Endometrial hyperplasia (EH) comprises a spectrum of changes in the endometrium ranging from a slightly disordered pattern that exaggerates the alterations seen in the late proliferative phase of the menstrual cycle to irregular, hyperchromatic lesions that are similar to endometrioid adenocarcinoma. Generally, EH is caused by continuous exposure of estrogen unopposed by progesterone, polycystic ovary syndrome, tamoxifen, or hormone replacement therapy. Since it can progress, or often occur coincidentally with endometrial carcinoma, EH is of clinical importance, and the reversion of hyperplasia to normal endometrium represents the key conservative treatment for prevention of the development of adenocarcinoma. Presently, cyclic progestin or hysterectomy constitutes the major treatment option for EH without or with atypia, respectively. However, clinical trials of hormonal therapies and definitive standard treatments remain to be established for the management of EH. Moreover, therapeutic options for EH patients who wish to preserve fertility are challenging and require nonsurgical management. Therefore, future studies should focus on evaluation of new treatment strategies and novel compounds that could simultaneously target pathways involved in the pathogenesis of estradiol-induced EH. Novel therapeutic agents precisely targeting the inhibition of estrogen receptor, growth factor receptors, and signal transduction pathways are likely to constitute an optimal approach for treatment of EH.
Antineoplastic Agents, Hormonal/adverse effects ; Disease Management ; Disease Progression ; Endometrial Hyperplasia/classification/etiology/*therapy ; Female ; Gonadotropin-Releasing Hormone/therapeutic use ; Humans ; Hysterectomy ; Molecular Targeted Therapy/methods ; Progesterone Congeners/therapeutic use ; Risk Factors ; Tamoxifen/adverse effects

BACKGROUNDThere is an association between postmenopausal tamoxifen therapy and endometrial pathologies. We investigated the usefulness of diagnostic hysteroscopy and transvaginal ultrasonography (TVS) and estimated whether diagnostic hysteroscopy improves detection of endometrial pathologies in postmenopausal breast cancer patients on tamoxifen.

METHODSNinety-seven postmenopausal breast cancer patients who had been taking tamoxifen 20 mg/d for ≥ 6 months went through TVS, diagnostic hysteroscopy, and endometrial biopsy examinations. The presence of endometrial histopathologic features with abnormal TVS and diagnostic hysteroscopic findings were correlated.

RESULTSNo endometrial cancer was found in any of the 97 patients. Fifty-three patients (54.6%) developed endometrial polyps as diagnosed histopathologically. Fifty-nine patients (60.8%) tested positive in TVS exams, of whom 43 had polyps, four had hyperplasia, and 12 atrophy. Thirty-eight patients (39.2%) tested negative in TVS exams, of whom 10 had polyps, three hyperplasia, and 25 atrophy. TVS exams presented 63.6% specificity, 81.8% sensitivity, 72.9% positive-predictive value, and 73.7% negative-predictive value, whereas the corresponding values of diagnostic hysteroscopy were 100%, 98.1%, 100%, and 97.8% respectively. The correct ratio of hysteroscopy was significantly higher than that of TVS (P = 0.000).

CONCLUSIONSIn postmenopausal breast cancer patients treated with tamoxifen, TVS alone is not sufficient for the detection of endometrial pathologies. Additional use of diagnostic hysteroscopy considerably improves the detection of polyps, thus significantly reducing the rate of false-negative findings of endometrial pathologies.

Adult ; Aged ; Antineoplastic Agents, Hormonal ; adverse effects ; therapeutic use ; Breast Neoplasms ; drug therapy ; Endometrium ; diagnostic imaging ; pathology ; Female ; Humans ; Hysteroscopy ; methods ; Middle Aged ; Postmenopause ; Tamoxifen ; adverse effects ; therapeutic use ; Ultrasonography

The increased survival of patients with breast cancer has given rise to other problems associated with the complications of chemotherapy. One major complication is premature ovarian failure, an especially harmful outcome for women of reproductive age. This study was performed to evaluate the efficacy of GnRH agonist (GnRHa) treatment on protecting ovarian function in young breast cancer patients (30.59+/-5.1 yr) receiving chemotherapy after surgery. Twenty-two women were enrolled and given subcutaneous injections of leuprolide acetate (3.75 mg) every 4 weeks during chemotherapy. Follow-up laboratory tests (luteinizing hormone [LH], follicle stimulating hormone [FSH], and estradiol) were performed 1, 3, and 6 months after chemotherapy. Menstruation patterns and clinical symptoms were followed up for a mean duration of 35.6+/-1.7 months. FSH and LH levels were normal in all patients 6 months after completing chemotherapy (8.0+/-5.3, 4.4+/-2.7 mIU/mL, respectively). During follow-up, none of the patients complained of menopausal symptoms and 81.8% experienced recovery of menstruation. This report is the first trial of GnRHa as a treatment modality to protect ovarian function during adjuvant chemotherapy in young Korean breast cancer patients.
Adult ; Antineoplastic Agents/adverse effects/therapeutic use ; Antineoplastic Agents, Hormonal/therapeutic use ; Breast Neoplasms/diagnosis/*drug therapy/surgery ; Combined Modality Therapy ; Cyclophosphamide/adverse effects/therapeutic use ; Doxorubicin/adverse effects/therapeutic use ; Female ; Follicle Stimulating Hormone/analysis ; Gonadotropin-Releasing Hormone/*agonists ; Humans ; Leuprolide/administration & dosage ; Luteinizing Hormone/analysis ; Menstruation ; Ovarian Function Tests ; Primary Ovarian Insufficiency/etiology/*prevention & control ; Republic of Korea ; Tamoxifen/therapeutic use ; Time Factors

No abstract available.
Breast Neoplasms/*drug therapy ; Consent Forms/*statistics & numerical data ; Endometrial Neoplasms/*chemically induced ; Female ; Humans ; Patient Education as Topic/*statistics & numerical data ; Tamoxifen/*adverse effects/*therapeutic use

No abstract available.
Breast Neoplasms/*drug therapy ; Consent Forms/*statistics & numerical data ; Endometrial Neoplasms/*chemically induced ; Female ; Humans ; Patient Education as Topic/*statistics & numerical data ; Tamoxifen/*adverse effects/*therapeutic use

OBJECTIVETo observe the effect of Shugan Liangxue Compound (SLC) for relieving hot flashes in breast cancer patients medicated with tamoxifen.

METHODSA randomized, double blind clinical trial for observing the therapeutic effects of SLC was carried out on 73 breast cancer patients hospitalized from October 2004 to November 2006, who were treated with tamoxifen, and revealed hot flashes. They were randomly assigned to two groups, the 37 in the treated group treated by SLC, and the 36 in the control group treated with placebo. Taking the improvement of hot flashes as an end point index and that of sleep as a secondary index, the effects of treatment were compared by Kupperman scoring with the average times of hot flashes per day and condition of sleep within 1 week before treatment as baseline.

RESULTSThe effects on 66 patients (33 in the treated group and 33 in the control group) were evaluable. In the treated group hot flashes disappeared in 5 patients (15.2%), relieved in 14 (42.4%) and unchanged in 14 (42.4%); while in the control group, it disappeared in none, relieved in 10 (30.3%) and unchanged in 23 (69.7%), comparison between groups showed significant difference (P = 0.012). As for the condition of sleep, it was improved in 21 (63.6%) and unchanged in 12 (36.4%) in the treated group; while the condition of sleep in the control group was improved in 13 (39.4%) and unchanged in 20 (60.6%), also with significant difference between the two groups (P = 0.002).

CONCLUSIONSLC is effective in alleviating tamoxifen-induced hot flashes and improving the condition of sleep.

Adult ; Breast Neoplasms ; drug therapy ; Double-Blind Method ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hot Flashes ; chemically induced ; drug therapy ; Humans ; Middle Aged ; Phytotherapy ; Sleep ; Tamoxifen ; adverse effects ; therapeutic use

Idiopathic oligoasthenoteratozoospermia (iOAT) affects approximately 30% of all infertile men. This mini-review discussed recent data in this field. Age, non-inflammatory functional alterations in post-testicular organs, infective agents (Chlamydia trachomatis, herpes virus and adeno-associated viruses), alterations in gamete genome, mitochondrial alterations, environmental pollutants and "subtle" hormonal alterations are all considered possible causes of iOAT. Increase of reactive oxygen species in tubules and in seminal plasma and of apoptosis are reputed to affect sperm concentration, motility and morphology. iOAT is commonly diagnosed by exclusion, nevertheless spectral traces of the main testicular artery may be used as a diagnostic tool for iOAT. The following can be considered therapies for iOAT: 1) tamoxifen citrate (20 mg/d) + testosterone undecanoate (120 mg/d) (pregnancy rate per couple/month [prcm]: 3.8%); 2) folic acid (66 mg/d) + zinc sulfate (5 mg/d); 3) L-carnitine (2 g/d) alone or in combination with acetyl-L-carnitine (1 g/d) (prcm: 2.3%); and 4) both carnitines = one 30 mg cinnoxicam suppository every 4 days (prcm: 8.5%). Alpha-blocking drugs improved sperm concentration but not morphology, motility or pregnancy rate. Tranilast (300 mg/d) increased sperm parameters and pregnancy rates in an initial uncontrolled study. Its efficacy on sperm concentration (but not on sperm motility, morphology or prcm) was confirmed in subsequent published reports. The efficacy of tamoxifen + testosterone undecanoate, tamoxifen alone, and recombinant follicle-stimulating hormone is still a matter for discussion.
Acetylcarnitine ; therapeutic use ; Animals ; Antioxidants ; therapeutic use ; Apoptosis ; physiology ; Autoimmunity ; Chlamydia Infections ; complications ; Chlamydia trachomatis ; Chromosome Deletion ; Chromosomes, Human, Y ; Diagnosis, Differential ; Environmental Pollutants ; adverse effects ; Folic Acid ; therapeutic use ; Follicle Stimulating Hormone, Human ; therapeutic use ; Genitalia, Male ; pathology ; Humans ; Inflammation ; complications ; Male ; Oligospermia ; diagnosis ; etiology ; therapy ; Reactive Oxygen Species ; adverse effects ; Recombinant Proteins ; therapeutic use ; Sperm Count ; Spermatozoa ; immunology ; Tamoxifen ; therapeutic use ; Zinc Sulfate ; therapeutic use

Breast cancer is the most common type of female cancer. Tamoxifen, a selective estrogen receptor modulator, is widely used to decrease breast cancer recurrence and mortality among patients. However, it also increases the risk of endometrial cancer. This study aimed to assess knowledge and decisional conflict regarding tamoxifen use. Between June and October 2014, breast cancer patients using tamoxifen were consecutively screened and requested to complete a survey including the EQ-5D, Satisfaction with Decision Scale (SWD), Decisional Conflict Scale (DCS), and a self-developed, 15-item questionnaire measuring tamoxifen-related knowledge. The study sample comprised 299 patients. The mean total knowledge score was 63.4 of a possible 100.0 (range, 13.3-93.3). While 73.9% of the participants knew that tamoxifen reduces the risk of breast cancer recurrence, only 57.9% knew that the drug increases endometrial cancer risk. A higher education level (> or =college) was associated with a higher, total knowledge score (beta = 4.291; P = 0.017). A higher knowledge score was associated with a decreased DCS score (beta = -0.366; P < 0.001). A higher SWD score was also associated with decreased decisional conflict (beta = -0.178; P < 0.001). In conclusion, the breast cancer patients with higher levels of tamoxifen-related knowledge showed lower levels of decisional conflict regarding tamoxifen use. Clinicians should provide the exact information about tamoxifen treatment to patients, based on knowledge assessment results, so as to aid patients' decision-making with minimal conflict.
Adult ; Aged ; Antineoplastic Agents, Hormonal/adverse effects/therapeutic use ; Breast Neoplasms/*drug therapy/epidemiology ; Consent Forms/*statistics & numerical data ; Decision Making ; Endometrial Neoplasms/*chemically induced/epidemiology/prevention & control ; Female ; Health Knowledge, Attitudes, Practice ; Health Surveys ; Humans ; Middle Aged ; Patient Education as Topic/*statistics & numerical data ; Patient Participation/statistics & numerical data ; Prevalence ; Republic of Korea ; Risk Assessment ; Tamoxifen/*adverse effects/*therapeutic use

BACKGROUND/AIMS: Encapsulating peritoneal sclerosis (EPS) is an often-fatal complication of long-term peritoneal dialysis (PD). We here report the clinical features of EPS in Korean PD patients from a single university center. METHODS: The data were collected retrospectively from 606 PD patients at Kyungpook National University Hospital, between August 2001 and August 2011. The diagnosis of EPS was based on clinical signs and symptoms, and confirmed by radiological findings. RESULTS: Eight patients (1.3%, four males) were diagnosed with EPS. The mean age of the patients was 48.5 years (range, 33 to 65). The mean duration of PD was 111.8 months (range, 23 to 186). All patients except for one had three or more episodes of peritonitis. Seven patients were diagnosed with EPS after stopping PD, and only one stayed on PD after initial diagnosis and treatment. Total parenteral nutrition and corticosteroids, in addition to tamoxifen therapy, were used to treat most of the patients, and one patient underwent surgery (adhesiolysis). The overall mortality rate was 50%. CONCLUSIONS: EPS is a serious, life-threatening complication in patients on long-term PD. To reduce the incidence and mortality rate of EPS, careful monitoring and early diagnosis is needed.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Female ; *Hospitals, University ; Humans ; Male ; Middle Aged ; Parenteral Nutrition, Total ; Peritoneal Dialysis/*adverse effects/mortality ; *Peritoneal Fibrosis/diagnosis/etiology/mortality/therapy ; *Peritonitis/diagnosis/etiology/mortality/therapy ; Republic of Korea ; Retrospective Studies ; Tamoxifen/therapeutic use ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome