Exogenous androgens influence body composition and regional body fat distribution in obese postmenopausal women--a clinical research center study.

Abdominal fat distribution is influenced by androgen levels in both men and women. The purpose of this study was to assess the effects on fat distribution of administering nandrolone decanoate (ND; an anabolic steroid with weak androgenic activity) or spironolactone (SP; an antiandrogen) in obese postmenopausal women. The design was a randomized, placebo-controlled, 9-month trial with simultaneous calorie restriction for weight loss. Women in all three groups lost comparable amounts of weight, but the ND-treated women gained lean mass relative to the other two groups (P < 0.0005) and lost more body fat than women in the SP group (P < 0.01). The resting metabolic rate also increased slightly in the ND group. ND treatment produced a gain in visceral fat, as determined by computed tomography scan, and a relatively greater loss of sc abdominal fat. SP-treated women lost significantly less sc fat than the other two groups. Serum cholesterol decreased in the placebo group, but increased slightly in the other two groups (significant for SP vs. placebo, P < 0.05). High density lipoprotein cholesterol decreased significantly in the ND-treated women. There were no significant changes in fasting glucose or insulin sensitivity. We conclude that administration of exogenous androgens modulates body composition in obese postmenopausal women and independently affects visceral and sc abdominal fat.

Hysterectomy at the time of cesarean section: analysis of 108 cases.

One hundred eight cases of cesarean hysterectomy are analyzed. Important differences in operative complications and postoperative morbidity between elective and emergency cases are emphasized. Elective cases had a higher incidence of urinary tract injury but a much lower incidence of excessive blood loss, blood transfusion, and febrile morbidity. Transfusion was required in 19% of all operations, including 66.6% of emergency cases and 11.8% of elective operations. Febrile morbidity occurred in 30.5% and morbidity of all types in 35.2% of patients. A close correlation is demonstrated between operating time and febrile morbidity. No maternal mortality occurred in this series. Operative injury to the urinary tract, adnexal bleeding, broad ligament hematomas, vaginal cuff bleeding, and adequate identification of the cervix are problems that must be dealt with when performing a cesarean hysterectomy. Details of operative technique are described that address these problems and minimize blood loss and postoperative morbidity.