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Biomedical subjects

M M Gelfand

Publications and source records attributed to M M Gelfand.

At least 19 recordsLinked to original sources
PubMed2002

Endometrial safety and bleeding patterns during a 2-year study of 1 or 2 mg 17 beta-estradiol combined with sequential 5-20 mg dydrogesterone.

OBJECTIVE: To assess the endometrial safety and bleeding patterns of 17 beta-estradiol sequentially combined with dydrogesterone. METHODS: Endometrial safety and bleeding patterns were assessed in 579 postmenopausal women randomized to oral treatment with placebo, 1 mg/day 17 beta-estradiol sequentially combined with 5 or 10 mg/day dydrogesterone for the last 14 days of each 28-day cycle, or 2 mg/day 17 beta-estradiol sequentially combined with 10 or 20 mg/day dydrogesterone for the last 14 days of each 28-day cycle. Treatment was continued for 26 cycles. Proliferative endometrium, endometrial hyperplasia and endometrial malignancy in the end-of-study biopsy were considered as inadequate progestational responses. RESULTS: Biopsies were not available in 137 women mainly because of an insufficient treatment period or non-compliance. An adequate progestational response was seen in more than 98% of the 442 women who underwent biopsy after treatment. Bleeding data were not available in 193 women, most of whom did not remain on treatment for the full 26 cycles. The 1-mg 17 beta-estradiol dose was associated with less cyclic and intermittent bleeding than the 2-mg dose. Higher doses of dydrogesterone were associated with a higher incidence of cyclic bleeds and a later day of onset, while duration, severity and regularity were similar in all groups irrespective of estradiol or dydrogesterone dose. CONCLUSION: Sequential combinations of 1 mg 17 beta-estradiol with 5 or 10 mg dydrogesterone and 2 mg 17 beta-estradiol with 10 or 20 mg dydrogesterone are associated with very good endometrial safety. The incidence of bleeding is lower with the 1-mg dose of 17 beta-estradiol.

Aged↗
PubMed2000

Sexuality among older women.

The population of the world is living longer. Currently, the average life expectancy is 78.9 and 72 years of age for women and men, respectively. By the year 2030, it is estimated that elderly people will make up approximately 17% of the total United States population. Our responsibility as physicians is, therefore, very clear. The care of this population must provide an acceptable quality of life and allow elderly people to enjoy living. This is where the question of sexuality plays an important part. Hormonal transition encompasses decreased levels of estrogen and testosterone, the latter being associated with decreased sexual libido, sensitivity, and response. Additional genitourinary effects associated with menopause include atrophic changes in the vagina, vulva, urethra, and neck of the bladder. Vaginal atrophy and diminished vaginal lubrication interfere mechanically with sexual comfort and pleasure. In addition to hormonal changes with aging, disease and associated medications may also negatively affect sexuality. Determining the impact of medications, both alone and in combination with others, on quality of life must be considered when providing comprehensive care for elderly patients.

Adolescent↗
PubMed1999

Role of androgens in surgical menopause.

For the patient who has had her ovaries and uterus removed, the acute onset of surgical menopause is of primary concern during the immediate postoperative period. The initiation of hormone replacement therapy at this time eliminates most symptoms that result from the abrupt onset of menopause. Thus the patient can deal with the side effects from her operation without the added burden caused by the physiologic changes from the loss of her gonadal hormones. Most patients who undergo surgical menopause (total abdominal hysterectomy with bilateral salpingo-oophorectomy) at the McGill University Menopause Clinic receive estrogen-androgen replacement therapy in the recovery room. This occurs provided that the diagnosis is not cancer of the uterus and there are no other serious contraindications to hormone replacement therapy. Vasomotor flushes are almost entirely eliminated with estrogen-androgen replacement therapy. In addition, the androgen component of this regimen provides an increased healing effect because of its anabolic property. After 6 months we discuss whether estrogen-androgen replacement therapy should be continued or the therapy should be changed to estrogen replacement therapy only. Sexual desire and arousal, well-being, and energy level are enhanced by the addition of androgen. Side effects such as mild hirsutism are dose related and can be managed easily by dose reduction. Treatment with estrogen-androgen replacement therapy may be continued indefinitely if guidelines are followed and the patient is satisfied.

Androgens↗
PubMed1997

Human papillomavirus infection in postmenopausal women with and without hormone therapy.

OBJECTIVE: To determine whether postmenopausal hormone therapy is associated with high-risk human papillomavirus (HPV) infection. METHODS: The detection rate of HPV DNA was studied in cellular residue from liquid-based collection tubes taken from 180 postmenopausal hormone users attending a menopausal clinic and 126 postmenopausal nonusers. The samples were analyzed with a hybrid capture technique using a mix of high- to intermediate-risk viral RNA probes. In all patients, information on potential confounding factors for HPV infection, including sociodemographic, reproductive, and gynecologic characteristics, was obtained. RESULTS: The prevalence of HPV DNA in this cohort of postmenopausal women was 1% (three of 306); only two of the 180 current users and one of the 124 nonusers tested positive. Only one of the three women with HPV-positive tests had lesional tissue (i.e., vulvar condylomata acuminata). The remaining two HPV-positive women had negative cytology, colposcopy, and biopsy. In all three cases, viral burden was low, about 10 pg per cellular sample. The very low HPV prevalence precluded the analysis of correlation with age, ethnicity, education, sexual history, smoking, history of abnormal Papanicolaou smear, therapy for HPV-related lesions, and contraceptive use. CONCLUSION: Identification of high-risk HPV types in post-menopausal women is rare, as detected by hybrid capture in cellular residue from the liquid-based cytology-collection system. Postmenopausal hormone therapy does not appear to promote viral replication or the risk of carrying high-risk HPV DNA or related lesional tissue in the lower genital tract.

Aged↗
PubMed1997

Endometrial histology and bleeding patterns in post-menopausal women taking sequential, combined estradiol and dydrogesterone.

OBJECTIVES: To determine the endometrial response and bleeding patterns in post-menopausal women who were given a sequential hormone replacement regimen with estradiol 2 mg and dydrogesterone 10 mg. METHODS: One-hundred-and-eighty-eight (188) post-menopausal women with amenorrhea of 6 months or longer, with FSH/estradiol (E2) levels in the post-menopausal range and normal endometrium were entered in the study. All patients received a daily dose of 2 mg E2 during day 1-14 of each 28 day cycle and 2 mg E2 combined with 10 mg dydrogesterone during cycle day 15-28. The total duration of treatment was 12 months (13 cycles of 28 days). RESULTS: The rate of adequate progestational response (secretory or atrophic) in the 146 patients who remained in the study for at least 356 days with 90% study medication compliance and received an endometrial biopsy after 13 cycles of study medication was 97.2%. Three patients had proliferative endometrium and one simple hyperplasia. Cyclic bleedings in the 153 women who remained on study medication for at least 76 days occurred in over 85% of all cycles; the day of onset occurring regularly on day 13 or 14 of the combined period; the mean duration of bleeding per cycle was approximately 5 days with most patients having (very) slight bleeding. Sixty percent of patients had no intermittent bleedings over the whole 12-month study period. The average incidence of intermittent bleeding in the remaining patients was only 2.7 and generally of very slight quantities and of short duration. Per evaluable cycle the percentage of patients with an intermittent bleeding varies from 4.6 to 9.8%. Only two patients discontinued therapy because of bleeding problems. A clear decrease in the incidence of typical menopausal symptoms, i.e. hot flushes and night sweats was observed by the first visit after 6 weeks of treatment. CONCLUSIONS: The endometrial safety of 2 mg E2 sequentially combined with 10 mg dydrogesterone is very good as determined by the histologic response of the endometrium. The incidence of cyclic bleedings with this combination therapy is very high as is the regularity of day of onset and duration of bleeding. Blood loss during intermittent bleedings was mild and of short duration.

Climacteric↗
PubMed1994

Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation.

OBJECTIVE: Our purpose was to compare consequences for women of receiving versus not receiving median episiotomy early and 3 months post partum on the outcomes perineal pain, urinary and pelvic floor functioning by electromyography, and sexual functioning and to analyze the relationship between episiotomy and third- and fourth-degree tears. STUDY DESIGN: A secondary cohort analysis was performed of participants within a randomized clinical trial, analyzed by type of perineal trauma and pain, pelvic floor, and sexual consequences of such trauma, while controlling for trial arm. The study was conducted in three university or community hospitals; 356 primiparous and 341 multiparous women were studied. RESULTS: Early and 3-month-postpartum perineal pain was least for women who gave birth with an intact perineum. Spontaneous perineal tears were less painful than episiotomy. Sexual functioning was best for women with an intact perineum or perineal tears. Postpartum urinary and pelvic floor symptoms were similar in all perineal groups. At 3 months post partum those delivered with an intact perineum had the strongest pelvic floor musculature, those with episiotomy the weakest. Among primiparous women third- and fourth-degree tears were associated with median episiotomy (46/47). After forceps births were removed and 21 other variables potentially associated within such tears were controlled for, episiotomy was strongly associated with third- and fourth-degree tears (odds ratio +22.08, 95% confidence interval 2.84 to 171.53). Physicians using episiotomy at high rates also used other procedures, including cesarean section, more frequently. CONCLUSION: Perineal and pelvic floor morbidity was greatest among women receiving median episiotomy versus those remaining intact or sustaining spontaneous perineal tears. Median episiotomy was causally related to third- and fourth-degree tears. Those using episiotomy at the highest rates were more likely use other interventions as well. Episiotomy use should be restricted to specified fetal-maternal indications.

Adolescent↗
PubMed1992

Does episiotomy prevent perineal trauma and pelvic floor relaxation?

OBJECTIVE: To compare the outcomes of the current practice of liberally or routinely employing episiotomy to prevent perineal tears and pelvic floor relaxation (control group) to a policy of restricting episiotomy use to specific fetal and maternal indications (experimental group). DESIGN: A randomized controlled trial (RCT). SETTING: Three university hospitals in Montreal. SUBJECTS: Seven hundred three low-risk women enrolled at 30 to 34 weeks of gestation were randomized late in labor to the designated trial arm, by parity, and followed up to 3 months postpartum. MAIN OUTCOME MEASURES: Antepartum and postpartum information on perineal trauma and pain, pelvic floor symptoms (urinary incontinence), and sexual activity was collected through the use of standard questionnaires; pelvic floor function was measured by electromyographic (EMG) perineometry. RESULTS: Restricting episiotomy use in primiparous women was associated with similar sutured perineal trauma to the liberal or routine approach. Multiparous women in the restricted episiotomy group more often gave birth with an intact perineum (31% compared with 19%, odds ratio (OR) = 1.85, 95% confidence interval (CI) = 1.09 to 3.16). All but one 3rd/4th-degree perineal tear was associated with median episiotomy (46 of 47 in primiparous women and 6 of 6 among multiparous women). No difference between trial groups was found in postpartum perineal pain, antepartum and 3-month postpartum EMG perineometry, and urinary and pelvic floor symptoms. CONCLUSIONS: We found no evidence that liberal or routine use of episiotomy prevents perineal trauma or pelvic floor relaxation. Virtually all severe perineal trauma was associated with median episiotomy. Restriction of episiotomy use among multiparous women resulted in significantly more intact perineums and less perineal suturing.

Adult↗
PubMed1989

A prospective 1-year study of estrogen and progestin in postmenopausal women: effects on the endometrium.

The endometrial response to oral, cyclic conjugated equine estrogens with and without the randomized addition of medroxyprogesterone acetate was evaluated in 95 postmenopausal women with respect to morphology and bleeding patterns. At 1 year, therapy with 0.625 mg conjugated equine estrogens or 1.25 mg conjugated equine estrogens for 25 days of a 30-day cycle and 5 mg medroxyprogesterone acetate added to the last 11 days of the conjugated equine estrogens cycle was associated with hyperplasia in 0 and 10% of the patients, respectively (P = not significant). Hyperplasia developed in 30 and 57% of the patients who received the above conjugated equine estrogens and placebo regimens, respectively. Irregular, breakthrough bleeding occurred in 14% of the conjugated equine estrogens/medroxyprogesterone acetate users and in 54% of the conjugated equine estrogens/placebo users. The results of this study indicate that 1 year of therapy with 0.625 mg conjugated equine estrogens and 5 mg medroxyprogesterone acetate provided the most satisfactory endometrial protection against hyperplasia and was associated with relatively low rates of breakthrough bleeding.

Drug Therapy, Combination↗
PubMed1989

A prospective one-year study of estrogen and progestin in postmenopausal women: effects on clinical symptoms and lipoprotein lipids.

Ninety-five healthy women who had been amenorrheic for at least 6 months were randomly assigned to one of four cyclic, sequential hormone regimens for 1 year. Groups A and C received 0.625 or 1.25 mg conjugated equine estrogen (Premarin), respectively, from days 1-25 and 5 mg medroxyprogesterone acetate (Provera) from days 15-25. Groups B and D were given 0.625 or 1.25 mg conjugated equine estrogen, respectively, from days 1-25 and placebo from days 15-25. Plasma estrone levels were physiologic after the lower dose of conjugated equine estrogen and supraphysiologic after ingestion of the higher dose. All four treatment regimens successfully controlled hot flushes, but patients who received 1.25 mg conjugated equine estrogen with or without medroxyprogesterone acetate had a higher energy level and a more enhanced sense of well-being (P less than .05). The four treatments all had favorable effects on lipid metabolism, albeit in a dose-related manner: After 1 year of treatment, high-density lipoprotein levels increased 4.3, 13.7, 13.4, and 19% in groups A, B, C, and D, respectively, compared with pre-treatment values. The high-density lipoprotein/low-density lipoprotein ratios, an antiatherogenic index, increased by 7.3, 13.6, 24, and 43% in groups A, B, C, and D, respectively. The findings of this study on the relative effects of different doses of oral estrogen and progestin, administered sequentially, on clinical symptoms and lipid metabolism provide guidelines for the treatment of postmenopausal women.

Affect↗
PubMed1988

Closure of laparotomy incisions with or without peritoneal suturing and second-look laparoscopy.

The effect of peritoneal closure after reproductive surgery by Pfannenstiel incisions was studied clinically and by second-look laparoscopy. No difference was found in the length of hospital stay, the incidence of wound complications, and other postoperative complications after abdominal closure with (group peritoneal closure, n = 168) or without peritoneal suturing (group no peritoneal closure, n = 165). The laparoscopic findings of 63 patients in the group with peritoneal closure and 57 patients in the group without closure were compared with those in 150 infertile women with no history of abdominal surgery (control group). No adhesions to the anterior abdominal wall were found in the control group. The incidence of these adhesions was not statistically different between the group with peritoneal closure (22.2%) and the group without peritoneal closure (15.8%). This study suggests that there is no difference in postoperative complications, wound healing, and adhesions to previous laparotomy incisions after laparotomy closure with or without peritoneal suturing.

Adult↗
PubMed1988

Digital imaging analysis of normal, hyperplastic and malignant endometrial cells in endometrial brushing samples.

Sixty cytologic specimens obtained by endometrial brushing (using the Gynecyte device) were quantitated by digital imaging techniques. These samples included 25 from normal endometria, 6 from persistent proliferative endometria, 14 from cystic or adenomatous hyperplasias and 15 from carcinomas. The morphometric parameters surveyed included mean cell area, nuclear area, perimeter and long and short axes. The amount of hematoxylin dye in the nuclei was expressed by mean transmittance (mean of gray levels) and chromatin index (standard deviation of gray levels). The frequency distributions of cells derived from normal tissue and persistent proliferative endometrium were quite similar. The quantitative parameters of cystic and adenomatous hyperplasia, although intermediate between those of normal endometrium and carcinoma, were closer to the former than to the latter. Using stepwise discriminant analysis of the morphometric parameters, 83% of the specimens were correctly classified into the categories of normal/persistent proliferative, hyperplasia and carcinoma. The accuracy was improved to 88% when densitometric parameters were added. This study demonstrates the potential application of digital imaging techniques to the distinction and classification of normal, hyperplastic and malignant endometrial cells.

Adenocarcinoma↗
PubMed1987

Postmenopausal estrogen and androgen replacement and lipoprotein lipid concentrations.

The effect of a combined estrogen-androgen drug on the lipoprotein lipid profile of women who received it parenterally as long-term postmenopausal replacement therapy was compared to that of women who had been receiving estrogen alone parenterally and to untreated surgically menopausal women. Plasma estradiol, testosterone, total cholesterol, triglycerides, high-density lipoproteins, and low-density lipoproteins were measured at baseline (55 days after injection) and then on days 2, 4, 8, 15, 21, and 28 after injection. The plasma estradiol levels were greater in the two hormone-treated groups compared with the control group (p less than 0.01), and plasma testosterone levels of the combined group exceeded those of the other two groups (p less than 0.01) and remained above the normal female range for the duration of the study. There were no between-group differences in total cholesterol, triglycerides, high-density lipoprotein, or low-density lipoprotein values. Neither was the low-density/high-density lipoprotein ratio significantly different between groups at any of the test times. Therefore, the addition of testosterone to a long-term parenteral estrogen replacement regimen did not induce an increased atherogenic lipid profile compared with that produced by the parenteral administration of estrogen alone.

Cholesterol↗
PubMed1985

Differential symptom response to parenteral estrogen and/or androgen administration in the surgical menopause.

The investigation of estrogen and/or androgen administration on physical and psychological symptoms in the surgical menopause was carried out in a prospective, double-blind, crossover design. When patients who received either a combined estrogen-androgen drug or androgen alone were compared with those who received estrogen alone or placebo, energy level, well-being, and appetite were increased (p less than 0.01). The androgen-containing preparations also induced lower somatic, psychological, and total scores on the menopausal index. Superior functioning in the androgen-treated groups occurred in association with higher plasma testosterone levels during the treatment phases (p less than 0.01). These data suggest that reduced levels of circulating testosterone subsequent to bilateral oophorectomy may play an important role in the development of physical and psychological symptoms that are frequent sequelae of this surgical procedure.

Adult↗
PubMed1985

Sex steroids and affect in the surgical menopause: a double-blind, cross-over study.

The effect of estrogen and/or androgen on mood in surgically menopausal women was investigated with a prospective, double-blind, cross-over design. Oophorectomized women who received either estrogen (E), androgen (A), or a combined estrogen-androgen preparation (E-A) parenterally attained lower depression scores during both treatment phases compared to a placebo group (PL), coincident with their higher plasma estrogen and testosterone levels. When steroids were withdrawn, depression scores of all oophorectomized women were significantly higher than those of a hysterectomized control group with intact ovaries (CON). The A group also had higher hostility scores than the E, PL, and CON groups. These data provide evidence of a covariation between circulating levels of estrogen and testosterone and certain affects in healthy women.

Adult↗
PubMed1985

Florid mesonephric hyperplasia of the cervix: a report of a case with review of the literature.

A rare case of florid mesonephric hyperplasia (FMH) of the cervix found incidentally in the hysterectomy specimen of a 49-year-old woman was studied with light and electron microscopy as well as histochemistry and immunohistochemistry. A lack of architectural and cytologic atypia of the glands and tubules and a benign clinical course are consistent with a hyperplastic rather than neoplastic process. Direct histologic continuity between mesonephric duct remnants and hyperplastic glands with numerous cytotelolysosomes and lack of intracellular mucin and carcinoembryonic antigen are the features that distinguish FMH from minimal deviation adenocarcinoma of the endocervix.

Adenocarcinoma↗
PubMed1985

Effect of prostaglandin E2 on puerperal breast discomfort and prolactin secretion.

The effect of prostaglandin E2 (PGE2) (3 mg/day orally for four days) on puerperal breast discomfort and prolactin secretion was investigated in eight women in a double-blind, placebo-controlled study. Scoring systems were used for daily assessment of the degree of breast discomfort. PGE2 had no effect on breast lactation, breast swelling or pain. No difference was seen between serum prolactin in the placebo- and PGE2-treated women. Contrary to a previous report, in our experimental design PGE2 had no effect on puerperal breast lactation, swelling or pain or on serum prolactin.

Adult↗