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OBJECTIVE: To compare the effects of continuous combined conjugated equine estrogens plus medroxyprogesterone acetate (CEE/MPA) with those of tibolone on symptom control, bleeding pattern, lipid profile and tolerability in postmenopausal women. METHODS: This was a randomized, open-label, parallel-group, multicenter study. Generally healthy postmenopausal women with an intact uterus and no contraindications to hormone replacement therapy (HRT) or tibolone were enrolled. Each subject was randomly assigned to receive CEE/MPA 0.625 mg-5.0 mg or tibolone 2.5 mg daily for 13 treatment cycles, each of 28 days. RESULTS: A total of 85 subjects were enrolled and received at least one dose of study medication, of which 76 (89.4%) subjects completed the study (n = 40, CEE/MPA; n = 36, tibolone). The incidence of postmenopausal symptoms decreased significantly over time in both treatment groups, compared with baseline, including significant decreases in the incidence of urogenital and sexual health symptoms. Significant differences in symptom control (other than hot flushes) were observed between treatment groups in a few different cycles for different symptoms, but no consistent or clinically significant trends were observed. No statistically significant differences in the incidence of bleeding were observed between treatment groups after cycle 4. Significant decreases in total cholesterol (5.6%) and low-density lipoprotein (LDL) cholesterol (7.5%) were observed at cycle 13, compared with baseline, in the CEE/MPA group, and significant decreases in high-density lipoprotein (HDL) cholesterol (8.5%) and triglycerides (13.7%) were observed at cycle 13, compared with baseline, in the tibolone group. Significant weight gain was observed at cycle 13 in the tibolone group (3.05 kg), compared with the CEE/MPA group (0.96 kg). The incidences of adverse events were similar in both treatment groups. CONCLUSIONS: Women treated with CEE/MPA or tibolone showed significant improvement of postmenopausal symptoms, including urogenital and sexual health symptoms, and had similar bleeding patterns after four cycles of therapy. CEE/MPA and tibolone each induced a different mix of changes in the lipid profile.

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The pathogenesis of thrombocytopenia in chronic hepatitis is not well known. This study evaluated the relationship between liver injury, serum thrombopoietin, splenomegaly and thrombocytopenia in chronic viral hepatitis. Two hundred and nine patients were enrolled, 85 with splenomegaly and 124 without. Thrombocytopenia was present in 71% and 23% of patients with or without splenomegaly respectively. In subjects with low platelet count, those with splenomegaly showed significantly lower platelet numbers than those without splenomegaly. The spleen size correlated with portal hypertension. An inverse correlation between spleen size and platelet count was observed (r = -0.54; P < 0.0001). In patients without splenomegaly, thrombocytopenia was associated with the grade of fibrosis; platelet counts were the highest in patients with fibrosis 0-2, lower in those with grade 3 (P < 0.008) and lowest in those with grade 4 (P < 0.05). These findings were independent of demographic and biochemical characteristics, hepatic necroinflammatory activity, portal hypertension and splenomegaly. Patients with normal platelet counts showed higher thrombopoietin levels than those with low platelet counts (P < 0.0001). An inverse correlation between thrombopoietin levels and fibrosis grade was observed (r = - 0.50; P < 0.0001). Median thrombopoietin levels were 58 and 27 pg/ml for fibrosis grade 0-1 and grade 4 respectively (P < 0.001). These data indicate that advanced hepatic fibrosis, causing an altered production of thrombopoietin and portal hypertension, plays the central role in the pathogenesis of thrombocytopenia in chronic viral hepatitis.

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40 pacientes com dismenorreia primaria foram tratadas com piroxicam durante tres periodos menstruais seguidos, na posologia de 40 mg (dois primeiros dias) seguida de 20 mg (dois dias seguintes) sempre em dose unica diaria. No primeiro periodo de tratamento, 30 pacientes (75%) ou nao sentiram mais dor ou ela foi de leve intensidade. No segundo periodo, este numero elevou-se para 36 pacientes (90%) e no terceiro periodo, para 37 (92,5%) do total de 40 pacientes tratadas. Somente uma paciente (2,5%) apresentou dor de intensidade leve antes do tratamento. Houve diminuicao da severidade com os periodos de tratamento e regressao precoce da dor (a partir da 4a. hora do primeiro dia de tratamento).Os sintomas associados e o indice de absenteismo tambem diminuiram significativamente. Reacoes adversas leves (epigastralgia, pirose etc) em 6 (15%) pacientes. Conclui-se que o piroxicam e medicamento de escolha para o tratamento da dismenorreia primaria

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Os autores apresentam caso de gravidez tubaria, bilateral, dizigotica, tecendo consideracoes a respeito da etiopatogenia, da sintomatologia e dos aspectos anatomo-patologicos. Relatam os casos encontrados na literatura, comentando as principais localizacoes insolitas de gestacoes ectopicas e finalizam com o quadro clinico e a conduta terapeutica adotada

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Os A.A. apresentam um caso de endometriose vesical com sintomatologia sugestiva mas cujo diagnostico so foi firmado durante o ato cirurgico. Havia comprometimento da parede vesical posterior possivelmente consequente a manobra abortiva com perfuracao de parede uterina anterior e parede vesical posterior.Tecem tambem breves consideracoes sobre a endometriose, estudando sucintamente a sintomatologia, o quadro clinico, metodos diagnosticos e terapeuticos. Realcam a importancia da associacao endometriose esterilidade

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Os autores em revisao sobre as salpingites, acentuam sua atual importancia, comentando alem dos conhecimentos dos agentes etiologicos, as novas cepas de microorganismos, de real significado no contexto patologico. Apontam os inumeros fatores de risco, focalizando depois o quadro clinico, os aspectos patogeneticos e os principais comentarios anatomo-patologicos

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Os autores fazem consideracoes gerais iniciais sobre o hirsutismo. Estudam a producao e o metabolismo dos androgenios circulantes na mulher. Propoem classificacao e abordam as entidades clinicas mais relacionadas ao hirsutismo, assim como o esboco diagnostico e terapeutico dessas condicoes patologicas

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