1. Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin.
   
2. Six-month treatment with low-dose dexamethasone further reduces androgen levels in PCOS women treated with diet and lifestyle advice, and metformin.
   

Gynaecology

3. Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography.
   

Gynaecologic oncology

4. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer
   

1. Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin.

The controlled clinical study in twenty-nine patients with PCOS was performed to determine the clinical, hormonal, and biochemical effects of metformin therapy in obese and nonobese patients with polycystic ovary syndrome (PCOS).Patients were treated with 500 mg of p.o. metformin t.i.d. for 6 months. Clinical data as well as serum concentrations of sex steroids, sex hormone-binding globulin (SHBG), gonadotropins, leptin, GH, lipids, insulin, and glucose levels were assessed before and after treatment. In the metformin group of nonobese patients, the mean fasting serum insulin concentration decreased from a pretreatment value of 12.1 +/- 2.4 to 6.3 +/- 0.6 microU/mL after treatment, and the area under the curve of insulin decreased from 5,189.1 +/- 517.4 to 3,035.6 +/- 208.9 microU/mL per minute. Also in the metformin group of nonobese patients, the mean basal serum total testosterone, free testosterone, and androstenedione concentrations decreased by 38%, 58%, and 30%, respectively. In the obese patients treated with metformin, only free testosterone showed a statistically significant decrease (1.7 +/- 0.2). These data suggest that nonobese patients respond better than obese patients to a 1.5 g/day metformin regimen.

Reference

Maciel GA, Soares Junior JM, Alves da Motta EL, Abi Haidar M, de Lima GR, Baracat EC. Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin. Fertil Steril. 2004 Feb;81(2):355-60.

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2. Six-month treatment with low-dose dexamethasone further reduces androgen levels in PCOS women treated with diet and lifestyle advice, and metformin.

The purpose of this study was to investigate the effect of low-dose dexamethasone on androgen levels in women with polycystic ovary syndrome (PCOS) treated with diet and lifestyle counselling, and metformin. A prospective, randomized, double blind, placebo-controlled study was carried out. Thirty-eight women with PCOS were randomized to either dexamethasone 0.25 mg daily or placebo for 26 weeks. All received diet and lifestyle counselling at inclusion and metformin 850 mg three times daily during the whole study. Main outcome measures were: androgen levels, body mass index (BMI), insulin c-peptide, fasting glucose and serum lipids. Two-tailed t-tests and Pearson's statistics were used. Compared with the placebo, dexamethasone reduced testosterone by 27%, androstenedione by 21%, dehydroepiandrosterone sulphate by 46% and free testosterone index by 50% in women with PCOS treated with diet and lifestyle advice, and metformin. BMI, fasting glucose, insulin c-peptide and serum lipid levels were unaffected. The data show that six-month, low-dose dexamethasone treatment further reduces androgen levels in metformin-treated PCOS women.

Reference

Vanky E, Salvesen KA, Carlsen SM. Six-month treatment with low-dose dexamethasone further reduces androgen levels in PCOS women treated with diet and lifestyle advice, and metformin. Hum Reprod. 2004 Mar;19(3):529-33

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3. Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography.

The purpose of this study was to evaluate the impact of colorectal resection for endometriosis on symptoms and quality of life or on potential side effects. After magnetic resonance imaging and rectal endoscopic sonographic evaluations of symptomatic colorectal endometriosis, 27 consecutive women who underwent colorectal resection were included in this prospective study. They completed symptom questionnaires before and after the procedure. Linear pain scores for several gynecologic and digestive symptoms and impact on quality of life were recorded. The sensitivity and positive predictive value of magnetic resonance imaging and rectal endoscopic sonographic evaluation for the diagnosis of colorectal endometriosis were 92.6% and 100% and 89% and 100%, respectively. Nonmenstrual pelvic pain (P = .001), dysmenorrhea (P < .0001), dyspareunia (P = .0002), and pain on defecation (P < .005) were improved by colorectal resection. No correlation was found between symptom intensity and lesion size, as evaluated by magnetic resonance imaging, rectal endoscopic sonographic evaluation, or histologic examination of the surgical specimen. Respectively, the conditions of 14, 11, 0, and 2 women were cured, improved, unchanged, or worsened. Median overall pre- and postoperative quality-of-life scores were 9 (range, 4-10) and 0 (range, 0-10), respectively (P < .0001). It is concluded that colorectal resection for endometriosis appears to relieve some symptoms. However, women should be informed that some symptoms may persist and that there is a risk of urinary and digestive side effects.

Reference

Thomassin I, Bazot M, Detchev R, Barranger E, Cortez A, Darai E. Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography. Am J Obstet Gynecol. 2004 May;190(5):1264-71.

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4. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer.

In women 70 years of age or older who have early breast cancer, it is unclear whether lumpectomy plus tamoxifen is as effective as lumpectomy followed by tamoxifen plus radiation therapy. Between July 1994 and February 1999, 636 women were randomly assigned who were 70 years of age or older and who had clinical stage I (T1N0M0 according to the tumor-node-metastasis classification), estrogen-receptor-positive breast carcinoma treated by lumpectomy to receive tamoxifen plus radiation therapy (317 women) or tamoxifen alone (319 women). Primary end points were the time to local or regional recurrence, the frequency of mastectomy for recurrence, breast-cancer-specific survival, the time to distant metastasis, and overall survival. The only significant difference between the two groups was in the rate of local or regional recurrence at five years (1 percent in the group given tamoxifen plus irradiation and 4 percent in the group given tamoxifen alone, P<0.001). There were no significant differences between the two groups with regard to the rates of mastectomy for local recurrence, distant metastases, or five-year rates of overall survival (87 percent in the group given tamoxifen plus irradiation and 86 percent in the tamoxifen group, P=0.94). Assessment by physicians and patients of cosmetic results and adverse events uniformly rated tamoxifen plus irradiation inferior to tamoxifen alone. It is conclude that lumpectomy plus adjuvant therapy with tamoxifen alone is a realistic choice for the treatment of women 70 years of age or older who have early, estrogen-receptor-positive breast cancer.

Reference

Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, Wheeler J, Champion LA, Smith TJ, Smith BL, Shapiro C, Muss HB, Winer E, Hudis C, Wood W, Sugarbaker D, Henderson IC, Norton L; Cancer and Leukemia Group B; Radiation Therapy Oncology Group; Eastern Cooperative Oncology Group. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004 Sep 2;351(10):971-7.

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