Sakip Pekin

Comparison of the efficacy of spironolactone versus flutamide in the treatment of hirsutism

OBJECTIVE To compare the efficacy of two antiandrogens, spironolactone and flutamide, in the treatment of hirsutism. PATIENTS, PARTICIPANTS Twenty women with idiopathic hirsutism were randomized to receive either flutamide or spironolactone. DESIGN Twenty hirsute women were recruited from patients presenting to the hirsutism clinic in Marmara University, Istanbul. Each patient underwent a complete medical and gynecological examination as well as endocrine profile, hematologic, hepatic, and renal function analyses. Hirsutism scores were determined according to the Ferriman-Gallwey scoring system. These tests were then repeated at 3, 6, and 9 months of therapy. Ten patients received 250 mg of flutamide two times per day, and 10 patients received 100 mg of spironolactone for 9 months. RESULTS Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in flutamide and spironolactone group were as follows: 26.4% and 20.9% at 3 months; 39.5% and 32.9% at 6 months; and 46.4% and 39.6% at 9 months, respectively. There was a trend toward a better response with flutamide that did not achieve significance. None of the hormonal parameters changed significantly during this period of time. Irregular bleeding was observed in five patients (50%) of the spironolactone group, whereas none of the patients in the flutamide group experienced menstrual irregularity. Conversely, dry skin and increased appetite were experienced by two patients (20%) in the flutamide group but not in the spironolactone group. CONCLUSION These data suggest that both spironolactone and flutamide were similarly effective in treatment of hirsutism, and the pure antiandrogen flutamide is a safe and effective alternative in treatment.

Comparison of spironolactone-oral contraceptive versus cyproterone acetate-estrogen regimens in the treatment of hirsutism.

OBJECTIVE To compare the efficacy of two antiandrogens, cyproterone acetate (CPA) and spironolactone, in the treatment of hirsutism. DESIGN Prospective randomized single-blinded study. SETTING A tertiary hirsutism clinic. PATIENTS Forty-two premenopausal patients with hirsutism were selected. INTERVENTIONS Subjects were randomized to receive either 100 mg spironolactone and an oral contraceptive (OC) containing 150 microg desogestrel and 30 microg ethinyl E2 or 50 mg CPA daily on days 1 to 10 of the menstrual cycle, which was administered with 35 microg ethinyl E2 daily on days 1 to 21. MAIN OUTCOME MEASURES Hirsutism scores were measured according to Ferriman-Gallwey scoring system and side effects were monitored for 9 months of treatment. Blood samples were taken at each visit for assessment of endocrine, biochemical, and hematologic parameters. RESULTS Hirsutism scores were decreaded significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in CPA and spironolactone group were as follows: 19.23% +/- 14.77% and 24.48% +/- 14.27% at 3 months; 39.01% +/- 19.77% and 37.46% +/- 16.90% at 6 months; and 51.89% +/- 20.87% and 46.39% +/- 16.10% at 9 months, respectively. There was a trend toward a better response with CPA treatment, which did not achieve significance. None of the patients stopped treatment because of side effects. CONCLUSION The present data suggest that both spironolactone and CPA were similarly effective in treatment of hirsutism.

Combination of Vaginal Ultrasonography and Pipelle Sampling in the Diagnosis of Endometrial Disease

In this article, we aimed to investigate the value of Pipelle endometrial sampling with and without sonographic measurement of endometrial thickness in the diagnosis of endometrial disease. We studied prospectively 78 patients scheduled for dilatation and curettage in order to evaluate abnormal uterine bleeding. Sonographic measurement of the endometrial thickness and endometrial sampling with the Pipelle were performed before the curettage. The accuracy of ultrasonography and the Pipelle sampling was measured against the final diagnosis. In 68 cases (87.1%), the endometrial histological results of curettage agreed with those of the Pipelle sampling. Pipelle endometrial sampling had a sensitivity of 73% and a specificity of 100% for endometrial disease. The use of ultrasonography increased the sensitivity of the Pipelle aspiration from 73% to 90%.

Comparison of the impact of oral versus transdermal estrogen on serum lipoproteins

In an attempt to compare the effects of transdermal and oral conjugated estrogen on serum lipoproteins, 35 premenopausal women who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy were randomized to receive either 0.625 mg of conjugated oral estrogen or 0.05 mg transdermal 17 beta-E2 during the first postoperative year. Lipid profiles were assessed before surgery and at 3, 6, 9, and 12 months of therapy in each subject. Neither oral nor transdermal estrogen replacement therapy produced significant changes on serum lipoproteins at the end of first year when compared with baseline preoperative values. We conclude that both transdermal and oral administration of estrogen are promising in the maintenance of premenopausal lipid values after menopause.

A Randomized Comparison of the 3 Papanicolaou Smear Collection Methods

Summary: The purpose of this study was to compare the effectiveness of 3 cervical smear sampling devices for obtaining acceptable yields of endocervical cells in Papanicolaou smears. In a randomized, controlled clinical trial, we collected 346 smears over a 6‐month period, 110 with the Cervex brush, 125 with the cotton swab plus Ayre spatula and 111 with the Cytobrush plus Ayre spatula. The Cytopathology Laboratory, blinded to the Papanicolaou smear method, screened the smears using the Bethesda system guidelines. Statistical analyses were performed using the Pearson X2 and analysis of variance tests. There was an increased detection of endocervical cells in the Cytobrush plus Ayre spatula and the Cervex brush methods, compared with the cotton swab plus Ayre spatula group (p=2.39 × 10‐6, p=4.49 × 10‐7 respectively). There was no statistically significant difference between the Cytobrush‐spatula and Cervex brush groups (p=0.0779). We concluded that the Cytobrush‐Ayre spatula and the Cervex brush sampling methods were equally effective in obtaining endocervical cells in Papanicolaou smears.

The effect of tamoxifen on the endometrium, serum lipids and hypothalamus pituitary axis in the postmenopausal breast cancer patients

Background. There is still no cost‐effective endometrial screening method for asymptomatic postmenopausal breast cancer patients using tamoxifen. We investigated the effectivity of transvaginal ultrasonography and endometrial sampling as a screening method for asymptomatic patients. Additionally the effect of tamoxifen on hypothalamus‐pituitary axis and serum lipid profiles were investigated.

Combination of Endometrial Thickness and Pipelle Sampling in the Diagnosis of Endometrial Disease in Postmenopausal Women

In this article, we evaluate the value of the combined use of vaginal sonography and endometrial sampling for the diagnosis of endometrial disease in postmenopausal women. Fifty-three postmenopausal w