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Methotrexate in the therapy of symptomatic uterine leiomyomas
52
FC3.19.06 EFFECTS OF ESTROGEN REPLACEMENT ISOLATED AND ASSOCIATED WITH GESTRINONE IN OOPHORECTOMIZED ADULT RATS WITH EXPERIMENTAL ENDOMETRIOSIS VR Lobe; E Schor; EC Baracat; CE Lang; V Freitas; MJ SimBes; JM Soares Jr; G Rodrigues de Lima. Department of Gynecology Escola Paul&a de Medicina, Federal University of SBo Paula, SBo Paula, Brazil. Objective: The aim of this work was to analyze the effects of conjugated equine estrogens and gestrinone in oophorectomized adult rats previously submitted to endometrial implants. Study Methods: 50 adult female rats in which an endometrial implantation was made on the lateral abdominal wall. After four weeks a new laparotomy was achieved where implant sizes were measured, followed by bilateral oophorectomy. After six weeks, the animals were randomly divided into five groups: G I (n=lO) received 0,5 muday of propylenoglycol (control), GII (n=lO) received CEE (50 pgiday), GIII (n=lO) received CEE (25 pgiday), G IV (n = 10) received CEE (25 pgiday) associated with gestrinone (2,5 pgiday); GV (n = 10) received CEE (50 pgiday) associated with gestrinone (2,5 pgiday). All animals were daily treated for 21 consecutive days by subcutaneous route. After this period the animals were submitted to a new laparotomy and the implants were measured and resected for light microscopy analysis. Results: The results showed a meaningful growth of endometrial implants group GII, which presented as vesicles with clear liquid content. Light microscopy showed the presence of endometrial tissue containing stroma, glands and well-developed cysts. There was regression of implant in groups GI, GIII, GIV and GV, and its localization was possible only due to the presence of surgical material. Conclusion: Only 5Opg CEE promote growth of endometrial implants and gestrinone opposed the CEE effects.
FC3.19.07 METHOTREXATE IN THE THERAPY OF SYMmOMATIC UTERINE LEIOMYOMAS Aleksandar S. Arsenijevic, M. Brkic, S. Djukic-Dejanovic, Sazdanovic P. Clinic of Gynecology and Obstetrics, Clinical-HospitalCenter, Kragujevac, Yugoslavia Background: Abnormal bleeding occurs in about one third of patients with symptomatic uterine myoma. Estradiol increases a number of glandular mitosis in endometrium. Binding of thimidin in endometrium increases during follicular phase. Methotrexat is an antimetabolite drug that inhibits enzyme dihydrofolat-reductase. Due to that cells have a lack of reduced folan acids and therefore there is no possibility for synthesis of thimidin. The aim of this study is to evaluate effects of subendometrial methotrexat injections in perimenopausal women with sympthomatic myoma uteri, on menstrual bleeding and volume of myomas. Methods: Twenty premenopausal women with myoma uteri were analyzed. Methotrexat was applied as subendometrial injection in follicular phase, in dose of 5 mg/2ml per cycle during three menstrual cycles in total dose of 15 mg. The Pictorial Blood Loss Assessment Chart (PBAC) was used to assess the level of menstrual flow, before, through and after therapy. The volume of myoma before and after therapy was measured with Aloca 640 ultrasound. Results: Analysis of mean values of PBAC score before therapy and a second cycle showed a statistically significant decrease in menstrual flow (t=11.49, p
WEDNESDAY,
SEPTEMBER
6
FC3.19.08 THE EFFECT OF LONG-RELEASED LEVONOGESTREL ON BONE DENSITY OF REPRODUCTIVE WOMEN S. Reproductive Medical Center, National Research Institute for Family Planning, Beijing, China Objectives: The aim of the study was to evaluate the effect of longreleasing levonorgestrel only on the bone density and bone metabolism of reproductive women who used Implant type I, II and Norplant for three years. Study methods: Eight women who used LNG Implant and forty-three controls were recruited into the cross-section study. Except general states, calcium intake, movement and private habits, to compare the mean level of serum E2, biochemical indicators of bone metabolism: serum calcium (Ca), phosphate (P), alkaline phosphate (ALP) and osteocalcin (BGP); concentration of calcium (Ca), OH-praline (HYP) and cretonne (Cr); and the mean value of the bone density at middledistal forearm. Results: The mean levels of estrogen (E2) were lower at normal level in three groups and was no significant difference compared to the control group. The period formation of bone peak in all groups was 30-40 years old. There was no line-relationship between mean level E2 and BMD in three groups except control group. The changes of BMD. Ca/Cr and Hyp/Cr in women who used Norplant was suggested the bone absorption to be slight strengthens. Conclusions: Long-released LNG implant type I, II and Norplant for three years were no significant effect on BMD and other indicators of bone metabolism in women comparing with control. It was safe on bone metabolism in reproductive women.
FC3.20 OBSTETRICS:
LABOR
FC3.20.01 USING THE MEDICAL AUDlT TO IMPLEMENT GUIDELINES FOR INDUCTION OF LABOUR T.A. H. Mousa, C.K. Tan, Dept. OBIGYN, Forth Park Hospital, Kirkcaldy, Scotland, United Kindgom The incidence of induction of labor is steadily rising. Inappropriate use of prostaglandins can not only increase the risk of iatrogenic fetal distress but also of emergency cesarean delivery and therefore has been cited as an important contributing factor towards subclinical care. (CESDI 1997; Why Mothers Die, 1998.UK). Clinical guidelines facilitates implementation of evidence based practice. Objectives: The aim of this study was to determine whether implementation of guidelines for induction of labor could reduce induction to delivery interval. A “medical audit cycle” was used to demonstrate the delivery of a high quality evidence based health care. Study Methods: A retrospective audit of 380 consecutive case notes where labor had been induced in 1995 was carried out to identify inconsistencies in clinical management. New strategies for labor induction directed pre-induction cervical priming and use of low dosages of vaginal prostaglandins were developed and implemented. The effect was monitored prospectively during 1996, 1997, and 1998. Results were analyzed with X’ test. Results: A total of more than 2000 women were studied. They all had a viable singleton pregnancy, a cephalic presentation, no uterine scar and a gestational age greater than 37 weeks. They all had their labors induced. After management change, a significantly higher proportion of women had pre-induction cervical priming (change from 20% to 85%, p
FC3.19.06 EFFECTS OF ESTROGEN REPLACEMENT ISOLATED AND ASSOCIATED WITH GESTRINONE IN OOPHORECTOMIZED ADULT RATS WITH EXPERIMENTAL ENDOMETRIOSIS VR Lobe; E Schor; EC Baracat; CE Lang; V Freitas; MJ SimBes; JM Soares Jr; G Rodrigues de Lima. Department of Gynecology Escola Paul&a de Medicina, Federal University of SBo Paula, SBo Paula, Brazil. Objective: The aim of this work was to analyze the effects of conjugated equine estrogens and gestrinone in oophorectomized adult rats previously submitted to endometrial implants. Study Methods: 50 adult female rats in which an endometrial implantation was made on the lateral abdominal wall. After four weeks a new laparotomy was achieved where implant sizes were measured, followed by bilateral oophorectomy. After six weeks, the animals were randomly divided into five groups: G I (n=lO) received 0,5 muday of propylenoglycol (control), GII (n=lO) received CEE (50 pgiday), GIII (n=lO) received CEE (25 pgiday), G IV (n = 10) received CEE (25 pgiday) associated with gestrinone (2,5 pgiday); GV (n = 10) received CEE (50 pgiday) associated with gestrinone (2,5 pgiday). All animals were daily treated for 21 consecutive days by subcutaneous route. After this period the animals were submitted to a new laparotomy and the implants were measured and resected for light microscopy analysis. Results: The results showed a meaningful growth of endometrial implants group GII, which presented as vesicles with clear liquid content. Light microscopy showed the presence of endometrial tissue containing stroma, glands and well-developed cysts. There was regression of implant in groups GI, GIII, GIV and GV, and its localization was possible only due to the presence of surgical material. Conclusion: Only 5Opg CEE promote growth of endometrial implants and gestrinone opposed the CEE effects.
FC3.19.07 METHOTREXATE IN THE THERAPY OF SYMmOMATIC UTERINE LEIOMYOMAS Aleksandar S. Arsenijevic, M. Brkic, S. Djukic-Dejanovic, Sazdanovic P. Clinic of Gynecology and Obstetrics, Clinical-HospitalCenter, Kragujevac, Yugoslavia Background: Abnormal bleeding occurs in about one third of patients with symptomatic uterine myoma. Estradiol increases a number of glandular mitosis in endometrium. Binding of thimidin in endometrium increases during follicular phase. Methotrexat is an antimetabolite drug that inhibits enzyme dihydrofolat-reductase. Due to that cells have a lack of reduced folan acids and therefore there is no possibility for synthesis of thimidin. The aim of this study is to evaluate effects of subendometrial methotrexat injections in perimenopausal women with sympthomatic myoma uteri, on menstrual bleeding and volume of myomas. Methods: Twenty premenopausal women with myoma uteri were analyzed. Methotrexat was applied as subendometrial injection in follicular phase, in dose of 5 mg/2ml per cycle during three menstrual cycles in total dose of 15 mg. The Pictorial Blood Loss Assessment Chart (PBAC) was used to assess the level of menstrual flow, before, through and after therapy. The volume of myoma before and after therapy was measured with Aloca 640 ultrasound. Results: Analysis of mean values of PBAC score before therapy and a second cycle showed a statistically significant decrease in menstrual flow (t=11.49, p
WEDNESDAY,
SEPTEMBER
6
FC3.19.08 THE EFFECT OF LONG-RELEASED LEVONOGESTREL ON BONE DENSITY OF REPRODUCTIVE WOMEN S. Reproductive Medical Center, National Research Institute for Family Planning, Beijing, China Objectives: The aim of the study was to evaluate the effect of longreleasing levonorgestrel only on the bone density and bone metabolism of reproductive women who used Implant type I, II and Norplant for three years. Study methods: Eight women who used LNG Implant and forty-three controls were recruited into the cross-section study. Except general states, calcium intake, movement and private habits, to compare the mean level of serum E2, biochemical indicators of bone metabolism: serum calcium (Ca), phosphate (P), alkaline phosphate (ALP) and osteocalcin (BGP); concentration of calcium (Ca), OH-praline (HYP) and cretonne (Cr); and the mean value of the bone density at middledistal forearm. Results: The mean levels of estrogen (E2) were lower at normal level in three groups and was no significant difference compared to the control group. The period formation of bone peak in all groups was 30-40 years old. There was no line-relationship between mean level E2 and BMD in three groups except control group. The changes of BMD. Ca/Cr and Hyp/Cr in women who used Norplant was suggested the bone absorption to be slight strengthens. Conclusions: Long-released LNG implant type I, II and Norplant for three years were no significant effect on BMD and other indicators of bone metabolism in women comparing with control. It was safe on bone metabolism in reproductive women.
FC3.20 OBSTETRICS:
LABOR
FC3.20.01 USING THE MEDICAL AUDlT TO IMPLEMENT GUIDELINES FOR INDUCTION OF LABOUR T.A. H. Mousa, C.K. Tan, Dept. OBIGYN, Forth Park Hospital, Kirkcaldy, Scotland, United Kindgom The incidence of induction of labor is steadily rising. Inappropriate use of prostaglandins can not only increase the risk of iatrogenic fetal distress but also of emergency cesarean delivery and therefore has been cited as an important contributing factor towards subclinical care. (CESDI 1997; Why Mothers Die, 1998.UK). Clinical guidelines facilitates implementation of evidence based practice. Objectives: The aim of this study was to determine whether implementation of guidelines for induction of labor could reduce induction to delivery interval. A “medical audit cycle” was used to demonstrate the delivery of a high quality evidence based health care. Study Methods: A retrospective audit of 380 consecutive case notes where labor had been induced in 1995 was carried out to identify inconsistencies in clinical management. New strategies for labor induction directed pre-induction cervical priming and use of low dosages of vaginal prostaglandins were developed and implemented. The effect was monitored prospectively during 1996, 1997, and 1998. Results were analyzed with X’ test. Results: A total of more than 2000 women were studied. They all had a viable singleton pregnancy, a cephalic presentation, no uterine scar and a gestational age greater than 37 weeks. They all had their labors induced. After management change, a significantly higher proportion of women had pre-induction cervical priming (change from 20% to 85%, p