Vulvar lichen sclerosus in postmenopausal women: a comparative study for treating advanced disease with clobetasol propionate 0.05%.

BACKGROUND AND OBJECTIVE: Clobetasol propionate 0.05% has been the mainstay in treating vulvar lichen sclerosus (VLS) for the past ten years. The usual length of therapy is two to 12 weeks. We conducted this study to evaluate the efficacy and safety of treating severe lesions of VLS in postmenopausal women for a longer time on a regular basis using clobetasol propionate. MATERIALS AND METHODS: From 1997-2000, 137 women with VLS were examined in the Colposcopy and Laser Surgery Unit of "Alexandra" Hospital. Patients who were premenopausal, had previous therapy, exhibited mild or moderate disease or showed VIN or invasive cancer on vulvar biopsies were excluded from the study. The remaining women were divided into two groups. The first group applied clobetasol propionate 0.05% for three months and afterwards on an "as required" basis, whereas the second group used the ointment for six months on a regular basis. All patients were examined at two, three, six and 12 months following treatment. Signs and symptoms before and after therapy as well as side-effects caused by the ointment were recorded. RESULTS: The mean age of the women was 60.2 years. Fifty-four patients were divided into two categories. In the 6-month follow-up, 59% of the 1st group and 85% of the second had complete response regarding their symptoms whereas on the 12-month follow-up, the respective numbers were 48% and 74%. Concerning the signs, 30% of the first group and 55.5% of the second showed to have complete response after six months and 26% and 41% respectively after 12 months. All differences between the two groups, except the signs after 12 months, were statistically significant. There were no side-effects from the long-term use of clobetasol propionate 0.05%. CONCLUSIONS: Conservative management of severe lesions of VLS in postmenopausal women using clobetasol propionate 0.05% for a long time (6 months) on a regular basis, seems to be a safe and effective therapy. Improvement is observed primarily on the symptoms and less on the signs.

Colposcopically directed biopsy findings in the young female.

STUDY OBJECTIVE: To evaluate the colposcopic findings of cervical alterations in the young sexually active female. DESIGN, SETTING, PARTICIPANTS: Colposcopic examination and follow-up of 51 young sexually active females aged 15-20 yr was conducted due to abnormal cytology or a suspicious abnormality of the cervix. The study was conducted at the Colposcopy Units of the 1(st) and 2(nd) Departments of Obstetrics and Gynecology, University of Athens, Greece. ONTERVENTIONS: Colposcopic examination, LEEP, conization. MEAN OUTCOME MEASURES: Biopsy, human papillomavirus (HPV) typing. RESULTS: Colposcopic examinations were within normal limits in 8 of 51 (15.7%) cases. Cervical alterations were related to HPV infection in 14 cases (27.4%), to cervical intraepithelial neoplasia (CIN) I in 15 (29.4%) cases, to CIN II in 13 (25.5%) cases, and to CIN III in 1 (2.0%) case. Of all CIN I cases, 8 of 15 (53.3%) were HPV positive, and HPV type 11, 16, 18, 31, 33, and 11& 16 were found. In CIN II cases, 5 of 13 (38.4%) were HPV positive, and HPV type 11, 16, 18, and 11 & 31 were found. In the CIN III case, only HPV type 16 was found. CONCLUSIONS: Our findings strongly confirm the necessity of obtaining cervicovaginal smears on all sexually active gynecologic and obstetric teenage patients. Colposcopy plays a major role in the evaluation of the cervix and in the treatment that should be given for any individual CIN lesion.

Endometrial cancer in patients under 30 years of age. A report of two cases.

Two unusual cases of a 22- and a 28-year-old woman, respectively, who were found to have endometrial adenocarcinoma, are presented. The patients experienced abnormal vaginal bleeding and the diagnosis was made by dilatation and curettage. They declined treatment with progestagens, therefore, a total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy were performed in both cases. We emphasize the need of endometrial evaluation in young females with abnormal bleeding before starting any medical treatment. Specific problems of endometrial cancer at young age include delay in diagnosis, difficulty in pathologic interpretation of the curettings and the motivation of most patients to preserve their fertility.

Neonatal adaptation: sympatho-adrenal response to umbilical cord cutting.

The present studies were designed to assess the individual effects of delivery and umbilical cord cutting on the stimulation of the sympatho-adrenal system during parturition. Pregnant ewes with time-dated singleton pregnancies were used in an acutely exteriorized fetal lamb model with an intact umbilical circulation. We observed a minimal, transient elevation in plasma catecholamines (CAT) coincident with the operative procedures and delivery. Subsequent cord clamping was observed to evoke a rapid and marked increase of both norepinephrine and epinephrine (E), maximal at 5 min and persisting over the 4-hr study period. Animals could be grouped on the basis of the observed CAT responses, severity of postpartum acidosis, the extent of free fatty acid (FFA) mobilization and degree of postpartum hypothermia. A blunted FFA response and slower correction of hypothermia were observed in the more acidotic animals despite higher CAT concentrations. One group of four animals had high peak CAT concentrations, 32,000 pg/ml norepinephrine and 35,000 pg/ml E, a deep nadir in pH of 6.88 +/- 0.09, a 2-hr delay in maximal FFA mobilization and slower correction of hypothermia. The other group of four animals had peak norepinephrine of 2800 pg/ml and E of 1100 pg/ml, a nadir in pH of 7.09 +/- 0.08, maximal plasma FFA concentration by 1 hr after cord cutting and a higher nadir in body temperature 35.7 versus 32.5 degrees C. The results demonstrate that umbilical cord cutting itself is a potent stimulus for fetal CAT release and FFA mobilization. Acidosis is capable of markedly augmenting E release in the mature fetus and obtunding chemical thermogenesis.

Ontogenesis of tissue catecholamines in fetal and neonatal rabbits.

The ontogenesis of tissue catecholamine concentrations in heart, lung, brown adipose tissue, adrenal and para-aortic chromaffin tissue was assessed in fetal and newborn rabbits using a radioenzymatic assay adapted to perchloric extracts of tissue. Measurements were conducted at 20, 24, 27 and 31 days gestation and at 3 and 7 days of age. Myocardial norepinephrine was detectable at 20 days gestation, the earliest age studied. Lung norepinephrine was not detectable until 24 days gestation. Norepinephrine concentrations in brown adipose were similar to myocardial levels. Adrenal and para-aortic tissue catecholamine content increased significantly between 24 days gestation and 7 days of postnatal age. Epinephrine became the predominant adrenal catecholamine by 24 days gestation. Para-aortic body norepinephrine concentrations always were substantially less than adrenal norepinephrine or epinephrine contents. Epinephrine was undetectable in para-aortic bodies at 20 and 24 days and at 31 days was only 27% of norepinephrine content. Adrenal maturation as reflected by epinephrine content or epinephrine/norepinephrine ratio correlated positively with body weight in the 31 day gestation fetuses. Thus, significant changes in tissue norepinephrine concentrations occur during the developmental time period studied. Parallel maturational changes occur in adrenal and para-aortic chromaffin tissue.

Ontogenesis of beta-adrenergic receptors in the ovine placenta.

Radioligands with high specific activity and high affinity have recently become available to study the beta-adrenergic receptor (BAR). BAR may be important in the placenta for mediating a variety of metabolic and hemodynamic effects of catecholamines including placental hormone synthesis and secretion, placental glycogenolysis, and placental blood flow. Little is known regarding the development of the BAR. We have used the tritiated radioligand dihydroalprenolol to study the ontogenesis of BAR in the fetal and maternal portions of the ovine placenta. The receptor number decreased from 415 fmoles . mg-1 of protein at 120 days' gestation to 226 fmoles . mg-1 at 145 days; this trend was highly significant (r = -0.822, p less than 0.01). Similar changes were noted in the dissociation constant. Downward regulation as a result of fetal neurosympathetic maturation is proposed as an explanation for this observation.