Thesis (Ph. D.)--University of Washington, 1991. / Vita. Includes bibliographical references (leaves [129]-137).

Thesis (M.A.)--Eastern Illinois University, 2000. / Includes bibliographical references (leaves 71-73).

Thesis (M.Med.Sc.)--University of Hong Kong, 2004. / Also available in print.

Thesis (M.Tech.: Homoeopathy)-Dept. of Homoeopathy, Durban Institute of Technology, 2003 xiii, 73 leaves / This double blind, randomised, placebo controlled study investigated the efficacy of ProgestoNat® cream in the treatment of menopausal syndrome in terms of subjective and objective data. Menopause is defined as that point in time when permanent cessation of menstruation occurs following the loss of ovarian follicular activity. The perimenopause is the period just prior to the final menstrual period and is associated with the development of typical oestrogen deficiency symptoms such as hot flushes, night sweats, mood swings and loss of libido, to mention a few. The most widely used treatment for these symptoms is hormone replacement therapy. This form of treatment is effective for many women, but there are many risks and side effects associated with its use and there is a growing demand for natural alternatives, like natural progesterone creams. It is for this reason that the efficacy of ProgestoNat® cream was investigated as a natural alternative to hormone replacement therapy.

Resumo: Investigar o efeito independente e aditivo do treinamento resistido (TR) e da isoflavona de soja (ISO) sobre a densidade mineral óssea (DMO) e a composição corporal de mulheres na pós-menopausa. Foi conduzido estudo clínico prospectivo, duplo-cego (ISO), placebocontrolado e randomizado dois (ISO x Placebo) por dois (TR x sem TR). Oitenta mulheres sedentárias na pós-menopausa (amenorréia últimos 12 meses, FSH > 40UIml), idade entre 45 a 70 anos, foram randomizadas a um dos quatro grupos (71 completaram 9 meses de intervenção): ISO + TR (n=15; 55,7±7,0); ISO + sem TR (n=20; 56,6±8,8); placebo + TR (n=18; 56,0±5,8); placebo + sem TR (n=18; 55,3±8,0). As participantes randomizadas para ISO receberam 250mg de extrato de soja, total de 100mg/dia de isoflavona. Aquelas randomizadas para TR realizaram sessões de exercícios resistidos supervisionados, mínimo de dois dias na semana, durante 9 meses, que incluiu 2-3 exercícios para os grupamentos musculares maiores (coxa, peito e costa) e 1 exercício para os menores (bíceps e tríceps), em 3 séries de 8-12 repetições máximas. No momento basal e aos 9 meses, a composição corporal (massa gordurosa e muscular) e a DMO (corpo inteiro, colo de fêmur e coluna lombar) foram estimadas pela absortometria radiológica de feixes duplos de energia (DXA, Hologic QDR-2000). Valores plasmáticos de CTX (serum levels of C-terminal cross-linked telopeptides of type I collagen) e de osteocalcina foram dosados como marcadores da reabsorção e formação óssea, respectivamente. Para avaliação antropométrica foram obtidos: peso, estatura, índice de massa corpórea (IMC=peso/altura2), circunferência da cintura (CC) e relação cintura/quadril (RCQ). Valores plasmáticos de isoflavona foram realizados ao final da intervenção para analisar a aderência ao tratamento. Na análise... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To investigate the independent and additive effects of resistance training (RT) and soy isoflavone (ISO) on bone mineral density (BMD) and body composition in postmenopausal women. This study used a placebo-controlled, double-blind (soy), randomized two (ISO vs placebo) x two (RT vs no-RT) design. A total of 80 sedentary postmenopausal women (>12 months amenorrhea and FSH >40mIU/ml), aged 45- 70 years, was randomized one of four groups (71 completed 9-months intervention): ISO + RT (n=15; 55.7±7.0); ISO + no-RT (n=20; 56.6±8.8); placebo + RT (n=18; 56.0±5.8); placebo + no-RT (n=18; 55,3±8,0). Participants randomized to ISO received 250mg of standardized soy extract, total of 100mg/day of isoflavone. Subjects randomized to RT attended supervised resistance exercise sessions, three days/week for 9-months and included 2-3 exercises for the larger muscle groups, and 1 exercise for smaller groups in 3 series of 8-12 repetitions. At baseline and 9-months, body composition (fat and muscle mass) and BMD (whole body, lumbar spine and femoral neck) were estimated by dual-energy x-ray absorptiometry (DXA, Hologic QDR-2000). Serum levels of C-terminal cross-linked telopeptides of type I collagen (CTX) and osteocalcin were measured as markers of bone resorption and formation, respectively. The anthropometric indicators included: weight, height, body mass index (BMI= weight/height2), waist circumference (WC) and waist/hip ratio (WHR). The plasma levels of isoflavones were measured to assess compliance. The Shapiro-Wilk, Kolmogorov & Smirnov for distribution statistics, and Levene's test for homogeneity of variances, ANOVA-repeated measure, ANOVAone way and post hoc Fisher test, Pearson's correlation, test t and analyze regression forward stepwise were used in the statistical analysis. There were no significant difference... (Complete abstract click electronic access below) / Orientador: Eliana Aguiar Petri Nahás / Coorientador: Jorge Nahás Neto / Banca: Nailza Maestá / Banca: Leone A. Simonetti / Banca: Cesar Eduardo Fernandes / Banca: Aarão Mendes Pinto Neto / Doutor

Orientador: César Eduardo Fernandes / Banca: César Eduardo Fernandes / Banca: Eliana Aguiar Petri Nahás / Banca: Sérgio Peixoto / Resumo: O objetivo deste estudo foi avaliar a associação entre a densidade mineral óssea da coluna lombar e do fêmur e o perfil lipídico e lipoprotéico em pacientes pósmenopáusicas com osteoporose. Foram avaliadas 351 pacientes com média etária de 64,4 anos, em estudo de corte transversal. Foram analisadas as correlações entre a densidade mineral óssea da coluna lombar e as distintas variáveis do perfil lipídico e lipoprotéico. Iguais correlações também foram estudadas em relação à densidade mineral óssea do colo do fêmur. Levou-se em conta para as referidas análises o tempo de pós-menopausa e o índice de massa corporal das pacientes. Ao final, pode-se concluir pela existência de associação significativa entre os níveis plasmáticos de HDLC e a presença de osteoporose do colo do fêmur somente nas pacientes com mais de 10 anos de pós-menopausa. Estas apresentaram níveis plasmáticos de HDL-C significativamente mais elevados. Não houve associação entre a densidade mineral óssea do colo do fêmur e as demais variáveis do perfil lipídico e lipoprotéico (CT, LDL-C e TG). Também não houve associação entre a densidade mineral óssea da coluna vertebral e as variáveis analisadas do perfil lipídico e lipoprotéico (CT, LDL-C, HDL-C e TG) / Abstract: The aim of this study was to analyze the association between the bone mineral density (BMD) in the lumbar spine and hip and the lipid and lipoprotein profile in post-menopause women with osteoporosis. A sectional study was performed with 351 women. Their mean age was 64,4 years. We performed a linear correlation between the lumbar spine BMD and the variables of the lipid and lipoprotein profile (CT: total cholesterol; HDL-C: high lipoprotein density; LDL-C: low lipoprotein density; TG: tryglicerides). The same procedure was done with the hip BMD. We also analized the time since menopause and bone mass index. In the end of the study we concludes that there was a significant association between HDL-C plasmatic levels in the hip only in women with more than 10 years since menopause. They had HDL-C plasmatic levels signifcantly higher. There wasnþt an association between the hip BMD and the other lipid and lipoprotein variables (CT, LDL-C,TG). Also, there wasnþt an association between the lumbar spine BMD and the lipid and lipoprotein variables (CT, HDL-C, LDl-C, TG) / Mestre

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-24Bitstream added on 2014-06-13T18:39:57Z : No. of bitstreams: 1 borges_pcg_me_botfm.pdf: 374390 bytes, checksum: 7365aa0b75c69323c89af61d1a06938e (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Para o diagnóstico de pólipo endometrial, dispõe-se da ultrassonografia e da histeroscopia ambulatorial, sendo a última considerada padrão ouro. A ultrassonografia avalia a espessura do endométrio, sua alteração de ecogenicidade e seus limites. Os resultados de tal exame pode sugerir a doença. A histeroscopia ambulatorial, por sua vez, é um exame mais preciso, pois permite uma melhor identificação do pólipo endometrial. Além disso, ela permite a confirmação do diagnóstico através da biópsia, assim como o tratamento. Comparar a ultrassonografia e a histeroscopia ambulatorial como métodos propedêuticos dos pólipos endometriais nas mulheres menopausadas do Serviço de Endoscopia Ginecológica e Planejamento Familiar da Disciplina de Ginecologia do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Botucatu–Hospital das Clínicas (UNESP). Estudo analítico e retrospectivo cujos dados foram obtidos através de consultas a 323 prontuários de mulheres menopausadas submetidas a ultrassonografia e a histeroscopia ambulatorial no referido setor, no período de março de 2003 a março de 2009. Foram incluídas no estudo 281 mulheres menopausadas na faixa etária de 41 a 82 anos, que haviam sido submetidas à histeroscopia ambulatorial por apresentarem sangramento uterino e/ou ultrassonografia transvaginal alterada (EE≥5 mm), e que, por esses motivos, foram encaminhadas ao ambulatório. A idade média das pacientes foi de 61,3 anos, sendo que 27,6% apresentaram diabetes mellitus tipo II, 70,5% eram hipertensas, 5,7% eram tabagistas. A média do índice de massa corpórea (IMC) foi de 31,6 kg/m2, e 73% eram multíparas (com 3 ou mais partos). A média do tempo de menopausa (amenorreia) foi de 10,7anos, sendo que 15,3% das pacientes eram usuárias de terapia hormonal, e 6,8% estavam em tratamento de câncer de mama com tamoxifeno. Do total de pacientes, 38,1%... / Ultrasonography and outpatient hysteroscopy are considered the “golden standard” for the diagnostic of endometrial polyp. Ultrasonography evaluates the endometrial thickness, the echogenicity and the limits. Its results can suggest the pathology. Outpatient hysteroscopy, on the other hand, is a more accurate exam, providing a better identification of the endometrial polyp and confirming the diagnostic through histological examination. It also may be used as a treatment. Comparison of the ultrasonography with the outpatient hysteroscopy as diagnostic methods for endometrial polyps in postmenopausal women from the Endoscopic and Gynecologic Service of the Medical School of Botucatu – UNESP. Analytical and retrospective study based on the files of 323 postmenopausal women submitted to ultrasonography and to outpatient hysteroscopy from March 2003 to March 2009, wich were performed in the Gynecologic and Obstetric Department of the Medical School of Botucatu (UNESP) – Gynecology Discipline of Botucatu Medical School. In this study, 281 postmenopausal women, with ages between 41 and 82 years, and that had been submitted to outpatient diagnostic hysteroscopy, were included. They had uterine bleeding and/or altered transvaginal ultrasound (EE≥5 mm). Patients mean age was 61,3 years; 27,6% had diabetes mellitus II; 70,5% had systemic arterial hypertension; and 5,7% were smokers. IMC was 31,6 kg/m2, and 73% were multiparae (3 or more deliveries). Average menopause time (amnorrhea) was 10,7 years; 15,3% were under hormonal therapy; and 6,8% were under breast cancer treatment with taximofen. From the 323 patients, 38,1% had uterine bleeding and 61,9% were asymptomatic. Ultrasonography detected endometrial polyp in 22,8% of the patients, endometrial thickness in 59,8%, being 10,5mm the mean thickeness. Comparing the ultrasonography with the histopathology, it was observed that endometrial... (Complete abstract click electronic access below)

No description available.

Introduction New onset hyperandrogenism in postmenopausal female is a rare occurrence, presenting with hirsutism or signs and symptoms of virilization. The causes of hyperandrogenism in postmenopausal female can be categorized into tumorous (androgen-secreting ovarian or adrenal tumors) and non-tumorous in origin (Hyperthecosis, Cushing’s syndrome, Acromegaly, Congenital Adrenal Hyperplasia, and iatrogenic). Here we present a case of severe hyperandrogenism of ovarian origin in a postmenopausal female where definite etiology could not be ascertained either by imaging or pathology. Case A 72-year-old female was referred to endocrinology clinic for complaints of worsening alopecia and hirsutism for the past 4 years. History was positive for weight gain of 80 lbs in the last ten years, menstrual irregularities since menarche, and recent deepening of voice. She denied exposure to exogenous androgenic steroid. Physical examination was remarkable for android obesity, severe male pattern alopecia, hirsutism involving face and deepening of voice, no clitoromegaly was noted. Lab evaluation showed elevated total testosterone level 261 ng/dl (normal value: 2-45 ng/dL) and free testosterone 14.1 pg/mL (normal value: 0.2-3.7 pg/mL ). Estradiol level was elevated and FSH and LH were low for a post-menopausal state. 17 hydroxy progesterone, TSH, and 1 mg overnight dexamethasone suppression test were normal ruling out congenital adrenal hyperplasia, thyroid dysfunction and Cushing’s syndrome. IGF-1 was not elevated ruling out acromegaly. DHEAS level was normal and CT abdomen and pelvis showed no evidence of an adrenal tumor, excluding adrenal source of androgen excess. Transvaginal Ultrasound showed normal volume of the ovaries, thickened endometrium and uterine myomas. Given markedly elevated testosterone levels and exclusion of adrenal tumor, suspicion for an ovarian source remained high. An MRI of the pelvis was done that showed 1.9 cm left adnexal cyst. She was then referred to Gynecology and underwent total hysterectomy with bilateral salpingo-oophorectomy. Interestingly surgical pathology was negative for tumor, showed unremarkable ovaries and right fallopian tube, left fallopian tube with hydrosalpinx, and showed atypical hyperplasia of the endometrium. However, testosterone levels decreased to normal two months after surgery; Free testosterone 1.8 pg/ml (normal values: 0.2-3.7 pg/mL), total testosterone 31 ng/dl (normal value: 2-45 ng/dL) indicating removal of ovarian source of testosterone production. Discussion Although relatively rare, severe hyperandrogenism (total testosterone >150 ng/dL, DHEAS >700 mcg/dL, signs of virilization) in postmenopausal women is caused either by adrenal or ovarian androgen secreting tumor or ovarian hyperthecosis, which is characterized by a hyperplastic ovarian stroma. Severity of symptoms, degree of androgen excess followed by imaging studies lead to identification of source of excessive androgen secretion in most cases. Diagnosis of ovarian virilizing tumors can be difficult since size of such tumors is often too small to allow detection on imaging studies, but are generally detected on surgical pathology and therefore bilateral salpingo-oophorectomy is recommended after exclusion of adrenal cause. However, rarely etiology may remain undetermined in some cases with conventional histology as in our patient.

No description available.