Citations from the Literature The effects of combining noretbindrone with a gomdotropinrekaing hormone agonist in the treatment of symptomatic endometriosis Surrey ES; Gambone JC; Lu JKH; Judd HL Center for Reproductive Medicine, Cedars-Sinai Medical Center, 444 S San Vicente Boulevard, Los Angeles, CA 90048, USA FERTIL STBRIL 1990,53/4 (620-626) Treatment of endometriosis with gonadotropin-releasing hormone agonists (GnRH-a) is associated with side effects secondary to the induced hypoestrogenic state. In an effort to ameliorate these symptoms, 10 patients with symptomatic endometriosis self-administered the GnRH-a [D-His6(Imbxl)ProQIET]-GnRH in combination with norethindrone daily for 24 weeks. Painful symptoms were significantly suppressed after therapy (P < 0.005). Objective review of photographs taken at laparoscopy before and after therapy demonstrated significant reduction of visible implants (P < 0.005). Vasomotor symptoms were minimized when compared with a group of 16 patients previously treated with GnRH-a alone. Bone mineral density of the distal radius assessed by single photon absorptiometry was not reduced during therapy, although lumbar spine bone density assessed by quantitative computerized tomography was minimally but reversibly reduced. No metabolic derangements were detected. The combination of norethindrone with GnRH-a is a well tolerated and effective means of treating symptomatic endometriosis.
The use of the intravenous glucose tolerance test to evaluate nonobese hyperandrogenemk women Herbert CM III; Hill GA; Diamond MP Department of Obstetrics and Gynecology, Center for Fertility and Reproductive Research, Vanderbilt University Medical Center, Nashville, TN 37232-2515, USA FERTIL STERIL 1990,53/4 (647-653) To better define the association of hyperandrogenemia and insulin resistance, we evaluated nonobese, nonacanthotic hyperandrogenemic women utilizing intravenous glucose tolerance tests (IVGTT). Six women (group 1) all of whom had elevated serum testosterone (T) and were < 5% above their ideal body weight for height underwent IVGTTs. A control group (group 2, n = 5) with equivalent weight and height but normal levels of T were similarly tested. The T values (normal 0.1 to 0.6 ng/mL) in group 1 (0.93 f 0.05 ng/mL, mean + SEM) were significantly different from those in group 2 (0.34 f 0.03 ng/mL). Area under the curve (AUC) was calculated for the glucose and insulin values. The glucose AUC for group 1 (15,000 f 1,100) was not significantly different from the glucose AUC for group 2 (15,853 f 788). Interestingly, the insulin AUC for group 1 (3,829 f 583) was not significantly different from the insulin AUC for group 2 (2,987 f 456). Within group 1, a correlation between serum T and insulin AUC could not be established. We conclude that in these nonobese, nonacanthotic hyperandrogenemic females, although individual variation exists, collectively a significantly increased
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insulin response to an IVGTT challenge cannot be demonstrated. This data further challenges the concept of androgens being etiologic in insulin resistance.
ONCOLOGY Malignmt melanoma of the vulva: A ctinicopatbologkal study of 50 women Bradgate MG; Rollason TP; McConkey CC; Powell J Department of Pathology, Medical School, University of Birmingham, Binningham Bl5 2TJ. GBR BR J OBSTET GYNAECOL 1990.9712 (124-133) A clinicopathological review of 50 primary malignant melanomas of the vulva in the West Midlands region of England is presented. The overall 5-year-survival rate was 35%, when adjusted for age. Significant predictors of survival were clinical stage, patient age, tumour ulceration, cell type and mitotic rate. Tumour thickness was of prognostic importance but as a prognostic variable it did not operate independently of stage and as most lesions were deeply invasive at presentation vulval tumours must be separated for prognostic purposes into bands at greater overall thicknesses than those used for skin melanomas generally. There was no significant relation between survival and type of surgery performed as a primary therapeutic procedure.
Case-control study of cancer of the vulva Brinton LA; Nasca PC; Mallin K; Baptiste MS; Wilbanks GD; Richart RM Environmental Epidemiology Branch, National Cancer Institute, Executive Plaza North, Bethesda, MD 20892. USA OBSTET GYNECOL 1990,75/5 (859-866) A case-control study of 209 vulvar cancer patients and 348 community controls allowed assessment of risk factors for this rare tumor. As with cervical cancer, risk increased with the number of reported lifetime sexual partners, with five or more partners associated with two- to threefold increases in risk compared with zero to one partner. This factor largely explained the associations of risk with early age at first intercourse and low socioeconomic status. An independent association, however, was noted between vulvar cancer and a history of genital warts (relative risk 15.2; 95% confidence interval 5.5 -42.1). Women who reported a previous abnormal Papanicolaou smear were at excess risk (relative risk 1.8), as were current smokers (relative risk 2.0). A significant interaction was noted between smoking and genital warts, with women reporting both having 35 times the risk of those with neither factor. Menstrual, reproductive, and hygiene factors were generally unrelated to risk. The relationships with sexual factors and genital warts support a common etiology for cervical and vulvar cancers. Future studies should focus on the etiologic agents for genital warts - the human papillomaviruses - and their enhancement by other factors, especially smoking and/or immune deficiencies. Int J Gynecol Obstet 33
The use of the intravenous glucose tolerance test to evaluate nonobese hyperandrogenemk women Herbert CM III; Hill GA; Diamond MP Department of Obstetrics and Gynecology, Center for Fertility and Reproductive Research, Vanderbilt University Medical Center, Nashville, TN 37232-2515, USA FERTIL STERIL 1990,53/4 (647-653) To better define the association of hyperandrogenemia and insulin resistance, we evaluated nonobese, nonacanthotic hyperandrogenemic women utilizing intravenous glucose tolerance tests (IVGTT). Six women (group 1) all of whom had elevated serum testosterone (T) and were < 5% above their ideal body weight for height underwent IVGTTs. A control group (group 2, n = 5) with equivalent weight and height but normal levels of T were similarly tested. The T values (normal 0.1 to 0.6 ng/mL) in group 1 (0.93 f 0.05 ng/mL, mean + SEM) were significantly different from those in group 2 (0.34 f 0.03 ng/mL). Area under the curve (AUC) was calculated for the glucose and insulin values. The glucose AUC for group 1 (15,000 f 1,100) was not significantly different from the glucose AUC for group 2 (15,853 f 788). Interestingly, the insulin AUC for group 1 (3,829 f 583) was not significantly different from the insulin AUC for group 2 (2,987 f 456). Within group 1, a correlation between serum T and insulin AUC could not be established. We conclude that in these nonobese, nonacanthotic hyperandrogenemic females, although individual variation exists, collectively a significantly increased
381
insulin response to an IVGTT challenge cannot be demonstrated. This data further challenges the concept of androgens being etiologic in insulin resistance.
ONCOLOGY Malignmt melanoma of the vulva: A ctinicopatbologkal study of 50 women Bradgate MG; Rollason TP; McConkey CC; Powell J Department of Pathology, Medical School, University of Birmingham, Binningham Bl5 2TJ. GBR BR J OBSTET GYNAECOL 1990.9712 (124-133) A clinicopathological review of 50 primary malignant melanomas of the vulva in the West Midlands region of England is presented. The overall 5-year-survival rate was 35%, when adjusted for age. Significant predictors of survival were clinical stage, patient age, tumour ulceration, cell type and mitotic rate. Tumour thickness was of prognostic importance but as a prognostic variable it did not operate independently of stage and as most lesions were deeply invasive at presentation vulval tumours must be separated for prognostic purposes into bands at greater overall thicknesses than those used for skin melanomas generally. There was no significant relation between survival and type of surgery performed as a primary therapeutic procedure.
Case-control study of cancer of the vulva Brinton LA; Nasca PC; Mallin K; Baptiste MS; Wilbanks GD; Richart RM Environmental Epidemiology Branch, National Cancer Institute, Executive Plaza North, Bethesda, MD 20892. USA OBSTET GYNECOL 1990,75/5 (859-866) A case-control study of 209 vulvar cancer patients and 348 community controls allowed assessment of risk factors for this rare tumor. As with cervical cancer, risk increased with the number of reported lifetime sexual partners, with five or more partners associated with two- to threefold increases in risk compared with zero to one partner. This factor largely explained the associations of risk with early age at first intercourse and low socioeconomic status. An independent association, however, was noted between vulvar cancer and a history of genital warts (relative risk 15.2; 95% confidence interval 5.5 -42.1). Women who reported a previous abnormal Papanicolaou smear were at excess risk (relative risk 1.8), as were current smokers (relative risk 2.0). A significant interaction was noted between smoking and genital warts, with women reporting both having 35 times the risk of those with neither factor. Menstrual, reproductive, and hygiene factors were generally unrelated to risk. The relationships with sexual factors and genital warts support a common etiology for cervical and vulvar cancers. Future studies should focus on the etiologic agents for genital warts - the human papillomaviruses - and their enhancement by other factors, especially smoking and/or immune deficiencies. Int J Gynecol Obstet 33
