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Biomedical subjects

C Castelo-Branco

Publications and source records attributed to C Castelo-Branco.

At least 55 records · Page 3Linked to original sources
PubMed1995

Is MRI helpful in evaluating the response of cervical cancer to neoadjuvant chemotherapy?

BACKGROUND: To assess the potential role of magnetic resonance imaging (MRI) in evaluating the response of cervical tumor to neoadjuvant chemotherapy. METHODS: We studied 14 patients with locally advanced carcinoma of the cervix. MRI was performed before and after each cycle. All patients underwent laparotomy four weeks after the last cycle. MR images after chemotherapy were compared with surgical-pathologic findings. RESULTS: Related to parametrial state after chemotherapy, surgical examination correlated with MRI in nine patients (nine true negative). In three cases parametrial invasion was over-estimated (three false-positive) and in two it was underestimated, so that tumor resection was not possible once laparotomy was performed (two false-negative). MRI estimation of tumor size was confirmed at pathologic examination in only eight patients, whilst it was over-estimated in the other four ones. CONCLUSIONS: These initial results suggest that MRI could not be as precise for cervix cancer staging and evaluation of response to chemotherapy as has recently been postulated. This is especially important since a false negative result may induce the surgeon to perform laparotomy in error in cases of unresectable tumors.

Adult↗
PubMed1995

Circulating hormone levels in menopausal women receiving different hormone replacement therapy regimens. A comparison.

OBJECTIVE: To measure and compare plasma levels of sex hormones after the administration of different hormone replacement therapy (HRT) regimens. STUDY DESIGN: Ninety women with natural menopause were randomized into this comparative study. Eighty-five women completed one year of follow-up. Patients were randomly assigned to five groups. The first received 0.6 mg/d of conjugated equine estrogen (CEE) cyclically (n = 15). The second received 50 micrograms/d of transdermal estradiol (E2) cyclically (n = 17), and the third received 0.6 mg/d of CEE continuously (n = 17). All these groups also received 2.5 mg of medroxyprogesterone acetate (MPA) sequentially for the last 12 days of HRT, while the fourth therapy group received 0.625 mg/d of CEE and 2.5 mg/d of MPA continuously (n = 19). The fifth group constituted a treatment-free control group (n = 22). Levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), E2, estrone (E1), prolactin (PRL), testosterone (T), androstenedione (A4), dehydroepiandrosterone sulfate (DHEA-S) and sex hormone binding globulin (SHBG) were determined prior to HRT and during the last week of the 6th and 12th months of HRT, between days 21 and 24 of estrogen administration. RESULTS: After HRT we found decreases in FSH, LH and PRL levels, increases in E2, E1 and SHBG, and no modifications in T, A4 and DHEA-S plasma levels. There were no significant differences between the treatment groups in FSH, LH, E2, PRL, T, A4 or DHEA-S. E1 and SHBG were significantly higher in the groups with oral HRT. CONCLUSION: All the observed changes in hormone levels are to be expected after HRT except for the decrease in PRL levels. Finally, although MPA dosage was not the focus of the present study, our results suggest that the dosage of 2.5 mg/d of MPA in sequential regimens is clearly inadequate to protect the endometrium from hyperplastic changes.

Adult↗
PubMed1995

Postmenopausal hormone replacement therapy with low-dose medroxyprogesterone acetate. Endometrium, plasma lipids, lipoproteins and apolipoproteins.

Several studies have demonstrated that the use of estrogens in postmenopausal women has a protective effect against cardiovascular disease; however, this beneficial effect may be counteracted when concomitant progestogens are administered. We investigated the influence of hormone replacement therapy (HRT) with lower doses of medroxyprogesterone acetate (MPA) (2.5 mg/d) on the endometrium and on the plasma levels of lipids, lipoproteins and apolipoproteins. All the studied HRT regimens induced favorable changes in the levels of plasma lipids, lipoproteins and apolipoproteins, which may play an important role in the prevention of cardiovascular disease. The dosage of 2.5 mg/d of MPA is clearly inadequate to protect the endometrium from hyperplastic changes with sequential regimens, but probably this dosage is safe when MPA is administered continuously.

Adult↗
PubMed1995

Primary adenocarcinoma of the endometrium associated with genital tuberculosis. A case report.

BACKGROUND: Adenocarcinoma of the endometrium is a common tumor of the female reproductive tract, and tuberculosis accounts for only about 1% of postmenopausal metrorrhagia. Tuberculosis of the fallopian tubes is the most frequent location; that of the cervix is the most uncommon. CASE: A case of primary adenocarcinoma of the endometrium was diagnosed after curettage in a 58-year-old, postmenopausal woman complaining of a bloody vaginal discharge. A laparotomy was performed, and histologic examination of the uterus disclosed an endometrial carcinoma, grade 2/3, with extension to both tubes. The tumor was associated with an extensive granulomatous reaction, with numerous tubercles composed of epithelioid cells, multinucleate giant cells of Langhans and central necrosis type. These granulomas were seen close to the carcinoma in the endometrium and tubes and far from the neoplasm in sections of the cervix, myometrium and lymph nodes. CONCLUSION: The association of endometrial adenocarcinoma with genital tuberculosis is extremely rare. Moreover, similar granulomas may appear in the surrounding stroma of the tumor. For these reasons a diagnosis of genital tuberculosis associated with this neoplasm should be made with caution.

Adenocarcinoma↗
PubMed1994

Solitary vaginal metastasis as a presenting form of unsuspected renal adenocarcinoma.

Vaginal bleeding may be the first clinical manifestation of an occult renal neoplasm. The renal adenocarcinoma is a tumor with a wide variety of presenting forms. Sometimes the clinical signs of the metastatic lesions are the first evidence of disease. The prevalence of solitary metastases at diagnosis is lower than 3%, and solitary vaginal metastasis from this tumor is rare. Histologically, this metastasis is indistinguishable from that of a primary vaginal mesonephric adenocarcinoma, making electron microscopy necessary for the differential diagnosis. Treatment consists of surgical removal of the renal neoplasm as well as the vaginal lesion.

Adenocarcinoma, Clear Cell↗
PubMed1994

Antagonism of oestrogen-induced prolactin release by medroxyprogesterone acetate.

Previous studies conducted at our clinic suggested that the administration of hormone replacement therapy (HRT) in postmenopausal women could result in the inhibition of oestrogen-induced prolactin (PRL) release. The aim of this study was to determine how the pituitary function is affected by the sequential addition of medroxyprogesterone acetate (MPA) to oestrogen replacement therapy. Twenty-one postmenopausal women receiving no other medication were treated with a standard dose (0.625 mg/day) of conjugated equine oestrogens (CEE) for a period of 24 days, plus 5 mg/day MPA added sequentially during the last 12 days of the oestrogen therapy. Blood samples were collected before treatment, during oestrogen and oestrogen-progestogen administration and after cessation of treatment. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17 beta-oestradiol (E2) and PRL levels were studied. During treatment gonadotrophin concentrations decreased significantly, while after cessation of HRT the levels of FSH and LH increased. These gonadotrophin fluctuations indicated a sharp rise in E2 levels during therapy and a significant decrease during the treatment-free period. PRL levels were found to be higher during CEE therapy, but they fell when patients received CEE in combination with MPA. These observations suggest that the role of progestogens in a variety of experimental and clinically relevant situations needs to be investigated not only as regards their direct action but also their modulation of the effect of oestrogen.

Climacteric↗
PubMed1994

Transvaginal sonography of the endometrium in postmenopausal women: monitoring the effect of hormone replacement therapy.

BACKGROUND: It is well known that progestins given in sufficient dosage reduce the risk of endometrial cancer and endometrial hyperplasia. It is also not uncommon that patients receiving hormone replacement therapy (HRT) require endometrial biopsy in order to evaluate the effects of oestrogens and progestogens on endometrium. However, endometrial biopsy is often associated with pain and discomfort, and transvaginal sonography has been suggested as a new and painless method of monitoring the effects of HRT on the endometrium. METHODS: Transvaginal ultrasonography was performed in a series of women on several regimens of HRT immediately prior to endometrial biopsy (Cornier cannula). We correlated the morphology and thickness of the endometrium as assessed by transvaginal ultrasonography with the endometrial histology. Patients were assigned into four groups. The first (n = 15) received 0.6 mg/day of conjugated equine oestrogen (CEE) cyclically and the second (n = 6) received 50 micrograms/day of transdermal oestradiol cyclically. All these groups also received 5 mg of medroxy-progesterone acetate (MPA) sequentially for the last 12 days of HRT, while the third therapy group (n = 7) received 0.625 mg/day of CEE and 5 mg/day of MPA uninterruptedly. The fourth group (n = 8) constituted a treatment-free control group. In total 36 biopsies were taken. Our initial results suggest that endometrial thickness under 4 mm measured by ultrasonography is not associated with endometrial abnormalities and that transvaginal ultrasonographic scanning of the endometrium may be a useful tool in determining which patients require endometrial histologic evaluation and perhaps in detecting those who need adjustment in the progestin dosage.

Administration, Cutaneous↗
PubMed1994

Relationship between skin collagen and bone changes during aging.

There is evidence that skin collagen content and bone mass are influenced by estrogen deficiency, both of them declining in the years following menopause. The aim of our study was to analyze the relationship between changes in skin collagen content and bone mass during aging. A total of 76 nulliparous women who had been admitted for surgery of non-malignant processes were studied. All subjects were arranged into five age-groups (from 20 to 60 years). Bone mineral density was measured by dual photon absorptiometry and expressed in g/cm2 as the mean of the second to fourth lumbar vertebrae. Additionally, in all patients skin biopsies were taken from a non-sun exposed site in the lower abdomen (4 cm above the pubic symphysis) and osteocalcin levels were determined. Collagen decreased significantly with age after the 40s (P < 0.001) and after menopause (P < 0.001). Changes in bone mass were closely related to those detected in collagen (r = 0.586; P < 0.0001). In conclusion, our data suggest that bone mass and skin collagen decline in parallel with aging and that the hypoestrogenism developing in postmenopausal years has a significant effect on skin collagen content. Nevertheless, the question of whether osteoporosis is an intrinsic collagen disorder remains to be demonstrated.

Adult↗
PubMed1994

Vaginal hysterectomy with the Autosuture stapler.

Our objective was to assess the applicability of hysterectomy by the vaginal route completely performed with Autosuture staples. Between January 1992 and September 1993, 5 vaginal hysterectomies using Autosuture staplers were performed by the authors. Five vaginal hysterectomies matched for age, parity, and uterine size performed by the same surgeons using reabsorbable sutures during the same period were used as case controls. No febrile morbidity, cuff infections, thrombophlebitis, bladder injury, or hemorrhage complications were observed in the 10 women who entered the study. In summary, vaginal hysterectomy can be performed with Autosutures easily, probably faster with experience, and with less oozing from the operative field, thus providing a safe procedure.

Female↗
PubMed1993

Effects of oophorectomy and hormone replacement therapy on pituitary-gonadal function.

The purpose of this study was to determine how oophorectomy and different hormone replacement therapy (HRT) regimens using low doses of medroxyprogesterone acetate (MPA, 2.5 mg/day) influence the pituitary-gonadal axis function. Ninety (90) women, who had had regular menses prior to surgery, completed a 1-year follow-up period. Patients were assigned to 5 groups. The first (n = 16) received 0.625 mg/day conjugated equine oestrogens (CEE) cyclically, the second (n = 20) 50 micrograms day transdermal oestradiol (E2) cyclically and the third (n = 15) 0.625 mg/day CEE continuously. These 3 groups also received 2.5 mg MPA sequentially for the last 12 days of HRT administration. The fourth group (n = 20) received 0.625 mg/day CEE and 2.5 mg/day of MPA continuously, while the fifth (n = 19) constituted a control group. After oophorectomy all patients showed increases in follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, and decreases in those of E2, oestrone (E1), prolactin (PRL), sex-hormone-binding globulin (SHBG), androstenedione (delta A4) and testosterone (T). No changes were detected in dehydroepiandrosterone sulphate (DHEA-S) levels. After HRT, decreases in FSH, LH and PRL levels and increases in those of E2, E1 and SHBG were observed, but no changes were seen in T, delta A4 or DHEA-S plasma levels. As the differences that were found cannot be attributed to the presence of ovaries, it is reasonable to assume that they were perhaps due to the treatment. All these changes, with the exception of a decrease in PRL levels, are therefore to be expected after HRT.

Estradiol↗
PubMed1993

Effects of oophorectomy and hormone replacement therapy on plasma lipids.

The aim of this study was to determine the effects on plasma lipids and lipoproteins of oophorectomy and various hormone replacement therapy (HRT) delivery systems using low doses of medroxyprogesterone acetate (MPA, 2.5 mg/day). A total of 90 women completed the 1-year follow-up period. Patients were randomly assigned to five groups. The first (n = 16) received 0.625 mg/day conjugated equine oestrogens (CEE) cyclically, the second (n = 20) 50 micrograms/day transdermal oestradiol cyclically and the third (n = 15) 0.625 mg/day CEE continuously. These three groups also received 2.5 mg MPA sequentially for the last 12 days of HRT administration. The fourth group (n = 20) received 0.625 mg/day CEE and 2.5 mg/day MPA continuously, while the fifth (n = 19) constituted a treatment-free control group. After oophorectomy patients showed increases in low-density lipoprotein (LDL), apolipoprotein B and the atherogenic index, whereas after HRT patients exhibited falls in plasma LDL, apolipoprotein B and the atherogenic index and increases in high-density lipoprotein (HDL) and apolipoprotein A1. No significant changes in total cholesterol were observed after surgery or treatment and decreased levels of triglycerides were detected only in the transdermal treatment group.

Apolipoproteins↗
PubMed1993

Bone mineral density in surgically postmenopausal women receiving hormonal replacement therapy as assessed by dual photon absorptiometry.

A total of 118 postmenopausal women who had undergone hysterectomy and bilateral oophorectomy were invited to participate in this study. Patients were randomly allocated to one of four study groups which received, respectively, conjugated equine oestrogens (CEE) 0.625 mg/day over a 25-day cycle each month (n = 28); transdermal 17 beta-oestradiol 50 micrograms/day over a 24-day cycle each month (n = 28), CEE 0.625 mg/day every day of the month (n = 32) and no treatment the control group (n = 30). All the treated patients also received 2.5 mg/day medroxyprogesterone acetate sequentially for the last 12 days of each cycle. Dual photon absorptiometry was performed before therapy commenced and repeated after 1 year in all four groups. The three therapeutic regimens induced increases in bone mass, whereas a significant decrease was observed in the control group (P < 0.05).

Absorptiometry, Photon↗
PubMed1992

The effect of hormone replacement therapy on postmenopausal bone loss.

Eighty-four postmenopausal women who were randomly allocated to one of four groups, completed a 1 year follow-up. The first group (n = 20) received 0.625 mg/day conjugated estrogens cyclically (CE; 25 days/month). The second (n = 23) received 0.625 mg/day of CE continuously, and the third (n = 17) received 50 micrograms/day of transdermal 17 beta-estradiol cyclically (24 days/month). All these groups also received 2.5 mg of medroxiprogesterone acetate sequentially for the last 12 days of hormone replacement therapy, while the fourth group (n = 24) constituted a treatment-free control group. Dual photon absorptiometry was carried out before therapy and was repeated after 1 year. Serum calcium, phosphate and osteocalcine levels, and the urinary calcium/creatinine and hydroxyproline/creatinine ratios, were measured prior to treatment and 6 and 12 months thereafter. All treatment groups showed an increase in bone mineral content. This increase was higher in the continuous CE treatment group (4.4%, P less than 0.05) and in transdermal group (7.1%, P less than 0.01). Concomitant biochemical effects at 6 and 12 months, reduction in urine calcium and hydroxyproline, reduction in blood calcium, phosphate and osteocalcine, were compatible with the observed effects on bone mineral.

Bone Density↗
PubMed1992

Hormone replacement therapy and changes on pituitary function.

The aim of this study is to know how the pituitary function is affected by several delivery systems of estrogen replacement therapy. 116 menopausal women (54 natural and 62 surgical) were placed into three groups that received replacement therapy and in one control group. We determined prolactine (PRL), gonadotropins and 17 beta-estradiol (E2). We found a decrease in gonadotropin levels in treated patients with a natural menopause, and an increase in gonadotropin levels in the groups treated with conjugated estrogens in surgical menopausal women. 17 beta-E2 was found to be increased in all treated groups, mainly in the continuous therapy group (P less than 0.05). PRL was found to be decreased in patients treated with conjugated estrogens (oophorectomized and not oophorectomized) (P less than 0.05). Although these differences can not be attributed to the presence of the ovaries, we think that they may be the result of the treatment.

Adult↗
PubMed1992

Skin collagen changes related to age and hormone replacement therapy.

A total of 76 nulliparous women who had been hospitalized for minor operations, classified according to age group (by decade from 20s to 60s) and 118 postmenopausal women randomly allocated to one of four groups were studied. In all, 312 skin biopsies were taken from the lower abdomen at 0 and 12 months and the skin collagen changes noted. Collagen content decreased significantly with age beyond the 40s (P < 0.001) and after the menopause (P < 0.01). The decrease was preventable by the use of hormone replacement therapy. All the therapeutic regimens induced increases in skin collagen content, whereas in the control group a significant decrease was observed (P < 0.05).

Adult↗
PubMedDate not supplied

Changes in body mass index around menopause: a population study of Chilean woman.

OBJECTIVE: To evaluate the influence of menopause and hormone replacement therapy (HRT) on weight and the effect of weight gain on coronary risk factors. DESIGN: From 1991 to 1992 cardiovascular risk factors were assessed in 271 premenopausal women between the ages of 40 and 53 years. The women were not receiving HRT at that time. Five years later, these women were reevaluated. RESULTS: Weight and body mass index (BMI) increased steadily with age. During the observation period there was an average increase of 4.0 kg +/- 4.6 (p < 0.0001). Women who experienced menopause and those who did not experience menopause had a similar weight increase (3.8 +/- 4.4 kg vs. 4.3 +/- 4.8, p = 0.37). Likewise, weight gain was similar in those who did or did not use HRT (nonusers, 4.3 +/- 4.6 kg; users, 3.5 +/- 3.7 kg; ex-users, 3.4 +/- 5.8 kg). At their first checkups, overweight women and obese women already had significant differences in their risk factors, including higher systolic pressure (p < 0.02), diastolic pressure (p < 0.01), glucose (p < 0.02) and triglycerides (p < 0.0001), and lower high-density lipoprotein cholesterol (p < 0.004) as compared with women of normal weight. Unexpectedly, women of normal weight who became overweight or obese during the monitoring period did not show any deterioration in their risk factors. CONCLUSIONS: During the perimenopausal period there is a weight gain that does not seem to depend on the menopause or HRT. Being overweight or obese during the menopausal transition is not necessarily associated with deterioration in coronary risk factors. This seems to imply the existence of different metabolic populations within this group of women.

Adult↗