Treatment of lichen sclerosus with topical dihydrotestosterone

Article Abstract:

Lichen sclerosus is a disease characterized by the eruption of white papules on the skin. It frequently occurs in postmenopausal women, and affects the skin of the vulva and anus and causes clitoral atrophy as well as dissolution of the labia minora. An earlier report indicated that impaired dihydrotestosterone production by vulvar skin may be responsible for the disease. This study examined if topical application of dihydrotestosterone was effective in treating lichen sclerosus. Five women with this disease were treated with an ointment containing 2 percent dihydrotestosterone or placebo. The women were treated for six months: three months with the placebo ointment and three months with dihydrotestosterone. One patient had early-stage disease, three patients had mid-stage disease, and one patient had late-stage disease. All the women complained of itching. Treatment did not relieve the frequency, intensity, or duration of itching. Dihydrotestosterone ointment resulted in clitoral enlargement in all patients except the woman with late-stage disease. Her clitoris has disappeared prior to treatment. Two of the women received the dihydrotestosterone the first three months. Their clitoral size increased during the treatment period and decreased in size during the next three months when they used the placebo. Objective evaluation of gross and microscopic examinations showed improvement in the disease with treatment. This preliminary study indicates that treatment of lichen sclerosus with topical dihydrotestosterone may be beneficial. Further clinical testing is required to establish such benefits. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Skin diseases, Testosterone, Dosage and administration

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The long-term effectiveness of hysteroscopic treatment of menorrhagia and leiomyomas

Article Abstract:

Excessive bleeding in the uterus can be caused by benign tumors (leiomyomas) and menorrhagia, profuse menses. There are a number of possible treatments for these disorders, including hysteroscopic treatment, endoscopic surgery on the endometrial cavity, which is the mucous membrane-lined cavity of the uterus. The procedure is used to either remove the bleeding tumors or to destroy the membrane (ablation). This study examined the long-term effectiveness of hysteroscopic treatment for these problems in 156 patients. Results showed that 94 of the 156 patients had tumors removed (resection) and 62 had ablation with or without resection. Twenty-three of the 94 (24.5 percent) patients that only had resections reported postsurgical problems, with 15 requiring another surgery, seven having another resection or ablation and eight having more major surgery. Fourteen of the 62 (22.5 percent) patients that had ablation reported problems, of which five had further surgery, two of which were major. Overall, 91.3 percent of the patients required no further surgery after six years and 83.9 percent required no surgery after nine years. These results indicate that hysteroscopic treatment is highly effective over the long term. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Surgery, Menorrhagia, Hysteroscopy, Uterine fibroids

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A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip

Article Abstract:

Total hip arthroplasty (THA) can be cost-effective in improving the quality of life. THA is commonly known as total hip replacement. Researchers used decision analysis to calculate the cost of THA for every quality-adjusted year of life (QALY) saved. They estimated the costs of THA from hospital databases. The best-case scenario found that THA saved money in men and women younger than 80 years old. The worst-case scenario revealed that THA would cost between $20,000 and $40,000 per QALY saved among 60-year-olds and between $60,000 and $80,000 in those 85 or older. Sixty-year-old women who received THA would spend only two years in severe disability whereas those who did not receive THA would spend approximately 23 years in severe disability. The high cost of THA per QALY saved in the elderly compares favorably to other high-cost procedures such as coronary artery bypass and kidney dialysis.

Usage, Economic aspects, Quality of life, Cost benefit analysis, Artificial hip joints, Hip prostheses

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