Obravnava žensk v obdobju predmenopavze, ob menopavzi in kasneje se je v novem tisočletju pomembno spremenila. Randomizirane klinične raziskave so bistveno omejile indikacije za uvedbo hormonskega ...zdravljenja (HZ) in s tem menopavzno medicino postavile pred velik izziv. Na srečo so najnovejša dognanja potrdila, da je ob pravilni uporabi in izbiri HZ korist še vedno bistveno večja od tveganja. Zato smo pripravili posodobljena stališča o menopavzni medicini, ki so v skladu z aktualnimi mednarodnimi priporočili in prilagojena posebnostim slovenskega prostora.
Obravnava endometrioze v pomenopavznem obdobju Belak Magdalenić, Urška; Frangež, Helena Ban; Korošec, Sara
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
12/2023, Volume:
92, Issue:
11-12
Journal Article
Peer reviewed
Open access
Endometrioza je bolezen, ki lahko prizadene 2–5 % vseh žensk v pomenopavznem obdobju. Gre za bolezen, pri kateri se endometrijske žleze in stroma nahajajo zunaj maternice. O pomenopavzni endometriozi ...je zaenkrat v literaturi še malo znanih podatkov. V sklopu diagnosticiranja je v tem obdobju v ospredju predvsem skrb, da gre morda za maligno bolezen. Poročila v literaturi opisujejo ponovitev endometrioze v pomenopavznem obdobju kot tudi nastanek endometrioze »de novo«. Zdravljenje izbire simptomatske endometrioze v pomenopavzi je kirurško z odstranitvijo vsega vidnega endometriotičnega tkiva zaradi višjega tveganja za ponovitev bolezni in preobrat v maligno bolezen. Hormonsko zdravljenje po menopavzi (MHZ) se pogosto uporablja za lajšanje simptomov in preprečevanje izgube kostne mase. Obstajajo raziskave, ki dokazujejo, da MHZ lahko ponovno aktivira endometriotična žarišča in celo spodbuja maligno preoblikovanje žarišč pri ženskah z anamnezo endometrioze. Glede na ne povsem razjasnjena tveganja MHZ pri tovrstnih bolnicah se svetuje dodatna previdnost.
Background. In the past thirty years, there has been a significant rise of public and private health institutions’ interest in the prediction and management of medical risks. The need of risk ...management is a direct consequence of the growing number of legal actions against medical malpractice. The concept of risk management involves three basic processes: risk identification, risk analysis, and risk management. Risk includes an evaluation of vulnerability and management of events that could potentially endanger the operation of a health institution, comprising a balance between the consequential costs of medical malpractice and the costs of risk reduction (anticipation). Thus the potential financial consequences of risk exposure are crucial in the formation of diagnostic and treatment protocols, whereas improvement of the quality of medical care as well as patient protection are the primary aims of risk management. Conclusions. Postmenopausal health care is not an exempt when considering possible erorrs in medication or medical process per se. On the orther hand menopausal medicine is not only hormonal replacement therapy but also bunch of complementary and alternative specialities involved in the healing process where error could be easily achieved.
Background. Hormonal replacement therapy (HRT) after menopause can affect cardiovascular system in a positive and negative way. Positive effects are exerted through estrogenic action on metabolic ...risk factors, such as lipids, glucose and insulin metabolism, as well as direct arterial effects, reducing atherogenesis. Negative effects are dose-dependent transient increase in coagulation activation and adverse vascular remodelling. Observational studies suggested that HRT might have a beneficial effect on the incidence of coronary heart disease, which is not in line with later randomized clinical trials. The main difference between both types of the studies is that participants in observational trials were in their fifties and in average ten years younger compared to randomized trials. Post-hoc analysis of the Women’s Health Initiative trial found a trend toward cardioprotective HRT in younger patients. Conclusions. HRT is currently not recommended for the primary coronary prevention. But in women with menopausal symptoms, which are at the initiation of HRT younger than 60 years and are less than 10 years after menopause, HRT does seem not to increase cardiovascular events. Initiation of HRT early after menopause may reduce cardiovascular risk.
Background: In different human adult tissues and organs embryonic-like stem cells have already been found. A question is whether they are present also in the adult human ovary. In this study we tried ...to find whether embryonic-like stem cells are present in the ovarian surface epithe- lium of women with premature ovarian failure, and whether these cells can differentiate into oocytes by in vitro culture. Methods: In 10 women with premature ovarian failure the ovarian surface epithelium was laparo- scopically scraped. We tried to immunomagnetically isolate embryonic-like stem cells from the suspension of scraped cells and to confirm their existence immunocytochemically by the expression of the markers c-kit and surface antigen SSEA-4, characteristic of pluripotent stem cells. In the lab, we tried to differentiate stem cells into oocytes in a cell culture medium with added heterologous follicular fluid from the in vitro fertilization programme, which is rich in substances, and important for oocyte growth and maturation. The differentiation of oocyte-like cells was screened. Oocyte-like cells were isolated from the cell culture and im- munocytochemically stained for oocyte-specific markers (c-kit, VASA, ZP2-zona pellucida). Oocyte-like cells were analyzed for the expression of oocyte-specific genes (Oct-4A, ZP3, c-kit, SCP-3) by single-cell PCR. Results: From the ovarian surface epithelium of all patients small yellow coloured cells with diam- eters of 2 to 4 μm and positive for markers of pluripotent stem cells were isolated. In the lab, these cells were cultured into oocyte-like cells with diameter ranging from 60 to 80 μm. Some of oocyte-like cells were positive for oocyte-specific markers and expressed the genes, characteristic of oocytes, including meiotic genes. Conclusions: In patients with premature ovarian failure it is possible to culture oocyte-like cells from ovarian surface epithelium stem cells. Intense research is needed to evaluate the quality of oocyte-like cells developed in vitro and to estimate their potential use for in vitro fertilization in the far future.
