectomy. Six hundred and twenty-eight patients (mean age 52.2) with postmenopausal uterine bleeding were studied. Atrophic endometrium was found in 522 cases (83.1%), carcinoma of the endometrium in 70 cases (11.1%), proliferative endometrium in 29 cases (4.6%) and secretory endometrium in 7 cases (1.1%). The recurrence rate of uterine bleeding was very high in carcinoma of the endometrium, moderate in proliferative endometrium and low in secretory and atrophic endometrium.

Teenage pregnancy: comparison with two groups of older pregnant women.

To evaluate the risk of adolescent pregnancies, we examined three groups of primigravidae in a prospective study from 1987 to 1988. A special protocol for the evaluation and follow-up of adolescent pregnancies was made. The rate of adolescent pregnancies was found to be two times higher between the years 1985 and 1987-1988. The pregnancy complications seen in the adolescent patients were equal to or lower than those found in older women. The cesarean section rate was also found to be lower in adolescent pregnancies. We conclude that sexual education programs are necessary for the reduction of teenage pregnancies and adequate medical prenatal care, as well as psychologic and social support, must be given to avoid both medical and psychologic problems for the sensitive young mother.