In post-menopausal period vulvo-vaginal atrophy (VVA)-related symptoms may seriously affect women's quality of life. Hormonal replacement therapy effectively relieves these symptoms but it is not always safe or accepted, and a non-hormonal treatment is often needed instead. Over a period of 12 weeks, we tested the effect of a twice-a-week vulvo-vaginal application of a hyaluronic acid, AC collagen, isoflavones and vitamins-based cream (Perilei Pausa) on 35 women in post-menopausal period, reporting VVA-related symptoms. After 12 weeks of treatment with Perilei Pausa a significant improvement in vaginal dryness, vulvo-vaginal itching, dyspareunia (P < 0.001), dysuria (P = 0.02), nocturia (P = 0.009) and pollakiuria (P = 0.005) was reported by the women. Colposcopical score assessing the intensity of atrophic colpitis, cervico-vaginal paleness and petechiae was also reduced (P = 0.037, P = 0.016 and P = 0.032, respectively). No significant difference in terms of maturation value of cervico-vaginal epithelium was observed. In conclusion, Perilei Pausa may represent an effective and safe alternative treatment of symptomatic VVA in post-menopausal women.
In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society).
Soy supplements with genistein and other phytoestrogens have become an alternative to hormone replacement therapy in postmenopausal women, although there are conflicting findings on their benefit. Some clinical trials have shown that soy supplementation improves cardiovascular risk factors in postmenopausal women but other studies have found little such benefit. This randomized placebo-controlled study investigated the effect of genistein on glucose and lipid metabolism and on vascular reactivity in postmenopausal women with differing metabolic status. Fifty fasting postmenopausal women were randomized to 1 of 2 treatment groups for at least 24 weeks: group A (n = 30) were given an oral dose of 54 mg/day of genistein and group B (n = 20) received a placebo. Patients in group A were classified as normoinsulinemic (n = 14) and hyperinsulinemic (n = 12). Measured parameters included the body mass index and other anthropometric criteria, serum hormones and lipids, the oral glucose tolerance test, and glycemic, insulin, and C-peptide plasma levels. Insulin sensitivity was examined both with euglycemic-hyperinsulinemic clamps and a homeostasis model assessment for insulin resistance. Endothelial function (vascular reactivity) was analyzed by ultrasound. Compared with the placebo, basal fasting insulin levels were significantly decreased at 24 weeks by genistein treatment; insulin sensitivity (assessed by homeostasis model assessment for insulin resistance) and glucose levels were significantly improved. Among normoinsulinemic patients, a significant reduction was noted in both fasting glucose and area under the curve (AUC) glucose plasma levels after genistein treatment in comparison to the placebo. Conversely, among hyperinsulinemic patients, genistein treatment reduced insulin, C-reactive peptide, and AUC-insulin levels. No significant variation in the lipid profile occurred in the normoinsulinemic group after genistein, whereas there was a significant improvement in high-density lipoprotein cholesterol levels in the hyperinsulinemic women. Among normoinsulinemic but not hyperinsulinemic patients, genistein enhanced the endothelial response to stimuli both in flow-mediated and nitrate-mediated dilatation. These findings show that 6-month treatment with genistein significantly improves glycemic metabolism and endothelial function in postmenopausal women. Among normoinsulinemic patients especially, there is improvement in glycemic and vascular reactivity indexes. In contrast, among hyperinsulinemic patients, genistein seems to improve insulin sensitivity indexes and the lipid profile.
Perineurioma of the kidney in a 7-year-old girl is described. The tumor in the upper pole was discovered during the evaluation of a urinary tract infection. The neoplasm measured 2.6 cm and radiographically it mimicked a nephroblastoma. The diagnosis of perineurioma was confirmed with histologic, immunohistochemical, and ultrastructural studies. These revealed findings typical of perineurioma of other locations. Histopathologically, differential diagnosis may include nephroblastoma, mesoblastic nephroma, neurofibroma, schwannoma, malignant peripheral nerve sheath tumor with perineural cell differentiation, and other benign and malignant mesenchymal tumors with spindle cell pattern. To the best of our knowledge, we report a unique renal perineurioma in a child.
To verify if a chronic opioid blockade could affect the GH/IGF-I axis.We have investigated the effects of naltrexone (NTX) treatment on GH response to GHRH in normal women.GHRH test (50 micrograms i.v.) performed in seven normal female volunteers (age 25-38 years, with a body mass index ranging from 19.8 to 23.1 kg/m2) before and after 4-weeks NTX treatment (50 mg p.o. daily).Basal GH, IGF-I, insulin-like growth factor binding protein-3 (IGFBP-3) plasma levels and the IGF-I/IGFBP-3 molar ratio remained unaffected by NTX. NTX significantly reduced the GH peak values (15.52 +/- 3.59 vs 4.78 +/- 0.49 micrograms/l; P < 0.01), and GH area under curve (918.93 +/- 253.96 vs 401.09 +/- 79.63 micrograms/l; P < 0.01).This finding suggests that the long-term opioid receptor blockade has an inhibitory role on GHRH-induced GH secretion. A central influence on neurotransmitter control of GH might be hypothesised. The inhibition of stimulated GH release, without interference with the basal level, could indicate an enhanced somatostatin secretion and/or activity. Opioids could be involved only in the regulation of GH dynamics and not in basal secretion. Nevertheless, a direct involvement of opioids at the pituitary level, which could be modified by NTX, cannot be excluded.