Blog dedicated to the continuous education in Gynecology and Endocrinology

 

Second Daily issue from the 14th ISGE congress

A plenary session by young scientists

The Scientific Contest held for the first time this year has allowed 100 excellent young scientist of under 34 years to be supported by the Society to join us in Florence by providing free registration and accomodation, and the best five of them had the possibility to present their researches in a Plenary Session.

The following are two of the five best works presented yesterday.

Interviews with the five winners of the competition

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First Daily issue from the 14th ISGE congress

The First Training Course of the International School of Gynecological and Reproductive Endocrinology has been a major success. Nearly 100 particpantys joined two intensive training sessions on hyperandrogenisms and reproduction and on the therapeutical uses of hormonal contraceptives. The star-level Faculty was overwhelmed by questions and the highly interactive setting was the key to achieve the pricipal aim of the course, that is to facilitate the professional update in gynecological endocrinology through the privileged access to the leading physicians in the World. Listen to the speakers and to the participants in the interviews below, and consider joining the Second Training Course of the International School of Gynecological and Reproductive Endocrinology in Venice. This will be a 2 and 1/2-day full time course in the awesome venue of the Scuola di San Rocco, in the midst of ancient Venice, from October 28 to October 30, 2010. Registration is already available online! Follow the link and become and ISGE-certified practicioner in Gynecological Endocrinology!!

Interviews from the courses

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EFFECTS OF THE LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM ON CARDIOVASCULAR RISK MARKERS IN PATIENTS WITH ENDOMETRIOSIS: A COMPARATIVE STUDY WITH THE GNRH ANALOGUE.

3) Contraception. 2010 Feb;81(2):117-22.

Ferreira RA, Vieira CS, Rosa-E-Silva JC, Rosa-e-Silva AC, Nogueira AA, Ferriani RA.

BACKGROUND: The study was conducted to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intrauterine system (LNG-IUS) compared with the GnRH analogue (GnRHa) leuprolide acetate on these risk markers after 6 months of treatment. STUDY DESIGN: This was a randomized, prospective, open clinical study, with 44 patients with laparoscopically and histologically confirmed endometriosis. Patients were randomized into two groups: the LNG-IUS group, composed of 22 patients who underwent LNG-IUS insertion, and the GnRHa group, composed of 22 patients who received a monthly GnRHa injection for 6 months. Body mass index; systolic and diastolic arterial blood pressure; heart rate; and laboratory cardiovascular risk markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), homocysteine (HMC), lipid profile, total leukocytes and vascular cell adhesion molecule (VCAM) were measured before and 6 months after treatment. RESULTS: After 6 months of treatment, a significant reduction in pain score occurred in both groups with no significant difference in improvement between the two medications evaluated. In the LNG-IUS group, from pretreatment to posttreatment period, there was a significant reduction in the levels (mean+/-SD) of VCAM (92.8+/-4.2 to 91.2+/-2.7 ng/mL, p=.04), CRP (0.38+/-0.30 to 0.28+/-0.21 mg/dL, p=.03), total cholesterol (247.0+/-85.0 to 180.0+/-31.0 mg/dL, p=.0002), triglycerides (118.0+/- 76.0 to 86.5+/-41.5 mg/dL, p=.003), low-density lipoprotein cholesterol (160.5+/-66.0 to 114.5+/-25.5 mg/dL, p=.0005) and high-density lipoprotein cholesterol (63.0+/-20.5 to 48.5+/-10.5 mg/dL, p=.002). The GnRHa group showed an increase in HMC levels (11.5+/-2.9 to 13.0+/-2.7 mumol/L, p=.04) and a reduction in IL-6 levels (4.3+/-3.9 to 2.3+/-0.8 pg/mL, p=.005), VCAM (94.0+/-3.8 to 92.0+/-1.6 ng/mL, p=.03) and total leukocytes (7330+/-2554 to 6350+/-1778, p=.01). In the GnRH group, the remaining variables, including lipid profile, did not show any statistical difference. CONCLUSIONS: This study shows that some cardiovascular risk markers are influenced by both GnRHa and the LNG-IUS, but the latter had a greater positive impact on the lipid profile, which could lead to a favorable effect during long-term treatment.

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PREDICTIVE FACTORS OF ESSURE IMPLANT PLACEMENT FAILURE: PROSPECTIVE, MULTICENTER STUDY OF 495 PATIENTS.

1) Fertil Steril. 2010 Jan;93(1):29-34.

Panel P, Grosdemouge I.

OBJECTIVE: To assess a new hysteroscopic method of tubal sterilization; specifically, to examine the factors associated with placement failure of Essure implants. DESIGN: Observational, multicenter, 6-month study. SETTING: Seven gynecology clinics, including five public hospitals and two private clinics, in France. PATIENT(S): A total of 495 women who provided informed consent. INTERVENTION(S): All procedures were done by a vaginoscopic approach with a 5-mm operating hysteroscope. MAIN OUTCOME MEASURE(S): Data collected were age, parity, type of anesthesia, premedication, endometrial aspect, ostia visualization, duration of the procedure, pain during the procedure, and associated procedures. Unilateral and bilateral placement rates were assessed. Adverse events at 3 months (expulsion, migration, perforation) were also recorded. RESULT(S): Mean parity was 2.45; 20 women were nulliparous. In 56.3% of cases (n = 277), none or local anesthesia was used for the placement procedure. Overall, 86% of the women (n = 423) had nonsteroidal anti-inflammatory drug (NSAID) premedication, and 8.1% (n = 40) had another intrauterine surgical procedure performed at the same time. In 24 cases, at least one of the tubal ostia could not be visualized well during hysteroscopy. CONCLUSION(S): The failure rate for Essure micro-insert placement was 6% at first attempt and 3.3% after two attempts. Success rate was not significantly associated with parity, mode of analgesia, NSAID premedication, or combination with another procedure. The only factor significantly associated with the failure rate was poor visualization of the tubal ostia.

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A RANDOMIZED, CONTROLLED CLINICAL TRIAL COMPARING THE EFFECTS OF AROMATASE INHIBITOR (LETROZOLE) AND GONADOTROPIN-RELEASING HORMONE AGONIST (TRIPTORELIN) ON UTERINE LEIOMYOMA VOLUME AND HORMONAL STATUS.

4) Fertil Steril. 2010 Jan;93(1):192-8. Epub 2009 Jan 9.

Parsanezhad ME, Azmoon M, Alborzi S, Rajaeefard A, Zarei A, Kazerooni T, Frank V, Schmidt EH.

OBJECTIVE: To examine and compare the efficacy and safety of GnRH agonist (GnRHa) vs. aromatase inhibitor in premenopausal women with leiomyomas. DESIGN: Multicenter, randomized, controlled clinical trial. SETTING: University hospitals. PATIENT(S): A total of 70 subjects with a single uterine myoma measuring >or=5 cm. Subjects were randomized into two groups with use of a random table. They were treated with aromatase inhibitor (group A) or GnRHa (group B). INTERVENTION(S): Group A received letrozole (2.5 mg/d) for 12 weeks. Group B received triptorelin (3.75 mg/mo) for 12 weeks. MAIN OUTCOME MEASURE(S): Measurement of myoma volume and E(2), FSH, LH, and T levels. RESULT(S): Total myoma volume decreased by 45.6% in group A and 33.2% in group B. Reductions in myoma volume in the two groups were statistically significant. There was no significant change in hormonal milieu in group A. The serum level of hormones significantly decreased in group B by the 12th week of treatment. CONCLUSION(S): Uterine myoma volume was successfully reduced by use of an aromatase inhibitor. Rapid onset of action and avoidance of initial gonadotropin flare with an aromatase inhibitor may be advantageous for short-term management of women with myomas of any size who are to be managed transiently and who wish to avoid surgical intervention, specifically women with unexplained infertility having uterine myoma.

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