Fibronectin plasma levels in gynecological cancers.

PURPOSE: Fibronectin (FBN) is involved in the motility and migration of malignant cells. The purpose of this study was to investigate FBN plasma levels in gynecological cancers patients and in healthy women. METHODS: The study took place between 1998 and 2003. One hundred women with histologically diagnosed cancer of gynecological organs (cervix, ovary, endometrium, breast) formed the study group (group A), whereas the control group (group B) consisted of 100 healthy women. FBN plasma levels were measured with the radial immunodiffusion method. RESULTS: The average age of group A patients was 42.08 years (range 33-77), and of group B it was 41.1 years (range 32-65). Both groups were compared with the Student's-t test. The median plasma value of FBN in all gynecological malignancies was 258.4 mg/l (standard deviation/SD 163.9, p=0.0066, t-statistics: 2.768, (t95): 1.984, 95% CI: 225.4-290.9). The plasma levels were significantly elevated when compared to the control group (median=213 mg/l). The distribution of values showed a statistically important "tail" in high plasma levels (FBN >400 mg/l). Plasma levels of FBN were more increased in breast and cervical malignancies when compared to ovarian and endometrial cancers. CONCLUSION: FBN plasma levels were significantly increased in the total of group A patients, but not significantly increased in the endometrial and ovarian subgroup. Whether or not FBN could reliably be a marker for gynecological cancers should be confirmed in studies with larger number of patients.

The differential effect of estrogen, estrogen-progestin and tibolone on coagulation inhibitors in postmenopausal women.

OBJECTIVES: Hormone therapy increases the risk of venous thromboembolism, possibly through a negative effect on coagulation inhibitors. The aim of the study was to assess the effect of conjugated equine estrogens alone or in combination with medroxyprogesterone acetate, low-dose 17beta-estradiol combined with norethisterone acetate and tibolone on inhibitors of coagulation. METHODS: Two hundred and sixteen postmenopausal women received orally either conjugated equine estrogens 0.625 mg (CEE, n=24) or tibolone 2.5 mg (n=24) or CEE+medroxyprogesterone acetate 5 mg (CEE/MPA, n=34) or 17beta-estradiol 1 mg+norethisterone acetate 0.5 mg (E2/NETA, n=66) or no therapy (control, n=68) for 12 months. Plasma antithrombin, protein C and total protein S were measured at baseline and at 12 months. RESULTS: CEE, CEE/MPA and E2/NETA treatment were associated with a significant decrease in antithrombin levels (CEE: baseline 235.6+/-47.6 mg/l, follow-up 221.3+/-48.3 mg/l, p=0.0001; CEE/MPA: baseline 251.1+/-38.6 mg/l, follow-up 225.0+/-42.6 mg/l, p=0.009; E2/NETA: baseline 257.1+/-59.4 mg/l, follow-up 227.1+/-50.4 mg/l, p=0.007; tibolone: baseline 252.6+/-62.4 mg/l, follow-up 261.9+/-59.1 mg/l, p=0.39). Protein C decreased significantly in the CEE and CEE/MPA groups (CEE: baseline 3.64+/-1.17 mg/l, follow-up 2.48+/-1.47 mg/l, p=0.004; CEE/MPA: baseline 3.24+/-1.23 mg/l, follow-up 2.61+/-1.38 mg/l, p=0.001; E2/NETA: baseline 3.24+/-1.10 mg/l, follow-up, 3.15+/-1.11 mg/l, p=0.08; tibolone: baseline 3.26+/-1.25 mg/l, follow-up 3.09+/-1.32 mg/l, p=0.37). Protein S decreased significantly only in the CEE/MPA group (CEE: baseline 19.4+/-2.76 mg/l, follow-up 18.0+/-2.45 mg/l, p=0.56; CEE/MPA: baseline 18.4+/-3.42 mg/l, follow-up 14.5+/-3.43 mg/l, p=0.005; E2/NETA: baseline 19.0+/-3.11 mg/l, follow-up 19.5+/-3.43 mg/l, p=0.18; tibolone: baseline 18.5+/-3.09 mg/l, follow-up 18.0+/-4.09 mg/l, p=0.32). CONCLUSIONS: Estrogen and estrogen-progestin therapy are associated with a reduction in coagulation inhibitors, the extent of which depends on the regimen administered. Tibolone appears to have no effect on inhibitors of coagulation.

Effect of hormone replacement therapy, tibolone and raloxifene on serum lipids, apolipoprotein A1, apolipoprotein B and lipoprotein(a) in Greek postmenopausal women.

The aim of this study was to assess the effect of estrogen, two regimens of continuous combined hormone replacement therapy (HRT), tibolone and raloxffene on serum lipid, apolipoprotein A1 and B and lipoprotein(a) levels in Greek postmenopausal women. A total of 350 postmenopausal women were studied in a prospective open design. Women were assigned to one of the following regimens depending on the presence of risk factors for osteoporosis, dimacteric symptoms and an intact uterus: conjugated equine estrogen 0.625 mg (CEE, n = 34), continuous combined CEE 0.625 mg plus medroxyprogesterone acetate (MPA) 5 mg, (n = 80), continuous combined 17beta-estradiol 2 mg plus norethisterone acetate (NETA) 1 mg (n = 58), tibolone 2.5 mg (n = 83) and raloxifene HCl 60 mg (n = 50). Forty-five postmenopausal women with no indications for HRT served as controls. Total cholesterol (TC), low-density lipoprotein (LDL) cholestrol and high-density lipoprotein (HDL) cholesterol, triglyceride (TG), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and lipoprotein(a) (Lp(a)) levels were assessed in each subject at baseline, and at 6 and 12 months of therapy. All therapy regimens lowered TC levels compared to baseline (4.2-8.0% decrease). This effect was more prominent in the subgoup of women with high baseline TC levels (9.1-20.4% decrease). LDL cholesterol decreased significantly in CEE, CEE/MPA and raloxifene groups (-11.2%, -11.9% and -11.0%, respectively). Hypercholesterolemic women exhibited a steeper decrease in LDL cholesterol (10.6-27.8% in all therapy groups). TG levels increased significantly in the CEE and CEE/MPA groups (23.7% and 21.8%, respectively), while estradiol/NETA had no effect on TG levels. Tibolone decreased TG levels markedly, by 20.6%, while raloxifene had no TG-lowering effect. HDL cholesterol and ApoA1 were increased by CEE and CEE/MPA (HDL cholesterol, 7.4% and 11.8%, respectively; ApoA1, 17.8% and 7.9%, respectively) and decreased by tibolone (HDL cholesterol, -13.6%; and ApoA1, -9.9%). All therapy regimens except raloxifene lowered Lp(a) levels, with tibolone having the more pronounced effect (-13.2 to -29.0%). In conclusion, each therapy regimen had a diferent effect on lipid-lipoprotein levels, exerting favorable and unfavorable modifications. Hypercholesterolemic women seemed to benefit more from the cholesterol-lowering effect of estrogen replacement therapy/HRT. The choice for a particular regimen should be based on individual needs, indications and lipid-lipoprotein profile.

Breast pain and mammographic density increase as a consequence of raloxifene therapy.

A 55-yr-old post-menopausal woman with osteopenia and no history of breast disease is presented. She was placed on raloxifene HCl 60 mg and soon after developed severe breast pain. The follow-up mammogram, performed prematurely at 6 months, showed a marked increase in breast density. Therapy was accordingly stopped and mastodynia subsided. The patient's mammogram regressed to pre-treatment status after 6 months off-therapy.

Adolescent sexuality: a developmental milestone or risk-taking behavior? The role of health care in the prevention of sexually transmitted diseases.

Of the many perspectives from which one can view teenage sexual activity, the most evident are as a normal developmental milestone in the life of the adolescent, or as risk-taking and possibly health-compromising behavior. Since unfortunately, knowledge about sexuality, reproduction, and contraception is often acquired after sexual activity has begun, the prevention of pregnancy and sexually transmitted diseases (STDs) should be given high priority in health care and in education. The role of sex education has been a controversial issue for years and communication within the family vis-à-vis the teenager's decision to use contraception is often difficult both for the parents and for the adolescent. In the areas of adolescent sexual behavior, sex education, contraception, and counseling, it is imperative and of paramount importance that the health-care system focus on this target group.

Endothelin plasma levels in primary amenorrheic adolescents before and after estrogen treatment.

OBJECTIVE: We evaluated the effect of estrogen administration on endothelin (ET) secretion in primary amenorrheic (PA) adolescent girls. METHODS: Fifteen PA adolescents (ten hypergonadotropic, group A; five hypogonadotropic, group B) were treated with estrogen and progestogen tablets. A control group of ten healthy adolescents (group C) was included in the study. The ET 1-21, FSH, and LH plasma levels were tested before treatment (PrT) and immediately after the last estrogen tablet but before the progestogen administration (PoT). RESULTS: A statistically significant difference (P < .01) in ET 1-21 plasma values was found between PrT (9.66 +/- 0.80 pmol/L) and PoT (7.56 +/- 0.89 pmol/L) levels in group A cases. A similar reduction (P < .05) was recorded between PrT (8.06 +/- 0.46 pmol/L) and PoT (5.59 +/- 0.53 pmol/L) ET 1-21 plasma levels in group B cases. Endothelin 1-21 plasma PrT values were higher in both group A and B cases in comparison with controls (6.66 +/- 0.44 pmol/L; P < .01, P < .1, respectively). CONCLUSIONS: Estrogens administered to PA adolescents reduce ET 1-21 plasma levels in both hyper-and hypogonadotropism.

Untreated cervical infections, chorioamnionitis and prematurity.

OBJECTIVE: To examine the relationship of endocervical pathogens and cervicitis with the development of chorioamnionitis, premature rupture of membranes (PROM) and prematurity. METHODS: Three groups of pregnant women were included in the study: group A, controls with no evidence of cervicitis; group B, women with cervicitis due to pathogenic bacteria, who had been treated; and group C, women with untreated cervicitis who had not followed the prescribed therapy. Endocervical samples were cultured and aerobic and anaerobic bacteria isolated to examine the correlation of cervicitis with chorioamnionitis, PROM and prematurity. RESULTS: There was a significantly higher incidence of prematurity in women with untreated cervicitis (group C). Mixed endocervical pathogens were most often involved (36.3%). A significantly higher number of endocervical pathogens were isolated in cases of chorioamnionitis (P < 0.001). Prematurity was seen in 39.6% of cases of chorioamnionitis. Prematurity was also more common in women with PROM (42.1%) than in those with intact membranes (11.8%). CONCLUSION: It is concluded that untreated endocervical infections are an etiological factor of chorioamnionitis, PROM and prematurity.

Adolescent pregnancy in Europe.

The International Federation of Pediatric and Adolescent Gynecology surveyed physicians from 11 European countries to ascertain the countries' adolescent pregnancy and abortion rates. Pregnancy rates tended to remain stable or decrease through the 1980s, with some notable exceptions. Germany, Federal Republic exhibited the highest adolescent pregnancy rates; the rate increased from 16% to 21% among 16- to 18-year-olds from 1985 to 1987, and then decreased to 13% by 1989. The United Kingdom had the second highest rate of adolescent pregnancy, although in the 16- to 18-year-old group, the rate decreased from 9.1% in 1985 to 8.6% by 1989. The Netherlands and Denmark had the lowest adolescent pregnancy rates, with a cumulative total of 0.9% in both countries for adolescents under age 18 years in 1985 and 1987; data for 1989 were not available at the time of the survey. Abortion rates among adolescents--expressed as a percentage of the total number of abortions performed in each country--increased in most countries during the 1980s. By 1989, Hungary and Finland had the highest abortion rates, 11% and 9.5%, respectively. Belgium had the lowest rate; only 1% of abortions performed were in women aged 18 years and younger. Most of the countries included in this survey require parental consent for termination of pregnancy. Although the medical complications of pregnancy and birth in adolescents can be minimized with good management and follow-up, the social and psychological implications continue to take a toll. Sex-education programs are one means of reducing the rate of adolescent pregnancy. For adolescents who do become pregnant, however, psychological and social support must be provided in addition to medical care.

PIP: Findings are reported from the International Federation of Pediatric and Adolescent Gynecology's compilation of national adolescent abortion and pregnancy statistics. Data are obtained from physicians from 11 European countries: Belgium, the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, and the United Kingdom. Information was collected on adolescent pregnancy, Caesarean section, perinatal mortality, and abortion. Findings indicate that adolescent pregnancy rates during 1985-89 remained stable or declined. The exceptions were Germany, where pregnancy rates increased among adolescents aged 16-18 years from 16% in 1985 to 21% in 1987. Rates decreased among other adolescent age groups. Germany had the highest rates of adolescent pregnancy, followed by the United Kingdom. The lowest rate of adolescent pregnancy was in the Netherlands. Adolescent abortion rates as a percentage of total abortions performed increased during 1985-89 from 1.6% to 3.8% in Denmark, from 8.1% to 9.5% in Finland, and from 8% to 11% in Hungary. Adolescent abortion rates decreased in Germany, Greece, and the United Kingdom. The Netherlands had the lowest adolescent abortion rate (0.4% in 1987). For many countries that had a minimum age limit for abortion, the age limit was 16 years. The gestational age limit for an abortion was 12 weeks in all countries. Most of the 11 countries required parental consent and a physician's approval. There was no agreement on the protocol among countries for handling adolescent pregnancies and complications. Data could not be interpreted due to nonuniform reporting methods. All physicians concurred that adolescent pregnancy would be reduced by reducing the prevalence of premarital sexual activity through a comprehensive sex education curriculum.

Chronic or recurrent vaginal candidosis: short-term treatment and prophylaxis with itraconazole.

Twenty-one women (mean age, 35.3 years) with 2 to 4 episodes of vaginal candidosis in the last 6 months were included in the study to evaluate the efficacy and safety of itraconazole as short-term, as well as prophylactic, treatment of chronic candidosis. After clinical evaluation and laboratory confirmation of candidosis, 200 mg of itraconazole were given orally for 3 days. Twelve of the 21 patients were cured. The remaining nine repeated treatment, after which all were cured. All patients were entered in the maintenance phase, and received 200 mg of itraconazole the first day of the menstrual cycle for 6 months. One patient relapsed in the second month, but after taking 200 mg of itraconazole BID for 1 day she remained cured for the rest of the study period. All other patients remained cured for the 6 months of the maintenance period. Three months after the end of prophylactic therapy, 17 of 20 patients (85%) were clinically and mycologically cured. No adverse experiences were reported. It is concluded that itraconazole is an efficient and safe short-term treatment for chronic or recurrent vaginal candidosis. Moreover, the dose of 200 mg once monthly for 6 months proved to be a successful suppressive treatment.