דני שאלה שמטרידה אותי - E2

הי אילן, המינון של האסטרוגנים ב- HRT ניקבע על פי מחקרים שבדקו את המינון הנדרש למניעת אוסטיאופורוזיס, כאשר במינון זה בדרך כלל נמדד בדם אסטרדיול בטווח של 40 עד 100 פיקוגרם למ"ל. ברור שלאור האופי המחזורי של ההפרשה השחלתית קשה לקבוע בדיוק האם אלו רמות "טבעיות" ביחס לחשיפה של רקמת השד. לגבי השאלה השניה, הרי שמימת דווחה פעמים רבות כסיבוך נדיר של אנדומטריוזיס. Endometriosis with massive ascites. Muneyyirci-Delale O, Neil G, Serur E, Gordon D, Maiman M, Sedlis A. Gynecol Oncol. 1998 Apr;69(1):42-6. Department of Obstetrics and Gynecology, Radiology, State University of New York Health Science Center at Brooklyn, 11203, USA. We present 4 cases of endometriosis complicated by massive ascites from our institution and a review of 27 cases from the literature. In most of these patients, the presence of ascites with its related symptoms in association with pelvic masses suggested a neoplastic disease. However, a large proportion of these women had also classical manifestations of endometriosis, e.g., dysmenorrhea, cul-de-sac nodularities, and exacerbation of ascites and other symptoms during the menses. The response to hormonal therapy including GnRH agonists was often unsatisfactory. Repeat recurrences and severe complications required multiple laparotomies and thoracotomies for associated pleural and pulmonary involvement. Pericardial effusion, right-sided pleural effusion and ascites associated with stage IV endometriosis. A case report. J Reprod Med. 2003 Jun;48(6):463-5. Francis M, Badero OO, Borowsky M, Lee YC, Abulafia O. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Division of Cardiology, State University of New York, Downstate Medical Center, Brooklyn, USA. BACKGROUND: Endometriosis has rarely been associated with ascites and less often with pleural (usually right-sided) effusion. CASE: A multiparous, reproductive-aged woman was referred for evaluation of possible ovarian carcinoma following the development of dyspnea, progressive abdominal distention, weight loss and increasing secondary dysmenorrhea. Imaging demonstrated normal ovaries in the presence of massive ascites and right-sided pleural and pericardial effusions. At laparotomy, grade IV endometriosis was noted. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and appendectomy were performed, with subsequent resolution of all cavity fluid accumulations. CONCLUSION: Pericardial and pleural effusions in the presence of ascites may be associated with endometriosis. The role of angiogenesis in the accumulation of peritoneal fluid in benign conditions and the development of malignant ascites in the female. Gynecol Obstet Invest. 2000;50(4):217-24. Sherer DM, Eliakim R, Abulafia O. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA. Our objective was to present current data pertaining to the role of angiogenesis in the accumulation of peritoneal fluid in both benign conditions and in the development of malignant ascites in the female. To this goal, we conducted a computerized search to identify all relevant studies published in the English literature. MEDLINE, Current Contents and Index Medicus were searched utilizing the terms: angiogenesis, peritoneal fluid, ascites, vascular endothelial growth factor (VEGF), therapy and carcinoma through May 2000. Review of the literature supports that angiogenesis promoted by VEGF is associated with fluid accumulation in animal and human tumor effusions. Benign conditions involving accumulation of peritoneal fluid and associated angiogenesis in the female include ovulation, endometriosis and severe ovarian hyperstimulation syndrome. Malignant intra-abdominal conditions associated with increased VEGF activity include primary epithelial ovarian, gastric and colon carcinomas, omental and hepatic metastatic disease. Initial trials with antiangiogenic (angioinhibitor) therapy such as anti-VEGF antibodies, anti-VEGF receptor antibodies, tumor necrosis factor, and metalloproteinase inhibitors have been reported and antitumor activity observed in a limited number of patients with advanced (inoperable or metastatic) disease. Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature. Arch Gynecol Obstet. 2000 Jul;264(1):39-41. Bhojawala J, Heller DS, Cracchiolo B, Sama J. Department of Pathology, UMDNJ-New Jersey Medical School, Newark 07103, USA. [email protected] A 34 year-old female presented with blood-stained pleural effusion and ascites. Investigation revealed a pelvic mass. She underwent exploratory laparotomy, and was found to have endometriosis. Total abdominal West Indian Med J. 1999 Sep;48(3):158-9. Related Articles, Links Massive ascites secondary to severe endometriosis. Fletcher H, McFarlane M, Shirley SE, Clarke WF, Lyon K. Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica. Massive ascites is an unusual association with endometriosis. This case report is of such a condition in an Afro-Jamaican woman. The diagnosis was made at laparotomy and conservative treatment was adopted allowing for retention of reproductive function. Postoperative therapy was Goserelin, a Gonadotropin Releasing Hormone (GnRH) agonist, for six months. This relieved all of her symptoms. However, long term follow-up is needed, as recurrence is possible.