A prospective randomized comparative study of the effects of intranasal and transdermal 17 beta-estradiol on postmenopausal symptoms and vaginal cytology.

CONTEXT: Investigating the adverse effects of oral hormone replacement therapy (HRT), the clinical effectiveness of alternative combinations and route of administrations. AIM: To compare the effects of intranasal and transdermal 17 beta-estradiol combined with vaginal progesterone on vasomotor symptoms and vaginal cytology. SETTINGS AND DESIGN: A 12-week, prospective, randomized comparative study was conducted between July 2005 and September 2006. MATERIALS AND METHODS: Eighty postmenopausal women aged between 42-57 years, who had scores of > or =1.7 on the menopause rating scale-I (MRS-I) items "1-6", were randomly assigned to receive intranasal (300 microg/day, n =40) or transdermal (50 microg/day, n =40) 17 beta-estradiol continuously. All patients also received a vaginal progesterone gel twice weekly. Vasomotor symptoms were evaluated at weeks 0, 4, 8 and 12. Vaginal maturation index (VMI) was evaluated at weeks 0 and 12 of the study. STATISTICAL ANALYSES: The Mann-Whitney U and the Wilcoxon tests were used. P < 0.05 was regarded as significant. RESULTS: Thirty-two women in the intranasal and 29 women in the transdermal group completed the study. The total score of the MRS, the sum-scores of Factor 1 "HOT FLUSHES" and Factor 2 "PSYCHE" significantly decreased in both groups at week 4. Factor 3 "ATROPHY" scores significantly decreased only in the transdermal group at week 12. The VMI showed no changes within and between the two groups at the end of the study. CONCLUSION: Intranasal and transdermal 17beta-estradiol combined with vaginal progesterone gel as a continuous HRT caused a similar decrease in vasomotor symptoms but did not have any significant effect on VMI after 12 weeks of treatment in this study population.

Proliferative activity, angiogenesis and nuclear morphometry in renal cell carcinoma.

BACKGROUND: Prognostic parameters other than tumor stage and grade are essential for renal cell carcinoma (RCC) patients. This study was undertaken to determine the usefulness of cellular proliferation, angiogenesis and nuclear morphometry in predicting the biological aggressiveness of RCC. METHODS: Surgical specimens of 70 patients with RCC were investigated by conventional histology, Ki-67 immunostaining and stereological assessment of angiogenesis and mean nuclear volume. RESULTS: There was no difference in disease-specific survival with respect to sex, age and histopathological type (except sarcomatoid and other types). The survival was significantly lower and the chance of metastases was higher in the group with higher proliferative activity (P=0.007). There was no relation between angiogenesis, mean nuclear volume, stage and survival. There was a significant relation between both Fuhrman and WHO grades, tumor stage and survival. Histopathological type, grade, angiogenesis and mean nuclear volume failed to predict recurrences and/or metastases. In multivariate analysis, only TNM stage and proliferative activity were found to be independent prognostic factors. CONCLUSIONS: In addition to tumor grade and stage, proliferative activity of a given RCC may have the potential to identify patients with an impaired prognosis.

Comparison of microvascularization in diagnostic needle biopsies and radical prostatectomies in prostate carcinoma.

OBJECTIVES: Quantitation of microvessel density has been shown to predict tumor aggressiveness in prostate carcinoma (Pca). The correlation of estimated values of angiogenesis in needle biopsy and radical prostatectomy materials might show the efficiency of the diagnostic biopsy material to represent a good sample of the entire tumor. In this study, we assessed the correlation of microvascularization computed by morphometric methods in biopsy and radical operation materials. METHODS: Sections from diagnostic biopsy and radical prostatectomy materials of 23 patients with Pca were stained with factor- 8-associated antigen by immunohistochemistry and vascular surface density (VSD), microvessel numbers (NVES) and maximum microvessel number (NVES-MAX) were assessed by stereological methods. The microvascularization values in biopsy and radical operation materials were compared by Wilcoxon signed-ranks test for paired samples. RESULTS: No significant difference was observed between VSD and NVES values that were obtained from biopsy and radical operation materials of the same cases (p = 0.2478 and 0.3458, respectively). However, a significant difference was noted for NVES- MAX (p = 0.0004). CONCLUSION: We have shown, in a limited number of cases, that microvascularity prediction by stereological analysis using VSD and NVES in diagnostic needle biopsies correlates well with the radical operation specimens. Preoperative biopsies may predict overall tumor neovascularization characteristics that may have an impact on pathological stage and behavior.