ABSTRACT
Resumen OBJETIVO: Valorar el tratamiento a largo plazo del dolor pélvico con levonorgestrel en mujeres con endometriosis que desean posponer el embarazo y preservar su fertilidad. MATERIALES Y MÉTODOS: Estudio ambispectivo, con intervención medicamentosa, longitudinal y descriptivo de serie de casos. Parámetros de estudio: medición de la intensidad del dolor a los 12, 24 y 36 meses posteriores a la colocación de un implante único de goserelina (Zoladex de 10,6 mg, AstraZeneca AB, Gärtunavägen). Al retorno de la menstruación se colocó un dispositivo intrauterino con levonorgestrel (Mirena Bayer AG, Leverkusen). La intensidad del dolor pélvico se midió con la Escala Numérica del Dolor (Escala ENA). RESULTADOS: Se estudiaron 14 pacientes de las que 5 refirieron dolor: 4 con intensidad 1 y una con intensidad 3. El resto de las pacientes no refirió dolor. Todas las pacientes refirieron alivio general subjetivo a los 12 meses de seguimiento. CONCLUSIONES: El levonorgestrel administrado por vía intrauterina puede ser una alternativa para mantener, a largo plazo, sin dolor a pacientes con endometriosis que desean posponer el embarazo. Para confirmar lo aquí encontrado hacen falta estudios controlados, con asignación al azar y con un tamaño de muestra realmente representativo.
Abstract OBJECTIVE: To assess the long-term treatment of pelvic pain with levonorgestrel in women with endometriosis who wish to postpone pregnancy and preserve their fertility. MATERIALS AND METHODS: Ambispective study, with drug intervention, longitudinal and descriptive case series. Study parameters: measurement of pain intensity at 12, 24 and 36 months after placement of a single goserelin implant (Zoladex 10.6 mg, AstraZeneca AB, Gärtunavägen). At the return of menstruation, an intrauterine device containing levonorgestrel (Mirena Bayer AG, Leverkusen) was inserted. The intensity of pelvic pain was measured with the Numerical Pain Scale (NPS). RESULTS: Fourteen patients were studied of whom five reported pain: four with intensity 1 and one with intensity 3. The rest of the patients reported no pain. All patients reported subjective general relief at 12 months follow-up. CONCLUSIONS: Levonorgestrel administered intrauterine may be an alternative for the long-term pain-free treatment of patients with endometriosis who wish to postpone pregnancy. Controlled, randomized studies with a truly representative sample size are needed to confirm the findings.
ABSTRACT
Extensive evidence indicates that glucocorticoid hormones act in a variety of brain regions to enhance the consolidation of memory of emotionally motivated training experiences. We previously reported that corticosterone, the major glucocorticoid in the rat, administered into the dorsal striatum immediately after inhibitory avoidance training dose-dependently enhances memory consolidation of this training. There is also abundant evidence that the intrinsic cholinergic system of the dorsal striatum is importantly involved in memory consolidation of inhibitory avoidance training. However, it is presently unknown whether these two neuromodulatory systems interact within the dorsal striatum in the formation of long-term memory. To address this issue, we first investigated in male Wistar rats whether the muscarinic receptor agonist oxotremorine administered into the dorsal striatum immediately after inhibitory avoidance training enhances 48 h retention of the training. Subsequently, we examined whether an attenuation of glucocorticoid signaling by either a systemic administration of the corticosterone-synthesis inhibitor metyrapone or an intra-striatal infusion of the glucocorticoid receptor (GR) antagonist RU 38486 would block the memory enhancement induced by oxotremorine. Our findings indicate that oxotremorine dose-dependently enhanced 48 h retention latencies, but that the administration of either metyrapone or RU 38486 prevented the memory-enhancing effect of oxotremorine. In the last experiment, corticosterone was infused into the dorsal striatum together with the muscarinic receptor antagonist scopolamine immediately after inhibitory avoidance training. Scopolamine blocked the enhancing effect of corticosterone on 48 h retention performance. These findings indicate that there are mutual interactions between glucocorticoids and the striatal cholinergic system in enhancing the consolidation of memory of inhibitory avoidance training.
ABSTRACT
It is well established that glucocorticoid administration into a variety of brain regions facilitates memory consolidation of fear-conditioning tasks, including inhibitory avoidance. The present findings indicate that the natural glucocorticoid corticosterone administered into the dorsal striatum (i.e., caudate nucleus) of male Wistar rats produced dose- and time-dependent enhancement of inhibitory avoidance memory consolidation. However, as assessed with a modified inhibitory avoidance procedure that took place on two sequential days to separate context training from footshock training, corticosterone administration into the dorsal striatum did not enhance memory of either the contextual or aversively motivational aspects of the task.
