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Biomedical subjects

S Rozenberg

Publications and source records attributed to S Rozenberg.

At least 37 records · Page 2Linked to original sources
PubMed2001

Is coasting effective for preventing ovarian hyperstimulation syndrome in patients receiving a gonadotropin-releasing hormone antagonist during an in vitro fertilization cycle?

OBJECTIVE: To report two cases of coasting during receipt of GnRH antagonists. DESIGN: Case report. SETTING: University hospital. PATIENT(S): One 27-year-old and one 28-year-old woman, both with risk factors for the ovarian hyperstimulation syndrome (OHSS). INTERVENTION(S): Two IVF treatments during which hMG treatment was stopped until E2 decreased to a safer level during receipt of GnRH antagonist. MAIN OUTCOME MEASURE(S): Development of OHSS and pregnancy. RESULT(S): Embryos were transferred in both women. Neither woman developed OHSS and one ongoing pregnancy was obtained. CONCLUSION(S): Coasting is feasible when a GnRH antagonist is used during IVF. Further studies are needed to evaluate its preventive role in OHSS.

Adult↗
PubMed2001

Constant estrogen, intermittent progestogen vs. continuous combined hormone replacement therapy: tolerability and effect on vasomotor symptoms.

OBJECTIVE: To compare the efficacy and tolerability of a novel oral constant estrogen plus intermittent progestogen hormone replacement therapy (HRT) regimen to a continuous combined HRT regimen in postmenopausal women. METHODS: Subjects were randomly assigned to receive treatment with either constant 17beta-estradiol (E2), 1 mg, plus intermittent norgestimate (NGM) 90 microg (3 days off, 3 days on) (n=221) or E2 2 mg/norethisterone acetate (NETA) 1 mg (n=217) for 1 year. Treatments were evaluated based on the incidence of hot flushes and uterine bleeding. RESULTS: Both regimens had similar bleeding profiles and provided comparable vasomotor symptom relief. However, breast discomfort and edema were experienced by twice as many subjects who received E2/NETA. CONCLUSIONS: The constant E2/intermittent NGM regimen was well tolerated and possesses similar efficacy compared with a continuous combined E2/NETA regimen and may be considered whenever HRT without withdrawal bleeding is deemed appropriate.

Adult↗
PubMed2001

Clinical evidence supporting the rationale for constant oestrogen, intermittent progestogen hormone replacement therapy.

Hormone replacement therapy (HRT) effectively relieves vasomotor and other symptoms associated with menopause, yet is underutilised by the majority of menopausal women. Current HRT regimens combine continuous oestrogen with continuous or sequential progestogen in order to achieve the beneficial effects of oestrogen while avoiding the potential for increased risk of endometrial cancer. Uterine bleeding and other adverse progestogenic effects are major reasons for patient noncompliance and early discontinuation of combination HRT, which can ultimately limit the achievement of long-term oestrogenic benefits. A novel constant 17beta-oestradiol, intermittent norgestimate regimen has been developed based on theoretical hormone receptor dynamics in an attempt to minimise the hormonal doses needed, thereby potentially reducing the occurrence of adverse effects associated with higher oestrogen and progestogen doses. Clinical trial data with this novel low-dose HRT regimen demonstrate effective relief of vasomotor symptoms in postmenopausal women, acceptable bleeding rates, no endometrial hyperplasia, beneficial effects on lipids, and excellent tolerability. This regimen has the potential to increase long-term use resulting in important clinical benefits.

Animals↗
PubMed2001

"Fellow gynaecologists, help your patients stop smoking!".

BACKGROUND: Age-adjusted mortality from lung cancer in American women has increased dramatically and has even exceeded breast cancer mortality. Gynaecologists, are often involved as primary actors in prevention strategies but may not be aware of this epidemic. This is especially true in Europe where, lung cancer mortality for women is three times lower than in the US. OBJECTIVE: We aimed to investigate whether smoking data could explain the lower death rates found in Europe. METHOD: Analysis of smoking and mortality data in different European countries. RESULTS: European lung cancer mortality data shows a huge heterogeneity between countries (ranging from as low as 5/100,000 to 37/100,000). A strong correlation exists between the smoking prevalence in different countries, in women aged 55 years and more, and the mortality rates from lung cancer (R(2)=0.8; p<0.001). Smoking prevalence of younger women is much higher today than that of women over 55 years. CONCLUSION: These data strongly suggest that the epidemic of lung cancer will explode in Europe during the next decades. Gynaecologists should be aware of this and spend the necessary time to inform women adequately about the dangers of smoking and help them to quit.

Europe↗
PubMed2001

Effect of physicians opinion on patients' choice of treatment.

BACKGROUND: While it is obvious that patients should be involved in the decision making process, questions arise as to whether it is feasible to inform them objectively. OBJECTIVE: To assess the impact of the physician's opinion, on the choice of treatment, to the patient. SETTING: We imagined a hypothetical case of a 55-years-old woman with a high risk of osteoporosis. Two patient information letters were written, containing valid scientific information, but reflecting two diverging physicians' opinions, giving the choice between two available medications for osteoporosis prevention: hormone replacement therapy (HRT) and a selective estrogen receptor modulator (SERM), raloxifene. SUBJECTS: We submitted one of the letters (by lottery) to 58 nurses. They were asked to act as this potential patient, and to choose which treatment they preferred to have prescribed. RESULTS: 23/30 women receiving the version favouring the use of HRT, preferred HRT, 26/28 receiving the version favouring SERM preferred this treatment (Chi-Square Pearson 37.3; P<0.001). CONCLUSION: The content of the information provided and its wording have a great influence on the patients' decision.

Estrogen Replacement Therapy↗
PubMed2001

Forceful sacrococcygeal injections in the treatment of postdiscectomy sciatica. A controlled study versus glucocorticoid injections.

UNLABELLED: The role of epidural fibrosis in postoperative sciatica is unclear. Few therapeutic trials have been published. We evaluated the mechanical effects of forceful saline injections through the sacrococcygeal hiatus comparatively with glucocorticoid injections. PATIENTS AND METHODS: Forty-seven patients with postdiscectomy sciatica but no evidence of compression by computed tomography or magnetic resonance imaging were included in a multicenter, randomized, controlled, parallel-group study comparing forceful injections of saline (20 ml) with or without prednisolone acetate (125 mg) to epidural prednisolone acetate (125 mg) alone. Each of the three treatments was given once a month for three consecutive months. Outcome measures were pain severity on a visual analog scale (VAS) and the scores on the Dallas algofunctional self-questionnaire on day 0, day 60, and day 120. Analysis of variance for repeated measures and Student's t test for paired series were used to evaluate the data. RESULTS: Forty-seven patients were evaluated. The VAS score improved significantly between day 0 and day 30 in the glucocorticoid group as compared to the forceful injection group (P = 0.01). No other significant differences were found across the groups. The VAS score improved steadily in the forceful injection group, producing a nearly significant difference on day 120 as compared to baseline (P = 0.08). CONCLUSION: Forceful epidural injections produced a non-significant improvement in postdiscectomy sciatica four months after surgery. Epidural glucocorticoids used alone induced short-lived pain relief.

Adolescent↗
PubMed2001

Preventive attitude of physicians to avoid OHSS in IVF patients.

The ovarian hyperstimulation syndrome (OHSS) is a dramatic iatrogenic complication of fertility treatment. There is no consensus about its prevention strategies. We assessed whether physicians modify their preventive attitude in relation to clinical risk factors and to the oestradiol response chart. Three case scenarios with three levels of risk factors for OHSS were constructed. For each case scenario, four different charts of the oestradiol curve were described (peak serum oestradiol of 3590 or 6590 pg/ml obtained after a shorter or longer period). At random, we sent three out of the 12 artificially constructed case scenarios to 573 physicians who are members of the European Society of Human Reproduction and Embryology (ESHRE). They were asked whether they would cancel the cycle, take preventive measures or proceed to a regular IVF. A total of 389 cases from 130 different physicians was analysed. Globally, in 23% of the cases the physicians would proceed to a regular IVF. This decision varied significantly according to the risk level (between 38% in low risk to 8% in high risk cases; P < 0.01) and in relation to the oestradiol curve (P < 0.01). In 11% of the cases they would cancel the cycle and in 66% take some preventive measures. Among the selected preventive measures, coasting was by far the most popular choice (60%), followed by the use of i.v. albumin or hydroxyaethyl starch solution (36%) and cryo-preservation of all embryos (33%). In view of the sparse data as to whether coasting is really an effective method, and on how it should be carried out, we suggest that there is an urgent need to evaluate coasting as a preventive method in a large randomized trial in order to properly assess its efficiency and to provide precise guidelines for its use.

Attitude of Health Personnel↗
PubMed2001

Diagnostic value of ferritin and glycosylated ferritin in adult onset Still's disease.

OBJECTIVE: To determine the usefulness of serum ferritin and glycosylated ferritin (GF) levels in diagnosing adult onset Still's disease (AOSD). METHODS: We performed a retrospective multicenter study of 205 patients who had ferritin and GF assays in one hospital laboratory. Records of all patients were reviewed, and a standardized questionnaire used to extract all data available at the time of the assay. The clinicians' final diagnosis was also recorded. Patients were classified as having "certain AOSD" (based on Yamaguchi's criteria) or a control disease. The concordance of ferritin and GF levels with final diagnosis was evaluated. RESULTS: In total 49 AOSD and 120 control patients were eligible. The mean ferritin value was significantly higher in the AOSD group (4,752 +/- 9,599 microg/l) than in the control group (1,571 +/- 3,807 microg/l), p = 0.029. GF was significantly lower in AOSD patients (15.9 +/- 11.9%) than in the control group (31.5 +/- 18.7%), p < 0.001. The combination of a GF level of < or = 20% with ferritin above the upper limit of normal yielded a sensitivity of 70.5% and specificity of 83.2%. The combination of a GF level < or = 20% with ferritin 5 times normal produced a sensitivity of 43.2% and specificity of 92.9%. This latter combination allowed an AOSD diagnosis to be ruled out for 6 of the 8 control patients who met Yamaguchi's positive criteria. CONCLUSION: Ferritin and GF levels are powerful diagnostic markers of AOSD. They may be helpful in clinical practice for excluding differential diagnoses.

Adult↗
PubMed2000

Efficacy and tolerability of fully transdermal hormone replacement in sequential or continuous therapy at two doses of progestogen in postmenopausal women.

OBJECTIVES: Two randomized open-label studies were performed to evaluate fully transdermal hormone replacement therapy (HRT) with oestradiol (E2) and norethisterone acetate (NETA) in postmenopausal women. METHODS: Both hormones were delivered by transdermal matrix patches changed twice weekly. Subjects received E2, 50 microg/day and NETA, 170 microg/day or 350 microg/day, either continuously or sequentially. A one-year study (13 cycles of 28 days), including a reference regimen of transdermal E2 and sequential oral progestogen, was followed by a continuation study for a further year in 367 women. RESULTS: All regimens were highly and equally effective in the prevention of hot flushes. The fully transdermal regimens were associated with beneficial changes in the lipid profile. The sequential regimens provided effective scheduling of bleeding around the end of the progestogen phase. The continuous regimens were associated with irregular bleeding, which was rarely severe, and a gradually increasing incidence of amenorrhoea. With sequential or continuous therapy, bleeding was less severe at the lower dose of progestogen than at the higher dose. No endometrial hyperplasia was detected by biopsy in any treatment group. One serous endometrial carcinoma and one endometrial adenocarcinoma were detected. An endometrial thickness >5 mm did not predict the presence of hyperplasia at biopsy. Hormone-related adverse events were typical of those expected for HRT and dermal tolerability of the patches was good. CONCLUSIONS: Fully transdermal sequential or continuous HRT is effective and well tolerated in postmenopausal women. The lower dose of NETA may be preferable, because it confers adequate endometrial protection at a lower dose of progestogen.

Administration, Cutaneous↗
PubMed2000

[Local and general anti-inflammatory treatment of common low back pain].

Non-steroidal anti-inflammatory drugs are often prescribed with analgesics. They are proposed at the acute phase of low back pain or sciatica, or during flares of chronic back pain. Efficacy of NSAIDs have been demonstrated in acute back pain with randomised clinical trials. Efficacy is less clearly demonstrated in chronic back pain and sciatica. Local injections of steroids are required after failure of analgesics and NSAIDs, in patients with sciatica and chronic back pain. Different routes of injection are possible, depending of the symptoms and the mechanism of compression.

Acute Disease↗
PubMed2000

Estrogen replacement therapy in patients with endometrial cancer: prescription attitude of Belgian gynecologists.

BACKGROUND: Endometrial cancer is estrogen dependent and has been considered as a contraindication for HRT. Some uncontrolled studies reported no increase in recurrence in women who received ERT after they had suffered early stage endometrium cancer and many opinion leaders have mandated that early uterus cancer should not be considered as an absolute contraindication to HRT. AIM: We conducted a survey evaluating the prescription attitude of Belgian gynecologists (n=1363) towards a case describing a patient who presents indication for ERT (climacteric symptoms and osteoporosis) and a past history of early stage endometrium cancer. RESULTS: We obtained a 32% response rate. Overall, the physicians prescribed treatment in 67% of the cases. There was no difference in the prescription attitude in relation to gender or age of the physicians. Among the physicians who prescribed HRT, 49% stated that they would prescribe estrogen-only therapy (unopposed estrogens) and 27% would prescribe a combined estrogen-progestin therapy. CONCLUSION: Two out of three gynecologists, in Belgium, would accept, at least theoretically, to prescribe HRT to a woman with a history of early stage endometrial cancer, no signs of recurrence and recognized indications for HRT.

Attitude of Health Personnel↗
PubMed2000

Health perception by women who work in a medical environment.

A mail survey was sent to 1154 women working in a university hospital, to assess the perception of health and the uptake of prevention strategies in an optimal setting. A list of 13 diseases was submitted and the women were asked to list the five diseases they found to be the most important for a woman of their age. Breast cancer was ranked among the five most important diseases by 85% of the women and uterus cancer by 71.3%. Other diseases, which have a high occurrence and mortality, like myocardial infarction, colon- and lung cancer were only ranked by approximately 30% of them. A high uptake of medical follow-up was reported by the surveyed women; 89% of them had seen a general practitioner or a gynaecologist during the past 12 months. Among women aged 50 and over, 92% had had at least one mammography in the past. However, only 20% had ever had faecal occult blood testing. Even among women who benefit from superior conditions for medical follow-up, the awareness of some diseases is low. Campaigns to increase awareness should consider the prevalence of diseases, their mortality and morbidity and also their actual perception in the targeted population.

Adult↗
PubMed2000

[Involutional osteoporosis in women: therapeutic strategy. Recommendations of the Belgian Bone Club].

Osteoporosis is now considered as a major public health issue and a serious threat for the quality of life of elderly women. Several new compounds are currently marketed for the prevention and treatment of involutional osteoporosis in women. Therefore, it is important to offer to the practitioners pragmatic solutions to be used for the rational management of this disorder. This article is the result of a national consensus offering practical guidelines for the management of osteoporotic patients, based on the current published data.

Estrogen Antagonists↗