Kyung Koo Han

Benefits of soy isoflavone therapeutic regimen on menopausal symptoms

OBJECTIVE To examine the change in menopausal symptoms and cardiovascular risk factors in response to 4 months of daily 100‐mg soy isoflavone in postmenopausal women. METHODS In this double‐blind, placebo‐controlled study, 80 women were randomly assigned to isoflavone (n = 40) and placebo (n = 40) treatment. The menopausal Kupperman index was used to assess change in menopausal symptoms at baseline and after 4 months of treatment. Cardiovascular risk factors were assessed by evaluating plasma lipid levels, body mass index, blood pressure, and glucose levels in the participants. To examine the effects of this regime on endogenous hormone levels, follicle‐stimulating hormone (FSH), luteinizing hormone (LH), and 17β‐estradiol were measured. Transvaginal sonography was performed to quantify endometrial thickness. RESULTS The data showed a decrease in menopausal symptoms (P < .01, paired t test, two‐tailed, between baseline and isoflavone groups, and P < .01, unpaired t test, between placebo and isoflavone groups). Total cholesterol and low‐density lipoprotein decreased significantly in the isoflavone group compared with the baseline or placebo group (P < .001, paired t test, two‐tailed, between baseline and isoflavone groups, and P < .01, unpaired t test, between placebo and isoflavone groups). The isoflavone treatment appeared to have no effect on blood pressure, plasma glucose, and high‐density lipoprotein and triglyceride levels. CONCLUSION This study suggests that isoflavone 100‐mg regime treatment may be a safe and effective alternative therapy for menopausal symptoms and may offer a benefit to the cardiovascular system.

Tubal patency after clinical treatment of unruptured ectopic pregnancy

To evaluate tubal patency using hysterosalpingography after clinical treatment of tubal pregnancy.

Values of β-human chorionic gonadotropin as a risk factor for tubal obstruction after tubal pregnancy

Aim.  The hysterosalpingography (HSG) was evaluated after the clinical treatment of tubal pregnancy and the possible risk of tubal obstruction through the following parameters: β‐human chorionic gonadotropin (β‐hCG) levels, size of the adnexal mass, aspects of the image at ultrasound, and color Doppler.

Endometrial thickness as an orienting factor for the medical treatment of unruptured tubal pregnancy.

Objectives.  To evaluate the efficacy of the endometrial thickness measurement through transvaginal ultrasound as an orienting factor for the medical treatment of unruptured tubal pregnancy with a single dose of methotrexate in order to select the best cases for the medical treatment.

Efeitos dos fitoestrogênios sobre alguns parâmetros clínicos e laboratoriais no climatério

Purpose: to evaluate the estrogenic effects of soy phytoestrogens in postmenopausal patients. Method: we selected postmenopausal patients from the Climacteric Service of the Gynecology Department of the Federal University of Sao Paulo - Escola Paulista de Medicina. The patients were divided into two groups: GI (n=40) received daily 100 mg isoflavone (3 x 33.3 mg/day); and GCtr (n=40) received daily placebo. We included in this study the Kuppermann menopausal index, physical examination and the biochemical determination of total and fractions of cholesterol, triglycerides, estradiol, FSH e LH. We also performed sonographic examination to measure endometrial thickness. To compare baseline and after treatment values of both groups, the nonparametric Kruskal-Wallis test was used for the Kuppermann index, while the t test was performed for other data. Results: evaluation of the Kupperman Menopausal Index, 80% patients of GI showed a decrease in the total score, while the improvement of symptoms in GCtr was 12,5%. The analysis of total cholesterol levels showed that 35 patients of GI had levels above 200 mg/dL, and only 13 of GCtr presented similar levels. The body mass index reduction occurred in GI and the control group showed no changes. We also verified that echo endometrial thickness and FSH levels were similar to baseline values. However the values of estrogen increased after isoflavone treatment. Conclusion: we concluded that 100 mg/day isoflavone may be an alternative treatment for attenuating the climacteric symptoms in 80% of isoflavone users and that it reduced total cholesterol.

Tubal patency following surgical and clinical treatment of ectopic pregnancy

CONTEXT AND OBJECTIVE As there is little information about fertility outcomes among women following clinical treatment (methotrexate and expectant management) and surgery (salpingectomy) consequent to ectopic pregnancy, we evaluate the results from hysterosalpingography subsequent to treatment. The objective was to evaluate contralateral tubal patency using hysterosalpingography following surgery and clinical treatment of tubal pregnancy. DESIGN AND SETTING This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHOD Among 115 patients who underwent hysterosalpingography following surgery and clinical treatment of tubal pregnancy between April 1994 and February 2002, 30 were treated with a single intramuscular dose of methotrexate (50 mg/m(2)), 50 were followed up expectantly and 35 underwent salpingectomy. RESULTS The patency of the ipsilateral tube was 84% after methotrexate treatment and 78% after expectant management. In addition, contralateral tubal patency was 97% after methotrexate treatment, 92% after expectant management and 83% after salpingectomy. There were no statistically significant differences between the clinical treatment and surgery groups. CONCLUSIONS The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management.

Espessura Endometrial como Fator Orientador do Tratamento Clínico da Gravidez Tubária Íntegra

Purpose: to evaluate the importance of endometrial thickness measurement as an orienting factor for the clinical treatment of unruptured tubal pregnancy. Method: longitudinal observational study, in which the greatest measure of the endometrial thickness was evaluated in millimeters, in the uterine longitudinal axis, through transvaginal ultrasonography. Our study group included 181 patients, all of them respecting the utilization criteria for the clinical treatment (expectant or medicated with methotrexate). Through Students t test we evaluated the difference between the average thickness of the cases who presented successful results with the treatment and the average of those who failed. Results: the average endometrial thickness of the patients who presented successful results with the medical treatment (31 cases) was 6.4 mm, while the average in the cases of failure was 11.5 mm. These results were significantly different. The average thickness of the successful group with expectant management (128 cases) was 9.0 mm, while the average of those who failed was 9.6 mm. These values were not statistically different. Conclusions: the greatest measure of the endometrial thickness of the uterine longitudinal axis through transvaginal ultrasonography proved to be valuable as a new orienting factor for the medical treatment of patients with a diagnosis of unruptured tubal pregnancy. It may become a useful and auxiliary tool for the recommendation of the use of methotrexate. On the other hand, thickness did not show to be useful as an orienting factor for establishing expectant management.